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P Bech

Publications and source records attributed to P Bech.

At least 37 records · Page 2Linked to original sources
PubMed2004

Prevalence of major depression and stress indicators in the Danish general population.

OBJECTIVE: To estimate the prevalence rate of major depression in the Danish general population by using the Major Depression Inventory (MDI), a validated self-rating scale fulfilling the symptomatic criteria in DSM-IV and ICD-10 for a depressive episode. METHOD: A booklet containing the MDI and a number of questions on psychosocial factors was sent to 2040 randomly selected Danish citizens. The sample was age- and gender-stratified. Mean MDI scores were calculated. Logistic regression analysis was used in order to produce a model for the influence of psychosocial factors. RESULTS: The response rate was 60%. The point prevalence of major depression was 3.3%. Among the tested predictors of depression were sociodemographic variables, alcohol and smoking habit, bodily pain, somatic diseases and traumatic life events. For a traumatic event in personal life over the past year odds ratio was 6.4 [2.7; 15.5], for overconsumption of alcohol odds ratio was 3.2 [1.5; 6.8]. While the gender difference in major depression rate was not found statistically significant, a significant (P < 0.05) gender difference of male to female of 1 : 2 was found when including minor depression. Of people identified as having a major depression only 13% were currently treated by a medical doctor. CONCLUSION: Major depression has a high prevalence in the Danish general population and seems to be undertreated. The gender difference was only found statistically significant when including minor depression, indicating that the female predominance is less pronounced in the more severe depression states.

Adult↗
PubMed2004

Relapse prevention by citalopram in SAD patients responding to 1 week of light therapy. A placebo-controlled study.

OBJECTIVE: We have tested the relapse-preventive effect of citalopram when compared with placebo in 282 patients with Seasonal Affective Disorder (SAD) responding to 1 week of light therapy. METHOD: The response rate to 1-week light therapy and relapse during the continuation phase of 15 weeks were assessed by use of the Hamilton Depression Rating Scale (HAM-D17), the six-item subscale (HAM-D6), the Melancholia Scale (MES), and the combined HAM-D/SIGH-SAD. RESULTS: The response rate to light therapy was 62.5% on the HAM-D17 and the HAM-D6, 56.1% on the HAM-D/SIGH-SAD, 52.8% on the MES. In the continuation phase, citalopram was found superior to placebo on all scales, but the difference was only of statistical significance on the HAM-D6 and the MES. Mean citalopram dose was 26.3 mg. CONCLUSION: Light therapy was found to have and early onset of action. On the HAM-D6 and the MES citalopram significantly reduced the relapse rate in the continuation phase.

Adult↗
PubMed2004

The SCL-90 and SCL-90R versions validated by item response models in a Danish community sample.

OBJECTIVE: To evaluate the internal validity of the subscales of the combined SCL-90 and SCL-90R, the SCL-92, by item response analyses as compared with several previously reported factor analyses of this questionnaire in the literature. METHOD: The SCL-92 questionnaire was mailed to an age- and gender-stratified random sample of Danish citizens. The sample comprised 2040 individuals. The internal structure of the nine factors of the SCL-92 questionnaire was evaluated by Mokken-Loevinger analysis and Rasch analysis. RESULTS: In total, 1153 persons or 58% returned the questionnaire fully completed. Mokken analysis found all scales apart from the psychoticism scale acceptable. The Rasch analysis found most of the subscales to be robust. Minor problems were seen for the scales of phobic anxiety, obsession-compulsion and depression. Analysis of the Global Severity Index showed that the Rasch model was rejected for the full 92-item scale, but not for a scale consisting of the 63 items from the non-psychotic subscales. Spearman correlations among the subscales were all positive (range 0.34-0.79) and so were correlations between each of the subscales and the Global Severity Index (range 0.55-0.91). CONCLUSION: In this sample from the Danish general population the non-psychotic subscales, i.e. the subscales covering psychological distress were observed to function well. In a general population sample, the 63 non-psychotic items primarily appear to reflect one broad dimension of distress.

