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Background: In a previous study which made a comparison between disorder-specific and generic instruments to assess outcome of treatments for depression, the Beck Depression Inventory, Second Edition (BDI-II) seemed to be more sensitive to change than the Inventory of Depressive Symptoms- Self Rating (IDS-SR).Methods: A set with longitudinal data from Routine Outcome Monitoring (n=144) were analyzed with multilevel models with random intercepts. The sensitivity to change of two disorder-specific instruments, the BDI-II and the IDS-SR, were compared head to head.Results: The BDI-II was more sensitive to change when measuring treatment outcome compared to the IDS-SR. The BDI-II decreases significantly more over time than the IDS-SR: the average decrease per week for the IDS-SR is -.012 (95%CI -0.015, -0.009) and for the BDI-II it is -.017 (95%CI -0.021, -0.014).Limitations: Conclusions can only be preliminary due to a small sample size.Conclusions: Treatment outcomes measured with questionnaires may differ depending on the degree of sensitivity to change of the instruments.

Background: Dysthymia (DD) may be thought of as depression associated with personality disorder, a phase in the pleomorphic natural history of unipolar depression or a result of exposure to chronic physical illness. Prevalence, clinical features, risk factors and prognosis may change with age. Method: Large (n=3056) representative sample of elderly (55-85) in the Netherlands. Two-stage screen procedure to identify elderly with DD. The Center for Epidemiologic Studies Depression scale (CES-D) was used as a screen and the Diagnostic Interview Schedule (DIS) to diagnose DD. Data on 277 depressed elderly were available to assess the 6-year prognosis of DD. Results: The prevalence of DD (4.61%) was higher in women and declined with age. The symptom profiles of DD and MDD were very similar. Those with DD were very likely to have had MDD earlier in life (44% in pure DD and 80% in those with double depression). The average age at onset (31 years) was earlier than in MDD (53 years). Environmental and personal vulnerability dominated the risk-factors. The prognosis was unfavourable in most cases. Limitations: Considerable attrition and retrospective data on age at onset and previous histories of depression. Conclusion: Although the prevalence declines with age, DD remains common in later life. Many cases arise later than is often thought and clinical features intertwine with those of MDD in the course of life. Given the unfavourable prognosis, provision of effective treatment is warranted. © 2003 Elsevier B.V. All rights reserved.

Background: A validated screening instrument for PTSD in community dwelling older people is lacking. This study evaluates a newly developed measure, the self-rating inventory for posttraumatic stress disorder (SRIP) on its usefulness in survey research. The predictive value of the SRIP in a community setting is investigated. Methods: In a two-phase epidemiologic design the criterion validity of the SRIP was tested against diagnosis made with the comprehensive international diagnostic interview (CIDI) in 1721 older (55-90 years) inhabitants of the Netherlands. Optimal sensitivity and specificity was determined using a weighted receiver operator characteristic (ROC)-curve. Results: Optimal sensitivity (74.2%) and specificity (81.4%) was reached with a cut-off of 39 points. Limitations: According to a strictly applied CIDI algorithm the number of 'true' cases was limited. Conclusion: Overall findings indicate that posttraumatic stress disorder can be identified adequately in a community-based population of older adults using the SRIP. Use of the SRIP may improve recognition and diagnosis of posttraumatic stress disorder in the community.

Background: Clark and Watson developed the tripartite model in which a symptom dimension of 'negative affect' covers common psychological distress that is typically seen in anxious and depressed patients. The 'positive affect' and 'somatic arousal' dimensions cover more specific symptoms. Although the model has met much support, it does not cover all relevant anxiety symptoms and its negative affect dimension is rather unspecific. Therefore, we aimed to extend the tripartite model in order to describe more specific symptom patterns with unidimensional measurement scales. Method: 1333 outpatients provided self report data. To develop an extended factor model, exploratory factor analysis (EFA) was conducted in one part of the data (n = 578). Confirmatory factor analysis (CFA) was conducted in the second part (n = 755), to assess model-fit and comparison with other models. Rasch analyses were done to investigate the unidimensionality of the factors. Results: EFA resulted in a 6-factor model: feelings of worthlessness, fatigue, somatic arousal, anxious apprehension, phobic fear and tension. CFA in the second sample showed that a 6-factor model with a hierarchical common severity factor fits the data better than alternative 1- and 3-factor models. Rasch analyses showed that each of the factors and the total of factors can be regarded as unidimensional measurement scales. Limitations: The model is based on a restricted symptom-pool: more dimensions are likely to exist. Conclusion: The extended tripartite model describes the clinical state of patients more specifically. This is relevant for both clinical practice and research. © 2011 Elsevier B.V. All rights reserved.