Jenny Yang1, Maria Martinez2, Todd A Schwartz1,2, Linda Beeber2. 1. 1 Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina. 2. 2 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
Abstract
BACKGROUND: Adequate assessment of depressive symptomatology is a necessary step toward decreasing income-related mental health treatment inequity. No studies have focused on comparing instruments used to detect depression in women from low-income backgrounds who are mothers of young children-a period of increased risk for depressive symptoms. METHODS: To address this gap, two commonly used instruments (Center for Epidemiologic Studies Depression Scale [CES-D] and Hamilton Rating Scale for Depression [Hamilton]) were compared with a depression diagnosis (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-V]) in a sample (n = 251) of mothers from low-income backgrounds with children ranging from 1 to 54 months old. Diagnostic utility was examined in light of contextual factors associated with maternal depressive symptoms. RESULTS: In this sample, CES-D had better screening sensitivity and specificity than Hamilton. Our results suggest that Hamilton may underdiagnose cases of major depressive episodes (MDE) as defined by DSM-V among black and low-income mothers compared with CES-D. In addition, we identify items in CES-D, which do not contribute to alignment with DSM-V and are appropriate targets for future improvements. Our analysis identifies interpersonal relationships and mother's age as the primary risk factors, which differentiate between CES-D and Hamilton determinations versus MDE diagnosis. In addition, we find regional differences in CES-D and Hamilton. CONCLUSIONS: It is important to tailor the measure to the context, and a calibration sample should be considered for studies of sufficient size.
BACKGROUND: Adequate assessment of depressive symptomatology is a necessary step toward decreasing income-related mental health treatment inequity. No studies have focused on comparing instruments used to detect depression in women from low-income backgrounds who are mothers of young children-a period of increased risk for depressive symptoms. METHODS: To address this gap, two commonly used instruments (Center for Epidemiologic Studies Depression Scale [CES-D] and Hamilton Rating Scale for Depression [Hamilton]) were compared with a depression diagnosis (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-V]) in a sample (n = 251) of mothers from low-income backgrounds with children ranging from 1 to 54 months old. Diagnostic utility was examined in light of contextual factors associated with maternal depressive symptoms. RESULTS: In this sample, CES-D had better screening sensitivity and specificity than Hamilton. Our results suggest that Hamilton may underdiagnose cases of major depressive episodes (MDE) as defined by DSM-V among black and low-income mothers compared with CES-D. In addition, we identify items in CES-D, which do not contribute to alignment with DSM-V and are appropriate targets for future improvements. Our analysis identifies interpersonal relationships and mother's age as the primary risk factors, which differentiate between CES-D and Hamilton determinations versus MDE diagnosis. In addition, we find regional differences in CES-D and Hamilton. CONCLUSIONS: It is important to tailor the measure to the context, and a calibration sample should be considered for studies of sufficient size.
Authors: B N Gaynes; N Gavin; S Meltzer-Brody; K N Lohr; T Swinson; G Gartlehner; S Brody; W C Miller Journal: Evid Rep Technol Assess (Summ) Date: 2005-02
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Authors: Linda S Beeber; Todd A Schwartz; Maria I Martinez; Diane Holditch-Davis; Sarah E Bledsoe; Regina Canuso; Virginia S Lewis Journal: Res Nurs Health Date: 2014-06-19 Impact factor: 2.228