Quebec suicide rate slides. Reclaiming connections: understanding residential school trauma among Aboriginal people. Ottawa, Aboriginal Healing Foundation. DAHL J. Cambridge, MIT Press: DUBE S. Paris, Presses universitaires de France. Genesis and development of a scientific fact. Chicago, University of Chicago Press.
Stanford, Stanford University Press. Washington, National Academies Press. Toronto, Thompson Educational Publishing Inc. Suicide Among Aboriginal Peoples in Canada. Current approaches to aboriginal youth suicide prevention. Chichester, Wiley-Blackwell: Vancouver, UBC Press. Princeton, Princeton University Press. KRAL M. LOCK M. An anthropology of biomedicine , Chichester, Wiley. MANN J. Oxford, Oxford University Press: They carried out a study in six Swedish primary healthcare centers in two districts, one rural and one semi-urban, to validate the HSCL against the PSE-9 and establish a cut-off.
A cut-off of 1. The aim of this project, inspired by the Nettlebladt study, was to determine. It was a comparative, non-inferiority, multi-centered, survey. A multidisciplinary research network supported the study. The inclusion period was 20 weeks. The duration of participation for each patient was 1 week.
The study was conducted between June and February The population was a mix of patients from urban, semi-rural and rural environments. In the waiting room, before their primary care appointment, patients were given a leaflet explaining the study, an F-HSCL scale and a consent form.
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Participants were recruited spontaneously to ensure the representativeness of the recruited population, after they had read the explanatory notice and completed the F-HSCL paper version. The patients needed to be adults over 18 years. Patients had to give their written informed consent to participate.
To avoid possible cases of puerperal depression, which requires specific management, women with a reported pregnancy were not included in the study [ 20 ][ 21 ][ 22 ]. Also excluded were adults consulting for administrative purposes, patients known to be schizophrenic or having related disorders and patients requiring emergency care. This process ensured the two groups were as comparable as possible. The delay between interview and inclusion had to be between one week and one month in order to prevent bias in the results of the PSE-9 interview.
This required the recruitment of patients. To compensate for those lost to follow-up, the research team decided to include patients. The randomization was achieved independently, via computer software, excluding any human intervention in the selection. Patients had to give their written, ethical consent to participate. Descriptive Analysis: Quantitative variables are expressed as means, standard deviations, 25, 50 and 75 quantiles, minimum and maximum values.
Qualitative variables are expressed as ratios and percentages. The whole calculation is in S2 Appendix. To simplify the interpretation of results, a Varimax rotation was performed [ 26 ].
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The study included French outpatients consulting their GP. Patients were aged between 18 and 94 years. According to a prevalence of Items related to anxiety are items 1—10; items related to depression are items 11—25, in the HSCL original version Table 5. The first point of the graph indicates the amount of information provided by the first dimension. This point has a high eigenvalue.
The second point provides information on the second dimension. This point has a lower eigenvalue than the previous one. The important difference between the first and second dimensions and the significant break in the curve shows that F-HSCL is a one dimension tool Fig 2 , anxiety and depression are intimately combined. F-HSCL adequately assessed major depression. It is a useful first-line ergonomic diagnostic tool with a low number of false positive patients.
F-HSCL is a reliable one-dimensional tool. It was a consistent scale, since the elements depression and anxiety converged towards the same result [ 27 ][ 28 ]. Previous studies showed similar results in terms of sensitivity and specificity [ 19 ]. A cut-off point of 1.
Screening capacity is improved at the expense of diagnostic capacity. Due to the average sensitivity rate and the high specificity in the French study, the HSCL, with a cut-off point of 1.
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Nevertheless, the difference in randomization ratios allowed us to balance the number of F-PSE-9 patients in our groups more closely. A combined global scale also performed efficiently. Our results are comparable with the survey by Lundin and are better than the survey by Nettelbladt. These results merit comparison with the external validity data of other tools for use in primary care. HADS has been tested in primary care. It has a higher sensitivity and specificity compared to HSCL between 0. The ergonomics of this tool seemed more complex to the researchers who preferred the HSCL [ 12 ].
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The PHQ-9 has a sensitivity between 0. The tools are numerous; researchers will make their choices according to their objectives. Systematic reviews or Meta analyses would then be very useful [ 36 ]. HSCL focused on core and peripheral anxiety and depression symptoms.
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The HSCL combined anxiety and depression assessment [ 37 ][ 38 ][ 39 ]. Considering the 25 items independently, and as invariant, and considering the sub-parts separately could be a pitfall. As demonstrated by the principal component analysis, items can change from indicating depression to indicating anxiety and vice versa. F-HSCL should be considered as a global tool to assess the intensity of anxiety and depression [ 40 ]. In primary care research, the multiplicity of users requires the use of tools with high consistency [ 27 ]. Using self-questionnaires allows independent rating by GPs.
On the other hand, this specificity focused on patients makes it impossible to analyse results provided by inter-examiners.
Its format is not an interview-style conducted by an examiner, as is the case for example for HADS. The strength of this study and its relevance for GPs lies in the fact it is specifically set in primary care. Several types of data quality procedures were followed which increased the reliability of the results, including the appointment of a designated DRCI data manager at the Brest CHRU. Furthermore, the expertise of the stakeholders in the team was balanced to make data collection secure.
A stratified randomization was used to ensure both satisfactory statistical power and affordable logistics. The mean age was 59 years. These sample features were comparable to other studies in primary care settings 51 years. The sample characteristics are close to European population-based norms which make it feasible to generalize from these results [ 2 ]. A prevalence of This study focused on a population which consulted the GP [ 42 ].
Overestimation of the prevalence is possible due to the internal structure of the HSCL This may occur when anxiety and depression are considered separately; however, it is consistent when anxiety and depression are combined [ 42 , 43 ]. In research, the high NPV and specificity, which enable us to eliminate the false positives, also limit this bias. Therefore, physicians should take this into account in their clinical work. With Brittany currently having the highest rate of suicide in France, it is possible that the depression rate in this region may be higher than in France as a whole [ 44 ].
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This difference has been taken into account in the statistical analysis. The number of subjects was reassessed during the study because of the unexpected distribution of the patients in the two groups. The number of subjects necessary to guarantee the statistical power of the study did not depend on this prevalence but on the minimum number of patients placed in each subgroup.