Lara MA, Navarro C, Mondragón L, Rubí NA, Lara MC

Language: Spanish
References: 34
Page: 13-20
PDF size: 369.21 Kb.

ABSTRACT

Treatment of depression has changed due to the fact that certain patients are seen outside mental health institutions, at the primary health care level or at general hospitals and because the effectiveness of interventions for the treatment of depression at this level must be proved. This situation has led to the search and development of instruments for the detection of depression, that are brief, do not require the participation of a mental health specialist, not include physical symptoms, and are sensitive to the effects of an intervention. The aim of this paper is to describe the results of the application of the MHI-5 in a study of depression in women that seek treatment at the primary health care level. The article describes the internal consistency and validity of the instrument: the criterion validity when compared with the diagnosis established by a consultant, the concurrent validity in regard to other scales of symptoms and also data on its sensitivity for the measurement of changes resulting from an anti-depressive intervention (predictive validity).
The study was carried out at three Mental Health Community Centers and a Health Center of the Secretary of Health. The sample consisted of 254 women that requested treatment in response to an offer of a psycho-educational intervention for depression. The women that sought help and met the criteria for inclusion were interviewed based on a questionnaire on sociodemographic variables, life events and other relevant aspects to the study, as well as on emotional symptoms. The latter were evaluated by using the MHI-5, the Depression Scale of the Center for Epidemiological Studies Depression Scale (CES-D; the Anxiety and Somatization Scales of the SCL-90 and Coopersmith’s Self- Esteem Inventory. Current depressive episodes were evaluated using the SCID, which is based on the DSM-IIIR criteria. The study compares a group intervention (IG) of six sessions and a minimal intervention (IIM) of one session, with pre-, post- and follow-up evaluations. A sub-sample of 39 randomly selected women was evaluated nearly two years after the intervention. This article only reports the data relevant to the afore mentioned objectives.
The mean age of the interviewees was 35.3 years (DS 6.5), and their socio-economic level was lower middle or low. The internal consistency of the MHI-5, measured through Cronbach’s coefficient, was 0.83. The sensitivity of the instrument (validity of criterion) to identify women with a depressive episode diagnosis according to the DSM-IIIR was 95.6% and 94.1% with cut-off points of 16 and 17 respectively. The corresponding specificity for both cut-off points was 33.9% and 43.25%. As for concurrent validity, extremely high, significant correlations were observed with the scales of comparison: depression symptoms, somatization, anxiety and negative self-esteem symptoms, at the four points of the evaluation (pre-, post and four-months and two-years followup). Predictive validity (sensitivity to change) determined by the application of the MHI-5 in the three evaluations showed significant differences within the groups (between pre; post and four-month follow-up) (F=52.779; P =.00) but not between conditions (group and individual) (F=.513; P=.60) in the MANOVA for repeated measures. These results were very similar to those observed in the other scales. For the sub-sample evaluated after two years, the MANOVA for repeated measures showed significant differences between the groups (F= 13.319; P=00), but not between the conditions (F=.287; P=.835).
The results of this study show that the MHI-5 is a valid, reliable instrument to measure depression in women that attend community mental health institutions and seek primary health care. It is worth noting the high internal consistency obtained, because despite being an instrument with only five items, it stands within the range regarded as appropriate. At the same time, the validity of the MHI-5 as a screening instrument was demonstrated by the high sensitivity observed. The use of the cut-off points recommended by the authors of the instrument means that the possibility of false negatives is virtually null. The MHI-5 proved to be as sensitive to the changes produced by an intervention as other instruments with a higher number of items, a fact that proves the usefulness of this instrument.

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