Humans↗
PubMed2003

Reliability, validity and psychometric properties of the Greek translation of the Major Depression Inventory.

BACKGROUND: The Major Depression Inventory (MDI) is a brief self-rating scale for the assessment of depression. It is reported to be valid because it is based on the universe of symptoms of DSM-IV and ICD-10 depression. The aim of the current preliminary study was to assess the reliability, validity and psychometric properties of the Greek translation of the MDI. METHODS: 30 depressed patients of mean age 23.41 (+/- 5.77) years, and 68 controls patients of mean age 25.08 (+/- 11.42) years, entered the study. In 18 of them, the instrument was re-applied 1-2 days later and the Translation and Back Translation made. Clinical diagnosis was reached with the use of the SCAN v.2.0 and the International Personality Disorders Examination (IPDE). The Center for Epidemiological Studies-Depression (CES-D) and the Zung Depression Rating Scale (ZDRS) were applied for cross-validation purposes. Statistical analysis included ANOVA, the Spearman Product Moment Correlation Coefficient, Principal Components Analysis and the calculation of Cronbach's alpha. RESULTS: Sensitivity and specificity were 0.86 and 0.94, respectively, at 26/27. Cronbach's alpha for the total scale was equal to 0.89. The Spearman's rho between MDI and CES-D was 0.86 and between MDI and ZDRS was 0.76. The factor analysis revealed two factors but the first accounted for 54% of variance while the second only for 9%. The test-retest reliability was excellent (Spearman's rho between 0.53 and 0.96 for individual items and 0.89 for total score). CONCLUSION: The current study provided preliminary evidence concerning the reliability and validity of the Greek translation of the MDI. Its properties are similar to those reported in the international literature, but further research is necessary.

Adolescent↗
PubMed2003

The internal and external validity of the Major Depression Inventory in measuring severity of depressive states.

BACKGROUND: We have developed the Major Depression Inventory (MDI), consisting of 10 items, covering the DSM-IV as well as the ICD-10 symptoms of depressive illness. We aimed to evaluate this as a scale measuring severity of depressive states with reference to both internal and external validity. METHOD: Patients representing the score range from no depression to marked depression on the Hamilton Depression Scale (HAM-D) completed the MDI. Both classical and modern psychometric methods were applied for the evaluation of validity, including the Rasch analysis. RESULTS: In total, 91 patients were included. The results showed that the MDI had an adequate internal validity in being a unidimensional scale (the total score an appropriate or sufficient statistic). The external validity of the MDI was also confirmed as the total score of the MDI correlated significantly with the HAM-D (Pearson's coefficient 0.86, P < or = 0.01, Spearman 0.80, P < or = 0.01). CONCLUSION: When used in a sample of patients with different states of depression the MDI has an adequate internal and external validity.

Adult↗
PubMed2003

Association between clinically depressed subgroups, type of treatment and patient retention in the LIDO study.

BACKGROUND: Few data are available with which to evaluate the association between depressed subgroups, type of treatment and patient retention during episodes of major depression. METHOD: This observational study followed 1117 depressed patients over a 12-month period in the primary care setting of six different international sites. The patients were divided into three severity-linked subgroups: moderate to severe depression; moderate depression co-morbid with serious medical conditions; and mild depression. RESULTS: In general, a low dropout rate was found, with significant differences in the rates across the six sites. However, while there was no statistical significance in the association between the three subgroups of depression and overall dropout rates, we did find that older patients were less likely to drop out, more depressed patients were more likely to drop out, and if patients were on antidepressants they were less likely to drop out. Among the three subgroups of depression, patients with moderate depression co-morbid with serious medical conditions received the lowest amount of antidepressants and had the lowest quality of life. CONCLUSION: Although the overall dropout rate in this study was found very low and did differ between the six sites, an association between the use of antidepressants and patient retention was seen. The group of patients with serious co-morbid medical conditions received fewer antidepressants even when the level of their depressive states was taken into consideration. This group was the least satisfied with treatment and had the lowest self-reported quality of life.

