Depressive symptoms and abnormal illness behavior in general hospital patients

doi:10.1016/0163-8343(82)90053-6

General Hospital Psychiatry

Volume 4, Issue 3, September 1982, Pages 171-178

https://doi.org/10.1016/0163-8343(82)90053-6 Get rights and content

Abstract

There have been many accounts of depression and abnormal illness behavior in medical inpatients, but systematic studies of their prevalence and features in a general hospital are lacking. Occurrence and characteristics of depression and illness behavior were studied in 325 inpatients of a general hospital in the northern part of Italy. Patients were surveyed in six separate wards (medicine, surgery, dermatology, OB-GYN, orthopedics, and opthalmology) and represented about 90% of their actual population during a one-week period. Two self-report scales were used for screening: the CES-D (scale devised by the Center for Epidemiologic Studies of Depression at NIMH) for measuring depression and the Illness Behavior Questionnaire (IBQ), developed by Pilowsky and Spence. Both scales were administered in their validated Italian translations. The customary cut-off point of 16 in the CES-D score revealed about 58% of the patients as depressed. A more conservative cut-off point of 23 still showed 33.5% of the patients as depressed. The IBQ scores of the depressed patients showed significantly (p < 0.001) higher levels of general hypochondriasis, disease conviction, dysphoria, and irritability than the nondepressed patients. No relevant differences existed between wards in the amount of depression and IBQ scores, even when differences were adjusted for age, sex, marital status, and social class. Implications for psychosomatic research (sociodemographic characteristics of depression and illness behavior, bias in comparing hospital patients and controls in the general population, and so on) and treatment (consultation-liaison psychiatry) are discussed.

