Showing papers by "Janet B. W. Williams published in 2008"

Development and reliability of a structured interview guide for the Montgomery Asberg Depression Rating Scale (SIGMA).

Abstract: Background The Montgomery–Asberg Depression Rating Scale (MADRS) is often used in clinical trials to select patients and to assess treatment efficacy. The scale was originally published without suggested questions for clinicians to use in gathering the information necessary to rate the items. Structured and semi-structured interview guides have been found to improve reliability with other scales. Aims To describe the development and test–retest reliability of a structured interview guide for the MADRS (SIGMA). Method A total of 162 test–retest interviews were conducted by 81 rater pairs. Each patient was interviewed twice, once by each rater conducting an independent interview. Results The intraclass correlation for total score between raters using the SIGMA was r=0.93, P<0.0001. All ten items had good to excellent interrater reliability. Conclusions Use of the SIGMA can result in high reliability of MADRS scores in evaluating patients with depression.

The GRID-HAMD : standardization of the Hamilton Depression Rating Scale

Abstract: This report describes the GRID-Hamilton Depression Rating Scale (GRID-HAMD), an improved version of the Hamilton Depression Rating Scale that was developed through a broad-based international consensus process. The GRID-HAMD separates the frequency of the symptom from its intensity for most items, refines several problematic anchors, and integrates both a structured interview guide and consensus-derived conventions for all items. Usability was established in a small three-site sample of convenience, evaluating 29 outpatients, with most evaluators finding the scale easy to use. Test-retest (4-week) and interrater reliability were established in 34 adult outpatients with major depressive disorder, as part of an ongoing clinical trial. In a separate study, interrater reliability was found to be superior to the Guy version of the HAMD, and as good as the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D), across 30 interview pairs. Finally, using the SIGH-D as the criterion standard, the GRID-HAMD demonstrated high concurrent validity. Overall, these data suggest that the GRID-HAMD is an improvement over the original Guy version as well as the SIGH-D in its incorporation of innovative features and preservation of high reliability and validity.

Face-to-face versus remote administration of the Montgomery-Asberg Depression Rating Scale using videoconference and telephone.

Abstract: Although the use of telemedicine in psychiatry has a long history in providing clinical care to patients, its use in clinical trials research has not yet been commonly employed. Telemedicine allows for the remote assessment of study patients, which could be done by a centralized, highly calibrated, and impartial cohort of raters independent of the study site. This study examined the comparability of remote administration of the Montgomery-Asberg Depression Rating Scale (MADRS) by videoconference and by telephone to traditional face-to-face administration. Two parallel studies were conducted: one compared face-to-face with videoconference administration (N=35), and the other compared face-to-face with telephone administration (N=35). In each study, depressed patients were interviewed independently twice: once in the traditional face-to-face manner, and the second time by either videoconference or teleconference. A counterbalanced order was used. The mean MADRS score for interviews conducted remotely by videoconference was not significantly different from the mean MADRS scores conducted by face-to-face administration (mean difference=0.51 points), P=.388, intraclass correlation (ICC)=.94, P<0001. Similarly, the mean MADRS score for interviews conducted by telephone was not significantly different from the mean MADRS score conducted by face-to-face administration (mean difference=0.74 points), P=.270, ICC=.93, P<0001. Results of the study support the comparability of remote administration of the MADRS, by both telephone and videoconference, to face-to-face administration. Comparability of the administration mode allows for remote assessment of patients in both research and clinical applications.

A comparison of face-to-face and remote assessment of inter-rater reliability on the Hamilton Depression Rating Scale via videoconferencing.

Abstract: Poor inter-rater reliability (IRR) is an important methodological factor that may contribute to failed trials. The sheer number of raters at diverse sites in multicenter trials presents a formidable challenge in calibration. Videoconferencing allows for the evaluation of IRR of raters at diverse sites by enabling raters at different sites to each independently interview a common patient. This is a more rigorous test of IRR than passive rating of videotapes. To evaluate the potential impact of videoconferencing on IRR, we compared IRR obtained via videoconference to IRR obtained using face-to-face interviews. Four raters at three different locations were paired using all pair-wise combinations of raters. Using videoconferencing, each paired rater independently conducted an interview with the same patient, who was at a third, central location. Raters were blind to each others' scores. ICC from this cohort (n = 22) was not significantly different from the ICC obtained by a cohort using two face-to-face interviews (n = 21) (0.90 vs. 0.93, respectively) nor from a cohort using one face-to-face interview and one remote interview (n = 21) (0.88). The mean Hamilton Depression Rating Scale (HAMD) scores obtained were not significantly different. There appears to be no loss of signal using remote methods of calibration compared with traditional face-to-face methods.

The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings

Abstract: Low NC, Lee SS, Johnson JG, Williams JB and Harris ES. The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Family Practice 2008; 25: 321–327. Background. Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered. Objective. To test the association between current anxiety with alcohol versus cannabis abuse disorders. Method. Cross-sectional, clinician-administered, structured assessment—using the Primary Care Evaluation of Mental Disorders—to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings. Results. Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2–11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4–4.7) abuse. Conclusion. This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis’ anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.