Adolescent↗
PubMed2003

The validity of the depression rating scales in discriminating between citalopram and placebo in depression recurrence in the maintenance therapy of elderly unipolar patients with major depression.

The World Federation of Societies of Biological Psychiatry guidelines for treatment of unipolar major depression has recommended three depression rating scales for evaluating outcome: The Hamilton Depression Rating Scale (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Bech-Rafaelsen Melancholia Scale (MES). In this study we evaluated the ability of these scales to differentiate between citalopram and placebo in the recurrence prevention of unipolar depression. The study is a psychometric reexamination of a trial on the efficacy of citalopram versus placebo in the maintenance therapy of elderly patients with unipolar depression. Internal validity (the Cronbach coefficient alpha, the Loevinger coefficient of homogeneity, and factor analysis) of the three scales has been examined to evaluate their unidimensionality. In the outcome analysis for depression recurrence, the conventional cutoff scores of the three scales are used. In total, 60 patients received citalopram and 61 patients received placebo in the maintenance phase of 48 weeks. The results showed that the internal validity was higher for MES and MADRS than for HAM-D. Using the MADRS, 67.2 % of the patients on placebo and 31.6 % of the patients on citalopram developed a depression recurrence (ratio 2.12); using HAM-D17, 42.6 % on placebo and 13.3 % on citalopram developed a depression recurrence (ratio 3.20); and using the MES, 34.4 % on placebo and 11.7 % on citalopram developed a depression recurrence (ratio 2.94). The conventional cutoff scores of HAM-D17 and MES for depression recurrence indicated a ratio between citalopram and placebo of around 3, while the conventional cutoff scores of MADRS for depression recurrence indicated a ratio of only around 2. In future trials on the recurrence prevention of unipolar depression, a cutoff score of 25 rather than 22 on the MADRS is recommended.

Aged↗
PubMed2002

Citalopram dose-response revisited using an alternative psychometric approach to evaluate clinical effects of four fixed citalopram doses compared to placebo in patients with major depression.

RATIONALE: Among the many problems in interpreting dose-response studies with antidepressants are the psychometric problems in the identification of true antidepressive effect versus true adverse drug effect. OBJECTIVES: This study is a re-examination of a dose-response trial with citalopram in order to examine the explanatory ability of using strict psychometric dimensions to measure the wanted and unwanted drug effects of different doses compared to placebo. METHODS: The antidepressive response was measured after 2 and 6 weeks of therapy with the depression subscales of the HAM-D and on the Montgomery-Asberg Depression Scale (MADRS). The patient-reported Symptom Checklist (SCL) sub-scales for depression and anxiety were also examined. Subjective side-effects were measured on serotonin-specific items of the SCL. Effect size statistics were used to measure the antidepressive effect (an effect size of 0.30 equals a drug superiority over placebo of 15-20%). Side effects were statistically analysed using baseline-adjusted scores of the individual symptoms. RESULTS: The psychometric analysis of the outcome scales showed that the full HAM-D(17), the SCL-56 and the SCL side-effect subscale were multidimensional scales, while the HAM-D and MADRS subscales as well as the SCL-anxiety subscale were most homogeneous, indicating that their total scores are sufficient statistics. When the scales were used as well as the individual serotonin-specific SCL side-effect symptoms, the results showed that after 2 weeks of therapy a clinical response (effect side over 0.30) was only seen for the SCL-anxiety subscale in the citalopram doses of 40 mg and 60 mg daily. After 6 weeks of therapy response to even 10 mg and 20 mg was seen in the HAM-D and MADRS subscales and in the SCL-anxiety subscale, however, with lower effect sizes than found for 40 mg and 60 mg citalopram daily. The dose of 20 mg citalopram induced side-effects comparable with those seen for 40 mg and 60 mg, while 10 mg was not different from placebo. This was further confirmed by the fact that more patients dropped out on 20 mg than on 10 mg citalopram daily, due to adverse events. CONCLUSION: This psychometric re-examination of a citalopram dose-response trial has shown that the pure antidepressive or antianxiety effects can be observed after 6 weeks of therapy even in a dose of 10 mg daily. However, both 10 mg and 20 mg daily had lower effect sizes than 40 mg and 60 mg daily. At a dose level of 20 mg daily, side effects are more pronounced initially than at 10 mg daily; this should be taken into account clinically when evaluating the overall benefit of the drug. For a highly serotonin-specific drug such as citalopram, both wanted and unwanted effects are dose-related.

