Browsing by Author "Patel, Jay Sunil"

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    Longitudinal Relationships Between Depressive Symptom Clusters and Inflammatory Biomarkers Implicated in Cardiovascular Disease in People with Depression
    (2021-12) Patel, Jay Sunil; Stewart, Jesse; Cyders, Melissa; Wu, Wei; Gupta, Samir
    Systemic inflammation is one potential mechanism underlying the depression to cardiovascular disease (CVD) relationship. In addition, somatic rather than cognitive/affective symptoms of depression may be more predictive of poorer CVD outcomes due to systemic inflammation. However, the small existing literature in this area has yielded mixed results. Therefore, the present study aimed to examine longitudinal associations between depressive symptom clusters and inflammatory biomarkers implicated in CVD (i.e., interleukin-6, IL-6; and C-reactive protein, CRP) using data from the eIMPACT trial. In addition, race was examined as a moderator given findings from two previous studies. The eIMPACT trial was a phase II, single-center randomized controlled trial comparing 12 months of the eIMPACT intervention to usual primary care for depression. Participants were 216 primary care patients aged ≥ 50 years with a depressive disorder and CVD risk factors but no clinical CVD from a safety net healthcare system (Mage = 58.7 years, 78% female, 50% Black, Meducation = 12.8 years). Depressive symptoms clusters (i.e., somatic and cognitive/affective clusters) were assessed using the Patient Health Questionnaire-9 (PHQ-9). IL-6 and high-sensitivity CRP were assessed by the local clinical research laboratory using R&D Systems ELISA kits. Change variables were modeled in MPlus using a latent difference score approach. The results of this study were largely null. Very few associations between depressive symptom clusters and inflammatory biomarkers implicated in CVD were observed, and the detected relationships may be due to type I error. Similarly, only one association was observed for race as a moderator, and the detected relationship may be due to type I error. The present findings do not provide strong support for the longitudinal associations between depressive symptom clusters and inflammatory biomarkers implicated in CVD nor the moderating effects of race. However, the present findings do not rule out the possibility of these relationships given important study limitations, such as study design and power. Future prospective cohort studies with multiple waves of data collection are needed to determine the longitudinal associations between depression facets and various inflammatory biomarkers implicated in CVD. In addition, a biologically-based approach to identifying facets of depression – e.g., the endophenotype model – may provide a clearer understanding of the depression-inflammation relationship.
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    Measurement invariance of the Patient Health Questionnaire-9 (Phq-9) depression screener in U.S. adults across sex, race/ethnicity, and education level: Nhanes 2005-2014
    (2017-11-10) Patel, Jay Sunil; Stewart, Jesse C.; Rand, Kevin L.; Cyders, Melissa A.
    Importance: Despite its widespread use in clinical settings and in behavioral medicine research, little is known about the psychometric performance of the PHQ-9 across major U.S. sociodemographic groups. Thus, utilizing a large sample representative of the U.S. population and confirmatory factor analysis (CFA), we determine the factor structure and measurement invariance of the PHQ-9 across groups based on sex, race/ethnicity, and education level. Objective: Our objective was to address key knowledge gaps by definitively determining the factor structure and measurement invariance of the PHQ-9 across major U.S. sociodemographic groups based on sex, race/ethnicity, and education level. Design: The continuous National Health and Nutrition Examination Survey (NHANES) is a cross-sectional, epidemiologic study designed to assess the health and nutritional status of the U.S. population. We examined data from the 2005-2014 survey years. Setting: NHANES is uses a stratified multistage probability sampling approach to enroll civilian, non-institutionalized adults and children in the U.S. Participants: For our final sample, we selected the 26,202 adult respondents with no missing PHQ-9 data. The factors of interest were sex (49.3% men, 50.7% women), race/ethnicity (48.9% non-Hispanic White, 23.7% non-Hispanic Black, 17.8% Mexican American, 9.7% other Hispanic), and education level (9.9% less than 9th grade, 16.6% 9th-12th grade but no diploma, vii 23.7% high school graduate/GED or equivalent, 28.9% some college or Associate’s degree, 20/8% college graduate or above). Main Outcome(s) and Measure(s): The Patient Health Quessionnaire-9 (PHQ-9) Results: Results revealed that the best solution for the PHQ-9 consists of a cognitive/affective factor (items 1. anhedonia, 2. depressed mood, 6. feelings of worthlessness, 7. concentration difficulties, 8. psychomotor disturbances, and 9. thoughts of death) and a somatic factor (items 3. sleep disturbance, 4. fatigue, and 5. appetite changes; RMSEA = 0.034, RMSEA 90% CI = 0.032–0.036, TLI = 0.984, CFI = 0.988). To evaluate measurement invariance, we then conducted single-group and multiple-group CFAs to carry out the 5 steps of measurement invariance testing. Dimensional, configural, weak factorial, strong factorial, and strict factorial invariance was established for the PHQ-9 across the sex, race/ethnicity, and education level groups, as all models demonstrated close fit and the ΔCFI was < 0.010 for all steps. Conclusions and Relevance: Using a U.S. representative sample, we determined that a two-factor solution for the PHQ-9 with a cognitive/affective factor and a somatic factor is invariant across sex, race/ethnicity, and education level groups. Therefore, clinically, the PHQ-9 is an acceptable measure to utilize in major U.S. sociodemographic groups, extending the use of this depression screener from the primary care clinic to the community. Additionally, we show that PHQ-9 cognitive/affective and somatic subscale scores have the same meaning and can be compared across major U.S. sociodemographic groups and provide a consistent, evidence-based approach to computing PHQ-9 subscale scores to be used in future studies.