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  • Additional Info About loispgidleywriter
    Location: 4334 Watson Street Camden, NJ 08102
    Bio: My name is Lois P. Gidley and I am a professional writer. A patient who is actively abusing cannot be reliably assessed, and every effort should be made to have the patient abstain for a sufficient period to allow for a more accurate accounting of symptoms. However, this area is controversial and not sufficiently studied in the older population or, specifically, in the situation of older cancer patients. Importantly, older patients with a past history of substance abuse or dependence appear to be at higher risk for developing depression in the context of serious illness. While the previous discussion has focused on the diagnosis of major depression, it is important not to overlook what is involved, generally speaking, in the differential diagnosis. Included here are other medical illnesses and effects of medications or treatments, other depressive and psychiatric disorders, and life circumstances. Tables 2▶ and 3▶ display the sensitivity, specificity, positive and negative likelihood ratios, positive predictive value , and posttest likelihood of a negative test (PTL–, or 1–negative predictive value) for the PHQ-2 and the PHQ-9 when compared with the CIDI reference standard.

    The main disadvantage of the PHQ-9 is that it is more complicated to administer and takes longer to complete than the Whooley Questions. Thus, misclassification of major depression among participants with subthreshold depressive symptoms based on fully structured interviews might explain the lower sensitivity compared with semistructured interviews. The sensitivity of screening instruments is considered good when their range is 0.79–0.97 and when their specificity is 0.63–0.86 . Both languages of the PHQ-9 had relatively low sensitivity and acceptable specificity. The moderate specificity of the PHQ-9 for diagnosing major depression can be explained because it is possible to diagnose the disorder without having either of the two cardinal symptoms of major depression.

    The PHQ-2 was developed for depression screening, with some evidence for a role in diagnosing depression . These 2 questions, collectively known as the PHQ-2, ask about the frequency of the symptoms of depressed mood and anhedonia, scoring each as 0 to 3 . The validation study of the PHQ-2 by Kroenke et al. included a sample of 580 primary care patients . Specifically we wished to investigate the yields obtained with the PHQ-2 and the PHQ-9 at a range of thresholds compared with the scoring system originally described by Spitzer et al in 1999. We use the term PHQ major depression to describe the Spitzer scoring system, which requires a score of 2 or higher on at least 1 of the first 2 questions and then a minimum score of 2 or higher on 5 of the questions. Clinically this scoring system is onerous to calculate, and we wished to see how these criteria compared with simple additive scores.

    A subgroup analysis determined that the timing of when the physician saw the patient did not significantly influence the CIDI results. The physician then completed a form saying whether the patient was depressed and whether the physician offered any mental health treatment. Family physicians had access to the screening results and were expected to deal with any issues of suicidality. In each scenario, we calculated the number of participants who scored above the PHQ-2 threshold and, in practice, would need to complete the full PHQ-9. For these analyses, we excluded studies and participants without PHQ-9 scores. In additional analyses, we compared sensitivity and specificity for PHQ-2 scores of 2 or greater in combination with PHQ-9 cutoff scores of 5 to 15 vs PHQ-9 alone at cutoff scores of 5 to 15.
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    The PHQ-2 is accurate for depression screening in adolescents, adults, and older adults. Because there is no significant difference in performance among the different depression screening instruments, the most practical tool for the clinical setting should be used. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past two weeks. We would like to acknowledge the support and guidance of Dr. Julie Pallant during the statistical analysis phase of this study. We are grateful to all the staff and midwives who assisted and supported the recruitment of participants at the study site http://www.cqaimh.org/pdf/tool_phq2.pdf

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