Antidepressive Agents↗
PubMed2002

The Bech-Rafaelsen Melancholia Scale (MES) in clinical trials of therapies in depressive disorders: a 20-year review of its use as outcome measure.

OBJECTIVE: To evaluate the psychometric properties of the Bech-Rafaelsen Melancholia Scale (MES) by reviewing clinical trials in which it has been used as outcome measure. METHOD: The psychometric analysis included internal validity (total scores being a sufficient statistic), interobserver reliability, and external validity (responsiveness in short-term trials and relapse prevention in long-term trials). RESULTS: The results showed that the MES is a unidimensional scale, indicating that the total score is a sufficient statistic. The interobserver reliability of the MES has been found adequate both in unipolar and bipolar depression. External validity including both relapse, response and recurrence indicated that the MES has a high responsiveness and sensitivity. CONCLUSION: The MES has been found a valid and reliable scale for the measurement of changes in depressive states during short-term as well as long-term treatment.

Clinical Trials as Topic↗
PubMed2002

Quality of life after anterior resection versus abdominoperineal extirpation for rectal cancer.

BACKGROUND: Abdominoperineal extirpation has been assumed to put patients at higher risk of disruption to quality of life than sphincter-preserving surgery in rectal cancer surgery. The aim of this study was to investigate quality of life in patients after anterior resection versus abdominoperineal extirpation for rectal cancer and to evaluate the psychometrics of the Danish version of a symptom-specific Fecal Incontinence Quality of Life Scale. METHODS: Fourteen patients undergoing abdominoperineal extirpation and 26 undergoing anterior resection. The generic quality of life instrument SF-36 together with a new symptom-specific Fecal Incontinence Quality of Life Scale were used. Psychometric analysis of the symptom-specific scale was carried out. RESULTS: The only significant difference between the two groups was found in the total score of the symptom-specific scale in favour of anterior resection (P = 0.02). Psychometric evaluation of the symptom-specific fecal incontinence questionnaire proved it reliable and valid. CONCLUSIONS: The present study shows that a stoma influences quality of life only slightly, while a relatively high anterior resection does not. However, a few appropriate newer studies indicate that the cost of spinchter-preserving techniques in the form of incontinence disturbances may influence the quality of life seriously, which should be borne in mind when low anterior resection is intended. Further studies in this field are necessary and could benefit from use of the Fecal Incontinence Quality of Life Scale, including its total score.

Abdomen↗
PubMed2001

Reliability, validity and psychometric properties of the Greek translation of the Zung Depression Rating Scale.

INTRODUCTION: The current study aimed to assess the reliability, validity and psychometric properties of the Greek translation of the Zung Depression Rating Scale (ZDRS). METHODS: The study sample included 40 depressed patients 29.65 +/- 9.38 years old and 120 normal comparison subjects 27.23 +/- 10.62 years old. In 20 of them (12 patients and 8 comparison subjects) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (alpha) RESULTS: Both Sensitivity and specificity exceed 90.00 at 44/45, Chronbach's alpha for the total scale was equal to 0.09, suggesting that the scale covers a broad spectrum of symptoms. Factor analysis revealed five factors (anxiety-depression, thought content, gastrenterological symptoms, irritability and social-interpersonal functioning). The test-retest reliability was satisfactory (Pearson's R between 0.92). CONCLUSION: The ZDRS-Greek translation is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature, although the literature is limited. However one should always have in mind the limitations inherent in the use of self-report scales.

