Variables associated with emotional symptom severity in primary care patientsThe usefulness of a logistic regression equation to help clinical assessment and treatment decisions

  1. Ángel Aguilera-Martín 1
  2. Mario Gálvez-Lara 1
  3. Roger Muñoz-Navarro 2
  4. César González-Blanch 3
  5. Paloma Ruiz-Rodríguez 4
  6. Antonio Cano-Videl 5
  7. Juan Antonio Moriana 6
  1. 1 Universidad de Córdoba
    info

    Universidad de Córdoba

    Córdoba, España

    ROR https://ror.org/05yc77b46

  2. 2 Universitat de València
    info

    Universitat de València

    Valencia, España

    ROR https://ror.org/043nxc105

  3. 3 Hospital Universitario Marqués de Valdecilla
    info

    Hospital Universitario Marqués de Valdecilla

    Santander, España

    ROR https://ror.org/01w4yqf75

  4. 4 Comunidad de Madrid
    info

    Comunidad de Madrid

    Madrid, España

    ROR https://ror.org/040scgh75

  5. 5 Universidad Complutense de Madrid
    info

    Universidad Complutense de Madrid

    Madrid, España

    ROR 02p0gd045

  6. 6 Instituto Maimónides de Investigación Biomédica de Córdoba (Spain)
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Revista:
The Spanish Journal of Psychology

ISSN: 1138-7416

Año de publicación: 2023

Número: 26

Tipo: Artículo

DOI: 10.1017/SJP.2023.23 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: The Spanish Journal of Psychology

Resumen

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.