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The CES-D showed good validity and reliability (Dershem et al., 1996) and it has been widely used in the assessment of depression in fathers and mothers during the perinatal period (Paulson et al., 2016). In the current study, we used the validated Italian version of the CES-D (Fava et al., 1982). Reliability estimate in the present study was α = 0.714.
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This study used a cross-sectional design with a 3-month test-retest, involving respectively 385 (T1) and a sub-sample of 111(T2) fathers. Confirmatory factor analysis (CFA) was performed to test structural validity and concurrent validity was assessed by Spearman correlations. We assessed reliability using McDonald's ω and ordinal alpha. Group differences in PAPA scores based on sociodemographic were also tested.
The CFA reported a one factor structure as the optimal solution. The PAPA also showed adequate reliability and internal consistency as well as acceptable test–retest indices. Concurrent validity was confirmed by significant correlations between PAPA total score and standardized test scores. Non-Italian fathers and fathers who experienced recent stressful life events reported higher PAPA scores.
Our sample was not homogeneous in terms of nationality and most of the participants, were from Northern Italy. Some risk factors associated with paternal parental psychological distress (e.g., unplanned pregnancy) have not been considered.
This study provides initial evidence of validity and reliability of the PAPA as a brief and sensitive screening tool to detect signs and symptoms of paternal affective disorder during both prenatal and postnatal period.
Assessing mood symptoms through heartbeat dynamics: An HRV study on cardiosurgical patients
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It has a four-point Likert scale and scores range from 0 to 60, with higher scores indicating greater depressive symptoms. Numerous studies have reported that scores equal to or greater than 16 are indicative of clinically significant depression in medical and psychiatric patients (Blumenthal et al., 2003; Fava et al., 1982; McKhann et al., 1997; Radloff, 1977; Schulberg et al., 1985). Based on this cutoff twelve patients of our sample showed clinically significant depressive symptoms and nineteen patients did not.
Heart Rate Variability (HRV) is reduced both in depression and in coronary heart disease (CHD) suggesting common pathophysiological mechanisms for the two disorders. Within CHD, cardiac surgery patients (CSP) with postoperative depression are at greater risk of adverse cardiac events. Therefore, CSP would especially benefit from depression early diagnosis. Here we tested whether HRV-multi-feature analysis discriminates CSP with or without depression and provides an effective estimation of symptoms severity.
Thirty-one patients admitted to cardiac rehabilitation after first-time cardiac surgery were recruited. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D). HRV features in time, frequency, and nonlinear domains were extracted from 5-min-ECG recordings at rest and used as predictors of “least absolute shrinkage and selection” (LASSO) operator regression model to estimate patients' CES-D score and to predict depressive state.
The model significantly predicted the CES-D score in all subjects (the total explained variance of CES-D score was 89.93%). Also it discriminated depressed and non-depressed CSP with 86.75% accuracy. Seven of the ten most informative metrics belonged to non-linear-domain.
A higher number of patients evaluated also with a structured clinical interview would help to generalize the present findings.
To our knowledge this is the first study using a multi-feature approach to evaluate depression in CSP. The high informative power of HRV-nonlinear metrics suggests their possible pathophysiological role both in depression and in CHD. The high-accuracy of the algorithm at single-subject level opens to its translational use as screening tool in clinical practice.
Effect of falls on frequency of atrial fibrillation and mortality risk (from the REasons for Geographic and Racial Differences in Stroke study)
2015, American Journal of Cardiology
Citation Excerpt :
Scores range from 0 to 6, with lower scores indicating worse cognition, and cognitive impairment was defined as a score ≤4. The presence of depressive symptoms was defined as a score of ≥4 on the 4-item Center for Epidemiologic Studies Depression Scale.12 Impaired mobility was assessed using the physical functioning scale of the Short-Form 12-Item Health Survey.13
It is unclear if patients who have atrial fibrillation (AF) have a greater fall risk compared with those in the general population and if falls increase mortality beyond that observed in AF. A total of 24,117 (mean age 65 ± 9.3 years; 55% women; 38% black) participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were included. AF was identified from baseline electrocardiogram data and by self-reported history. Falls were considered present if participants reported ≥2 falls within the year before the baseline examination. Logistic regression was used to examine the relationship between prevalent AF and falls. Cox regression was used to examine the risk of death in those with AF and falls, separately and in combination, compared with those without either condition. A total of 2,007 participants (8.3%) had baseline AF and 1,655 (6.7%) reported falls. A higher prevalence of falls was reported in those with AF (n = 209; 10%) than those without AF (n = 1,446; 6.5%; p <0.0001). After adjustment for fall risk factors, AF was significantly associated with falls (odds ratio 1.22, 95% confidence interval [CI] 1.04 to 1.44). Compared with no history of AF or falls, the concomitant presence of AF and falls (hazard ratio [HR] 2.12, 95% CI 1.64 to 2.74) was associated with a greater risk of death than AF (HR 1.44, 95% CI 1.28 to 1.62) or falls (HR 1.61, 95% CI 1.42 to 1.82). In conclusion, patients with AF are more likely to report a history of falls in REGARDS. Additionally, participants with AF who report falls have an increased risk of death than those with either condition in isolation.
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Citation Excerpt :
The preponderance of depressive disorders was characteristic of the type of influence of mental disorders on the components of illness behaviour, since patients with psychiatric comorbidity scored higher in Hypochondriasis, Disease Conviction, Affective Disturbance and Irritability. This finding, being consistent with these of studies in which patients scored significantly higher in the Illness Behaviour Scale than healthy controls [7,14], discriminated the specific components of illness behaviour that related closely to psychiatric morbidity. To avoid masking differences due to multiple comparisons (Type II error) Bonferroni correction was applied and P-level was decreased.
Objective. – The aim of the present study was to examine whether psychiatric morbidity can influence the type of illness behaviour of neurological inpatients.
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Conclusion. – The present study has shown that neurological inpatients with psychiatric morbidity tend to develop more intense illness behaviour than those without. The effect of psychiatric morbidity on certain components of illness behaviour in neurological patients can be taken into account when therapeutic strategies are planned.
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Functional somatic symptoms are highly associated with hypochondriasis, anxiety, and depressive disorders. Despite the absence of an organic disorder, underlying psychological distress of patients with functional somatic symptoms may result in abnormal illness behavior such as inadequate treatment seeking or overuse of medical services. Using the Illness Behavior Questionnaire (IBQ), we examined the illness behavior of Japanese patients visiting a general medicine clinic whose physical symptoms were considered functional. We used the General Health Questionnaire-30 to classify patients with functional somatic symptoms as those with and without psychological distress. Patients with distress (n=35) reported more physical complaints and higher IBQ scores than did patients without distress (n=22). The IBQ profile of patients with psychological distress was identical to that of patients diagnosed with either hypochondriasis or major depression. The illness behavior of patients without psychological distress was indistinguishable from that of patients whose physical symptoms were attributed to organic disease. These results further support the hypothesis that functional somatic symptoms may be associated with hypochondriasis and major depression, the pathology of which may contribute to the development of abnormal illness behavior.

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Depressive symptoms and abnormal illness behavior in general hospital patients

Abstract

Gen Hosp Psychiatry

J Psychosom Res

J Psychosom Res

Pain

Psychiatric consultations in a Canadian general hospital

Can J Psychiatry

Psychiatric consultations in a general hospital

Dis Nerv Syst

Illness behavior and medical diagnosis

J Health Hum Behav

A general classification of abnormal illness behaviors

Br J Med Psychol

Diagnosing depression in medical inpatients