Adolescent↗
PubMed2001

Reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies-Depression (CES-D) Scale.

INTRODUCTION: The aim of the current study was to assess the reliability, validity and psychometric properties of the Greek translation of the Center for Epidemiological Studies- Depression Scale (CES-D). METHODS: 40 depressed patients 29.65 +/- 9.38 years old, and 120 normal controls 27.23 +/- 10.62 years old entered the study. In 20 of them (12 patients and 8 controls) the instrument was re-applied 1-2 days later. Translation and Back Translation was made. Clinical Diagnosis was reached by consensus of two examiners with the use of the SCAN v.2.0 and the IPDE. Statistical Analysis included ANOVA, the Pearson Product Moment Correlation Coefficient, Principal Components Analysis and Discriminant Function Analysis and the calculation of Cronbach's alpha (alpha) RESULTS: Both Sensitivity and specificity exceed 90.00 at 23/24, Chronbach's alpha for the total scale was equal to 0.95. Factor analysis revealed three factors (positive affect, irritability and interpersonal relationships, depressed affect and somatic complains). The test-retest reliability was satisfactory (Pearson's R between 0.45 and 0.95 for individual items and 0.71 for total score). CONCLUSION: The Greek translation of the CES-D scale is both reliable and valid and is suitable for clinical and research use with satisfactory properties. Its properties are similar to those reported in the international literature. However one should always have in mind the limitations inherent in the use of self-report scales.

Adolescent↗
PubMed2001

Differences in symptomatology and diagnostic profile in younger and elderly depressed inpatients.

BACKGROUND: Depression is the most prevalent psychiatric disorder in the elderly and several studies indicate that 10-15% of persons over 65 years suffer from significant depressive symptoms. Despite the high prevalence, most cases of depression in the elderly remain unrecognized and untreated, maybe because of a different pattern of symptoms across age groups. The objective of the study was to compare symptomatology and diagnostic profile between younger and elderly DSM-III and DSM-III-R major depressed inpatients and to advise an appropriate depression scale for the elderly. METHODS: The study covers 461 depressed inpatients evaluated with the Hamilton Depression Scale and the Newcastle 1965 Scale. To find differences between younger and elderly patients, the symptomatology was analyzed stepwise by principal component analyses, latent structure analyses and single item analyses. RESULTS: No clinically significant differences in symptomatology between younger and elderly depressed patients were found. The DSM-IV concept of Major Depression and the ICD-10 criteria for depression was not influenced by patients' age. LIMITATIONS: All patients were hospitalized and mainly endogenously depressed and generalization of the results to other populations should be made with caution. Only pretreatment data was analyzed. CONCLUSIONS: The DSM-IV concept of Major Depression and the ICD-10 criteria for depression can be used without modification for age.

Adult↗
PubMed2001

The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity.

BACKGROUND: A self-rating inventory has been developed to measure DSM-IV and ICD-10 diagnoses of major (moderate to severe) depression by the patients' self-reported symptoms. This Major Depression Inventory (MDI) can be scored both according to the DSM-IV and the ICD-10 algorithms for depressive symptomatology and according to severity scales by the simple total sum of the items. METHODS: The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used as index of validity for the clinician's DSM-IV and ICD-10 diagnosis of major (moderate to severe) depression. The sensitivity and specificity of MDI was assessed in a sample of 43 subjects covering a spectrum of depressive symptoms. RESULTS: The sensitivity of the MDI algorithms for major depression varied between 0.86 and 0.92. The specificity varied between 0.82 and 0.86. When using the total score of MDI the optimal cut-off score was estimated 26 and the total score was shown to be a sufficient statistic. LIMITATIONS: The sample of subjects was limited. Patients with psychotic depression were not included. CONCLUSION: The MDI was found to have a sensitivity and specificity which is acceptable. The questionnaire is brief and can be scored diagnostically by the DSM-IV and ICD-10 algorithms as well as by its simple total score.

