Differentiating Between Transitional And Pathological Depression Post Miscarriage

2.50
Hdl Handle:
http://hdl.handle.net/10755/158105
Type:
Presentation
Title:
Differentiating Between Transitional And Pathological Depression Post Miscarriage
Abstract:
Differentiating Between Transitional And Pathological Depression Post Miscarriage
Conference Sponsor:Western Institute of Nursing
Conference Year:2004
Author:Petras, Anthippy, MSW
P.I. Institution Name:Unviersity of Washington
Contact Address:University of Washington, Dept. of Family and Child Nursing, Seattle, WA, USA
Co-Authors:Kristen Swanson, RN, PhD, FAAN; Danuta Wojnar, RN, MN, MEd
Purpose: To determine appropriate CES-D cut-off scores for initiating further assessment for clinical depression in men and women who have recently miscarried. Background: Interpreting the meaning of sadness, subsequent to miscarriage, is clinically challenging. Symptoms of clinical depression and grief are similar. From a data safety and monitoring perspective distinguishing between symptoms of transitory grief and pathological depression is both clinically and scientifically essential. In our human subjects consent forms for the Couples Miscarriage Healing Project, it was stated that we would contact subjects by phone if their baseline CES-D scores suggested they were ‘extremely’ depressed. Of the first 55 couples enrolled, 51% of women and 25% of men had a score of 16 or higher on the CES-D, triggering a follow-up call by our social worker. Having contacted so many subjects, concerns were raised about the potential for interfering with the integrity of the test of effectiveness of our interventions. Discovering the prevalence of elevated depression scores in the first few weeks post loss combined with the need to reduce the false positives for ‘extreme’ depression led to a reexamination of our criteria for follow-up. The goal was to insure that all subjects at risk for suicide, harm to self or other, or significant depression would be contacted while reducing excessive, potentially invasive, follow-up telephone calls. Methods: We met with our Data Safety Monitoring Board (DSMB) to discuss: subject protection, preservation of integrity of the intervention, and interpretation of a meaningful elevation in CES-D scores. Literature was reviewed to determine recommended CES-D cut-offs for individuals who have experienced recent personal hardships. At the advice of our DSMB, the social worker’s clinical records of follow-up calls were carefully reviewed and measures of central tendency and dispersion of CES-D scores for our first 55 couples were examined to determine gender-based ‘norms’ for our post-miscarriage sample. Results: The literature reviewed suggested that when interpreting CES-D scores both gender and situational contexts should be considered. CES-D scores for women ranged from 7 to 33 with a mean of 17.4 (SD = + 9.06). CES-D scores for men ranged from 2 to 40 with a mean of 12.2 (SD = + 7.96). Of the 51% of women and 25% of men who received a follow-up call, none had suicidal ideation. Therefore, with the concurrence of our DSMB, cut-off scores for the CES-D were increased from 16 for everyone to a gender-specific cut-off of one standard deviation above the mean (26 for women and 20 for men). Implications: In re-considering criteria for CES-D follow-up, we attempted to find a balance between subject safety and preservation of scientific integrity of our intervention. This change has proven critical as our sample has increased CES-D scores have remained elevated. At N=112 baseline scores for women range from 2 to 52 with a mean score for women of 22.3 (SD= + 9.03) and for men, scores range from 2 to 40 with a mean of 16.1 (SD = + 7.97). It must be acknowledged, however, that our decision may have inadvertently increased the risk for false-negatives: failing to detect clinical depression in those individuals who score below our newly established criteria for follow-up.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDifferentiating Between Transitional And Pathological Depression Post Miscarriageen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158105-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Differentiating Between Transitional And Pathological Depression Post Miscarriage</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Petras, Anthippy, MSW</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Unviersity of Washington</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">University of Washington, Dept. of Family and Child Nursing, Seattle, WA, USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Kristen Swanson, RN, PhD, FAAN; Danuta Wojnar, RN, MN, MEd</td></tr><tr><td colspan="2" class="item-abstract">Purpose: To determine appropriate CES-D cut-off scores for initiating further assessment for clinical depression in men and women who have recently miscarried. Background: Interpreting the meaning of sadness, subsequent to miscarriage, is clinically challenging. Symptoms of clinical depression and grief are similar. From a data safety and monitoring perspective distinguishing between symptoms of transitory grief and pathological depression is both clinically and scientifically essential. In our human subjects consent forms for the Couples Miscarriage Healing Project, it was stated that we would contact subjects by phone if their baseline CES-D scores suggested they were &lsquo;extremely&rsquo; depressed. Of the first 55 couples enrolled, 51% of women and 25% of men had a score of 16 or higher on the CES-D, triggering a follow-up call by our social worker. Having contacted so many subjects, concerns were raised about the potential for interfering with the integrity of the test of effectiveness of our interventions. Discovering the prevalence of elevated depression scores in the first few weeks post loss combined with the need to reduce the false positives for &lsquo;extreme&rsquo; depression led to a reexamination of our criteria for follow-up. The goal was to insure that all subjects at risk for suicide, harm to self or other, or significant depression would be contacted while reducing excessive, potentially invasive, follow-up telephone calls. Methods: We met with our Data Safety Monitoring Board (DSMB) to discuss: subject protection, preservation of integrity of the intervention, and interpretation of a meaningful elevation in CES-D scores. Literature was reviewed to determine recommended CES-D cut-offs for individuals who have experienced recent personal hardships. At the advice of our DSMB, the social worker&rsquo;s clinical records of follow-up calls were carefully reviewed and measures of central tendency and dispersion of CES-D scores for our first 55 couples were examined to determine gender-based &lsquo;norms&rsquo; for our post-miscarriage sample. Results: The literature reviewed suggested that when interpreting CES-D scores both gender and situational contexts should be considered. CES-D scores for women ranged from 7 to 33 with a mean of 17.4 (SD = + 9.06). CES-D scores for men ranged from 2 to 40 with a mean of 12.2 (SD = + 7.96). Of the 51% of women and 25% of men who received a follow-up call, none had suicidal ideation. Therefore, with the concurrence of our DSMB, cut-off scores for the CES-D were increased from 16 for everyone to a gender-specific cut-off of one standard deviation above the mean (26 for women and 20 for men). Implications: In re-considering criteria for CES-D follow-up, we attempted to find a balance between subject safety and preservation of scientific integrity of our intervention. This change has proven critical as our sample has increased CES-D scores have remained elevated. At N=112 baseline scores for women range from 2 to 52 with a mean score for women of 22.3 (SD= + 9.03) and for men, scores range from 2 to 40 with a mean of 16.1 (SD = + 7.97). It must be acknowledged, however, that our decision may have inadvertently increased the risk for false-negatives: failing to detect clinical depression in those individuals who score below our newly established criteria for follow-up. </td></tr></table>en_GB
dc.date.available2011-10-26T20:30:50Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:30:50Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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