Article 1

Doering, L., et al.(2007).Utility of observer-rated and self-report instruments for detecting major depression in women after cardiac surgery: A pilot study.

ARTICLE LISTED HERE: https://www.researchgate.net/publication/6369531_Utility_of_Observer-Rated_and_Self-Report_Instruments_for_Detecting_Major_Depression_in_Women_After_Cardiac_Surgery_A_Pilot_Study

1) What was the purpose of the study?

2.) Why is this an important clinical issue?

3) The authors begin by stating that "in adults with coronary artery disease (CAD) depression is common and dangerous."How do the authors support this statement using statistics and what do these statistics mean?

4) If depression after CABG surgery were a benign condition, it might not be particularly important to detect. For example, if the presence of depression was only associated with the type of toothpaste you selected the next day, the toothpaste company might want to fund the study but the National Institute of Health probably would not. Therefore, to strengthen the argument that depression in women after CABG surgery is an important issue to address the nurse researchers need to support that the outcomes associated with the presence of depression are significant. How is statistics used to do this ?

5) Now the authors go on to use statistics in another way. They already told us there are few measures of depression in women after CABG surgery but there are reports of rates in a "similar population," those with coronary heart disease or heart failure. Do they report a difference in the gender specific prevalence rates of depression in these women?

6) The researchers then present information about the measurement tools they wish to examine in this study. They already have a valid and reliable tool, the structured diagnostic interview, to detect depression. What do we know about this tool from this description?

7) Why not just keep using this tool if we already know it works?

8) What are the advantages and disadvantages of the self-report and observer instruments used to detect depression?

9) What test is the "gold standard" (the one that will be used to establish that depression exists and test if the other measures are able to detect it)?

10) What type of study design was utilized?

A. Qualitative

B. Quantitative

11) What sampling technique was used?

12) What concerns do you have about the sampling technique?

13) What is the sample size?

14) With the small sample size, what type of error would be most concerning and what would be the result?

A. Type one error

B. Type two error

15) The researchers report that the structured diagnostic interview using DISH (the 'gold standard' for the study) has an inter-rater reliability of 93%. What does this mean about the instrument?

16) The nurse researchers report that the Beck Depression Inventory (BDI) has items rates on a scale of 0 to 3 with zero being no signs or symptoms and 3 being the most severe. Is this a quantitative or qualitative measure?

A. Qualitative

B. Qualitive

17) The nurse researchers report that the Beck Depression Inventory (BDI) has items rates on a scale of 0 to 3 with zero being no signs or symptoms and 3 being the most severe.Is each item categorical or continuous?

A. Categorical

B. Continuous

18) The nurse researchers report that the Beck Depression Inventory (BDI) has items rates on a scale of 0 to 3 with zero being no signs or symptoms and 3 being the most severe.Is the total score a continuous or categorical measure?

A. Categorical

B. Continuous

19) What level of measurement are the individual items in the BDI?

A. Nominal

B. Ordinal

C. Interval

D. Ratio

20) What would be the most appropriate measure of central tendency for the individual items in the BDI?

A. Mean

B. Median

C. Mode

21) What level of measurement is the total score on the BDI?

A. Nominal

B. Ordinal

C. Interval

D. Ratio

22) What options do researchers have for calculating a measure of central tendency for the BDI total score?

A. Mean

B. Median

C. Mode

D. All of the above

23) The nurse researchers report that concurrent validity (which is another name for convergent validity) is established for the BDI. What does this tell you?

24) The researchers go on to say that the Cronbach alpha coefficient is 0.92 in this study. What does this mean?

25) The study also talks about a modification of the BDI which is the Beck Depression Inventory Short Form (BDI-SF) which was developed because there were concerns that the original BDI which included physical signs and symptoms of depression might over diagnose depression if used with populations who are medically ill. (This is a perfect example of being careful not to over-generalize results. The appropriate total score in a medically healthy population indicating depression may not be appropriate for a population which has medical illnesses contributing additional physical symptoms.)The modified BDI-SF was designed for detecting depression in medically ill patients and when using a cutoff of a score of ten, the BDI-SF has a sensitivity of 100% and a negative predictive value of 100% for hospitalized patients.What does this mean?

26) The BDI was also modified and shortened for use in a primary care setting (BDI-PC). The specificity of the BDI-PC is 82-95% for detecting major depression in medically ill populations. What does this mean?

27) One of the variables used for comparison was educational level. What would be an appropriate null hypothesis for this comparison?

28) One of the variables used for comparison was educational level. What would be an appropriate alternative hypothesis?

29) If educational level is measured as: did not graduate from high school and graduated from high school, what level of measurement is this variable?

A. Nominal

B. Ordinal

C. Interval

D. Ratio

30) What statistical test would you use to test your hypothesis and why? The resulting p value is 0.01, what does this mean?If during your analysis you realize that one of the cells in your 2x2 table only had four subjects which test would you use?

31) What was the prevalence rate for depression?

32) Was there a statistically significant different in educational level for the subjects who were depressed and those who were not?

A. Yes

B. No

33) Was there a statistically significant difference in preoperative risk between the two groups?

A. Yes

B. No

34) Was there a difference in the postoperative intubation time for the two groups?

A. Yes

B. No

35) What was the median score for the original BDI in the whole sample?

36) If you use the cut off of a score of 10 on the BDI to diagnose depression what percent of patients meet the diagnostic criteria?

37) Which measurement tools detected significant differences between the patients who were depressed and those that were not?

A. HDRS

B. BDI

C. BDI-SF

D. BDI-PC

E. All of the above

38) The researchers examined the mean age of the patients who were depressed and those who were not. Write a n appropriate null and alternative hypothesis. What would be a good statistical test for this analysis and why? The corresponding p value is 0.25?What do you conclude?

39) Based on this article, if you need to screen a patient from a similar target population for depression at hospital discharge post CABG, what measurement instrument should you use?