Adult↗
PubMed2001

Meta-analysis of placebo-controlled trials with mirtazapine using the core items of the Hamilton Depression Scale as evidence of a pure antidepressive effect in the short-term treatment of major depression.

When attempting to demonstrate a purely antidepressive effect of new antidepressants the HAMD depression factor has been found adequate in placebo-controlled trials. When attempting to demonstrate an early onset of action of amitriptyline the HAMD item of depressed mood has previously been found sufficient, using effect size as outcome statistic. Therefore, the HAMD depression factor as well as the HAMD item of depressed mood have been used separately in this meta-analysis to evaluate the pure antidepressive effect and early onset of action of mirtazapine when compared to placebo or amitriptyline. The results showed that in all placebo-controlled trials mirtazapine obtained an effect size of 0.42 on the HAMD depression factor subscale and 0.49 on the full HAMD. In the trials in which mirtazapine was compared to amitriptyline the effect sizes for the HAMD depression factor subscale were 0.40 and 0.57, respectively. This difference was not statistically significant. An early onset of action was found for the HAMD item of depressed mood as well as the total HAMD both for mirtazapine and amitriptyline when compared to placebo. As early as after 1 wk of therapy both drugs were significantly better than placebo. In conclusion, a purely antidepressive effect of mirtazapine has been demonstrated concerning both improvement after the acute therapy of major depression and early onset of action.

Adult↗
PubMed2001

Dimensionality, responsiveness and standardization of the Bech-Rafaelsen Mania Scale in the ultra-short therapy with antipsychotics in patients with severe manic episodes.

OBJECTIVE: Typical antipsychotics have their indication in the ultra-short (first week) treatment of severe episodes of mania. In this setting the Bech-Rafaelsen Mania Scale (MAS) was psychometrically compared with the Clinical Global Impression scale (CGI) to assess its ability to measure response. METHOD: Ratings on patients with marked to severe mania (n = 80) who participated in the clinical trials to evaluate the ultra-short antimanic effect of zuclopenthixol acetate were assessed. The MAS was analysed for internal validity (total score a sufficient statistic) and for external validity. RESULTS: The MAS was shown to have a high internal validity showing onset of action already after days of treatment. After 6 days of treatment 53% of the patients responded according to the MAS but only 30% according to the CGI. The difference was statistically significant. CONCLUSION: The MAS has been found to be a valid scale to measure early onset of action and response in the ultra-short antimanic treatment with typical antipsychotics.

Aged↗
PubMed2001

Monitoring improvement using a patient-rated depression scale during treatment with anti-depressants in general practice. A validation study on the Goldberg Depression Scale.

OBJECTIVE: To perform a pilot study on the value of the Goldberg Depression Scale as an instrument for monitoring improvement in depressed patients treated with anti-depressants in general practice. DESIGN: A comparative study using simultaneous ratings on the observer-based 17-item Hamilton Depression Scale and the patient-rated Goldberg Depression Scale. SETTING: General practice. PATIENTS: Twenty-one patients meeting the ICD-10 criteria of a moderate depressive episode were assessed at the time of inclusion and through three follow-up visits. MAIN OUTCOME MEASURES: Scores on the Goldberg Depression Scale compared to the Hamilton Depression Scale. RESULTS: An acceptable internal and external validity of the Goldberg Depression Scale was demonstrated. The Loevinger coefficient varied from 0.25 at the time of diagnosis to 0.57, 0.65 and 0.69 by visits two, three and four. Factor analysis identified only one general factor explaining 50% or more of the variants, except at visit 1. When the Goldberg Depression Scale was correlated to the Hamilton Depression Scales, a coefficient of 0.74 was obtained (p < 0.001). CONCLUSION: This pilot study indicates that the Goldberg Depression Scale is suitable for monitoring improvement in depressed patients treated in general practice. Further studies are recommended.

Antidepressive Agents↗