Anxiety and depressive symptom identification using the Duke Health Profile

doi:10.1016/0895-4356(95)00037-2

Journal of Clinical Epidemiology

Volume 49, Issue 1, January 1996, Pages 85-93

https://doi.org/10.1016/0895-4356(95)00037-2 Get rights and content

Abstract

Duke Health Profile (DUKE) subscales were compared for their ability to identify anxiety and depressive symptoms as measured by the State Anxiety Inventory (SAI) and the Center for Epidemiologic Studies Depression Scale (CES-D) in 413 primary care patients. The seven-item Duke Anxiety-Depression Scale (DUKE-AD) was the best symptom identifier, with sensitivities and specificities greater than 70% for high scores on both the SAI and CES-D. Also, baseline DUKE-AD scores predicted five clinical outcomes during an 18-month follow-up period, with receiver operating characteristic (ROC) curve areas ranging from 57.1 to 58.7%. Patients shown by DUKE-AD scores to be at high risk (>30, scale 0–100) for symptoms of anxiety and/or depression were more often women, less well-educated, not working, and with lower socioeconomic status. Their severity of illness was higher than that of low-risk patients. Although the providers did not know which patients were at high risk, they made a clinical diagnosis of anxiety or depression more often in high-risk patients.

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Citation Excerpt :
Depressive mood was measured using the Duke Health Profile questionnaire (Parkerson et al., 1990), which was designed for self-administration, adapted and validated in French according to psychometric standards (Guillemin et al., 1997). The Duke Health Profile questionnaire has been shown to be an effective screener for clinical depression in primary care against both the Center for Epidemiological Studies Depression scale (Parkerson et al., 1996) and the criteria of the Diagnosis and Statistical Manual of Mental Disorders, Revised Third Edition (Parkerson and Broadhead, 1997). The instructions were: ‘Here are some questions about your health and feelings.
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A population-based survey including 6043 subjects (2892 men and 3151 women) was conducted in 1996 in the north-east of France with a questionnaire covering education, marital status, social support, health behaviors (smoking status, alcohol consumption, body mass index), and chronic diseases. Depressive mood was measured using the Duke Health Profile questionnaire. Cox regression models were used to examine its association with subsequent natural all-cause mortality, and cardiovascular and cancer mortality.
During a follow-up of 12.5 years, 406 men and 303 women died from a natural cause. Adjusting for all covariates, depressive mood predicted natural mortality in both men [Hazard Ratio (HR) = 1.30; 95% confidence interval (CI): 1.00–1.69] and women (HR = 1.37; 95% CI: 1.06–1.77). However, this association was significant for cardiovascular mortality in men (HR = 1.63; 95% CI: 1.00–2.65) whereas it was significant for cancer mortality in women (HR = 1.71; 95% CI: 1.11–2.64).
Baseline data were self-reported and the response rate was low.
Preventive strategies aiming at reducing the increased mortality associated with depressive mood should take gender into account. Depressed men may warrant a better screening for cardiovascular risk factors and diseases, whereas depressed women may benefit from better cancer prevention measures.
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Citation Excerpt :
In addition, they were asked about migraine or tension headache, Raynaud phenomenon, and irritable bowel syndrome. In the second part of the study, 152 consecutive patients were administered the Duke-Anxiety Depression (Duke-AD) scale (7), and the physical function items of the FM impact questionnaire (FIQ) scale (8). The Duke-AD is the 7-item anxiety-depression subscale of the DUKE that has been validated separately as a screening instrument for anxiety and depression.
This study aims to compare fibromyalgia (FM) and chronic widespread pain (CWP) patients who do not fulfill the criteria for tender points (TP).
We included 150 patients diagnosed with FM according to ACR 1990 criteria and 42 patients with CWP who did not fulfill TP criteria for FM into the study. The clinical features of the patients were recorded, and the TP count was determined. By means of a visual analog scale (VAS), all patients were questioned about the severity of pain and FM-related symptoms. In addition, the patients were administered the Duke Anxiety Depression (Duke-AD) scale and somatization symptom questionnaire. Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale was used to determine the neuropathic pain score.
According to VAS, the severity of pain, sleep disturbance, the number of somatization symptoms, LANSS, and Duke-AD scores were significantly higher in FM patients than in patients with CWP (all P values <0.05). The number of TP correlated with severity of pain (r = 0.32, P < 0.001), the number of somatization symptoms (r = 0.26, P = 0.01), sleep disturbance (r = 0.18, P = 0.01), and LANSS score (r = 0.4, P < 0.001). Multiple logistic regression analysis revealed that independent factors that affected the presence of ≥11 TP were the severity of pain on VAS (OR: 1.03, 95% CI: 1.01-1.06, P = 0.045) and LANSS score (OR: 1.36, 95% CI: 1.12-1.62, P = 0.001).
CWP patients have symptoms similar to FM patients, though less severe. The most important factor that affects the criteria for fulfilling the number TP in CWP patients is the neuropathic pain score, which suggests that FM is primarily a neuropathic pain syndrome.
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Quality of life (QOL) of adolescents has been scarcely documented in a general population sample. The study was aimed at translating and adapting the Adolescent Duke Health Profile to Vietnamese, validating the questionnaire, determining reference value, and identifying determinants of poor QOL.
Following a cross-cultural methodology, the Adolescent Duke Health Profile (ADHP) had content adapted to Vietnamese by alteration of 2 out of 17 items. Test–retest validity was checked in 408 adolescents. Construct validity and internal consistency were assessed in a 1408 probability sample of adolescents in Vietnam, and determinants were analysed by multiple linear regression.
The ADHP showed satisfactory internal consistency (Cronbach's α=0.87–0.92) and satisfactory construct validity in relation with drug abuse or not, or with parent situation living in couple or alone. Test–retest reliability was acceptable (ICC=0.7–0.8) and major determinants were age, sex, education, chronic disease, alcohol and drug use.
This works provide a validated, simple health related QOL scale suited to adolescent population with reference values. Taking into account determinants identified will help program prevention and intervention health policy and to evaluate the effect of these actions.

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^☆: Completion of the DUSOI Checklists at the time of patient visits was performed by W. E. Broadhead, M.D., Ph.D., James W. R. Harding III, M.D., M.P.H., Janet Jezsik, P.A.-C., Todd Shapley-Quinn, M.D., and Bret C. Williams, M.D., M.P.H. Funding was provided by Glaxo, Inc. (Research Triangle Park, NC) and the Department of Community and Family Medicine, Duke University Medical Center.

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Original articleAnxiety and depressive symptom identification using the Duke Health Profile☆

Abstract

The epidemiology of depression in medical care

Intl J Psych Med

Anxiety and depression in a primary care clinic

Arch Gen Psychiatry

Mental disorders in primary care: Epidemiologic, diagnostic, and treatment research directions

Gen Hosp Psychiatry

Treating depression and anxiety in primary care. Closing the gap between knowledge and practice

N Engl J Med

The development of DSM-IV

Arch Gen Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Mixed anxiety and depression

J Abn Psychol

Mixed anxiety-depression: A new diagnostic category?

The DSM-IV field trial for mixed anxiety depression

Am J Psychiatry

A rating instrument for anxiety disorders

Psychosomatics

An inventory for measuring depression

Arch Gen Psychiatry

A self-rating depression scale

Arch Gen Psychiatry

The CES-D Scale: A self-report depression scale for research in the general population

Appl Psychol Meas

Development of a brief screening instrument for detecting depressive disorders

Med Care

A scaled version of the General Health Questionnaire

Psychol Med

The structure of psychological distress and well-being in general populations

J Consult Clin Psychol

Performance of a five-item mental health screening test

Med Care

Validation of the SDDS-PC Screen for multiple mental disorders in primary care

Arch Fam Med

The PRIME-MD 1000 Study

The Sickness Impact Profile: Development and final revision of a health status measure

Med Care

Original article
Anxiety and depressive symptom identification using the Duke Health Profile☆