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Referencias bibliográficas

  • Aguinis, H., Gottfredson, R. K., & Joo, H. (2013). Best-practice recommendations for defining, identifying, and handling outliers. Organizational Research Methods, 16(2), 270–301. https://doi.org/10.1177/1094428112470848
  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
  • Aljurbua, F. I., Selaihem, A., Alomari, N. A., & Alrashoud, A. M. (2021). A cross-sectional study on generalized anxiety disorder and its socio-demographic correlates among the general population in Saudi Arabia. Journal of Family Medicine and Primary Care, 10(10), 3644–3649. https://doi.org/10.4103/jfmpc.jfmpc_847_21
  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). American Psychiatric Association Publishing.
  • Anderson, R., Capobianco, L., Fisher, P., Reeves, D., Heal, C., Faija, C. L., Gaffney, H., & Wells, A. (2019). Testing relationships between metacognitive beliefs, anxiety and depression in cardiac and cancer patients: Are they transdiagnostic? Journal of Psychosomatic Research, 124, Article 109738. https://doi.org/10.1016/j.jpsychores.2019.109738
  • Aznar-Oroval, E., Mancheño-Alvaro, A., García-Lozano, T., & Sánchez-Yepes, M. (2013). Razón de verosimilitud y nomograma de Fagan: 2 instrumentos básicos para un uso racional de las pruebas del laboratorio clínico [Likelihood ratio and Fagan’s nomogram: 2 basic tools for the rational use of clinical laboratory tests]. Revista de Calidad Asistencial, 28(6), 390–393. https://doi.org/10.1016/j.cali.2013.04.002
  • Bener, A., Ghuloum, S., & Abou-Saleh, M. T. (2012). Prevalence, symptom patterns and comorbidity of anxiety and depressive disorders in primary care in Qatar. Social Psychiatry and Psychiatric Epidemiology, 47(3), 439–446. https://doi.org/10.1007/s00127-011-0349-9
  • Cabello, R., Salguero, J. M., Fernández-Berrocal, P., & Gross, J. J. (2013). A Spanish adaptation of the Emotion Regulation Questionnaire. European Journal of Psychological Assessment, 29(4), 234–240. https://doi.org/10.1027/1015-5759/a000150
  • Cameron, I. M., Cardy, A., Crawford, J. R., Du Toit, S. W., Hay, S., Lawton, K., Mitchell, K., Sharma, S., Shivaprasad, S., Winning, S., & Reid, I. C. (2011). Measuring depression severity in general practice: Discriminatory performance of the PHQ–9, HADS-D, and BDI–II. British Journal of General Practice, 61(588), e419–e426. https://doi.org/10.3399/bjgp11X583209
  • Cano-López, J. B., García-Sancho, E., Fernández-Castilla, B., & Salguero, J. M. (2022). Empirical evidence of the metacognitive model of rumination and depression in clinical and nonclinical samples: A systematic review and meta-analysis. Cognitive Therapy and Research, 46(2), 367–392. https://doi.org/10.1007/s10608-021-10260-2
  • Cano-Vindel, A. (2001). Inventario de Actividad Cognitiva en Trastornos de Ansiedad [Inventory of Cognitive Activity in Anxiety Disorders] [Unpublished manuscript]. Departamento de Psicología Experimental, Universidad Complutense.
  • Cano-Vindel, A., Muñoz-Navarro, R., Moriana, J. A., Ruiz-Rodríguez, P., Medrano, L. A., & González-Blanch, C. (2022). Transdiagnostic group cognitive behavioral therapy for emotional disorders in primary care: The results of the PsicAP randomized controlled trial. Psychological Medicine, 52(15), 3336–3348. https://doi.org/10.1017/S0033291720005498
  • Carlucci, L., Saggino, A., & Balsamo, M. (2021). On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clinical Psychology Review, 87, Article 101999. https://doi.org/10.1016/j.cpr.2021.101999
  • Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates. Journal of Anxiety Disorders, 11(3), 279–296. https://doi.org/10.1016/S0887-6185(97)00011-X
  • Cordero-Andrés, P., González-Blanch, C., Umaran-Alfageme, O., Muñoz-Navarro, R., Ruíz-Rodríguez, P., Medrano, L. A., Hernández-de Hita, F., Pérez-Poo, T., & Cano-Vindel, A. (2017). Tratamiento psicológico de los trastornos emocionales en atención primaria: Fundamentos teóricos y empíricos del estudio PsicAP [Psychological treatment of emotional disorders in primary care: Theoretical and empirical basis of the PsicAP study]. Ansiedad y Estrés, 23(2–3), 91–98. https://doi.org/10.1016/j.anyes.2017.10.004
  • Corpas, J., Moriana, J. A., Venceslá, J. F., & Gálvez-Lara, M. (2023). Cognitive processes associated with emotional disorders: Implications for efficient psychological treatments. Journal of Mental Health, 32(1), 54–62. https://doi.org/10.1080/09638237.2021.1922651
  • Crittendon, J., & Hopko, D. R. (2006). Assessing worry in older and younger adults: Psychometric properties of an abbreviated Penn State Worry Questionnaire (PSWQ-A). Journal of Anxiety Disorders, 20(8), 1036–1054. https://doi.org/10.1016/j.janxdis.2005.11.006
  • Domínguez-Rodríguez, A., Herdoiza-Arroyo, P. E., Martínez Arriaga, R. J., Bautista Valerio, E., Mateu Mollá, J., de la Rosa-Gómez, A., Farfallini, L., Hernández Jiménez, M. J., Esquivel Santoveña, E. E., Ramírez-Martínez, F. R., Castellanos Vargas, R. O., Arzola-Sánchez, C. A., Arenas-Landgrave, P., & Martínez-Luna, S. C. (2022). Prevalence of anxiety symptoms and associated clinical and sociodemographic factors in Mexican adults seeking psychological support for grief during the COVID–19 pandemic: A cross-sectional study. Frontiers in Psychiatry, 13, Article 749236. https://doi.org/10.3389/fpsyt.2022.749236
  • Dryman, M. T., & Heimberg, R. G. (2018). Emotion regulation in social anxiety and depression: A systematic review of expressive suppression and cognitive reappraisal. Clinical Psychology Review, 65, 17–42. https://doi.org/10.1016/j.cpr.2018.07.004
  • Eysenck, M. W. (2000). A cognitive approach to trait anxiety. European Journal of Personality, 14(5), 463–476. https://doi.org/10.1002/1099-0984(200009/10)14:5<463::AID-PER393>3.3.CO;2-V3.0.CO;2-3>
  • Field, A. (2009). Discovering statistics using SPSS (3rd Ed.). SAGE Publications Ltd.
  • Firth, N., Barkham, M., & Kellett, S. (2015). The clinical effectiveness of stepped care systems for depression in working age adults: A systematic review. Journal of Affective Disorders, 170, 119–130. https://doi.org/10.1016/j.jad.2014.08.030
  • Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. https://doi.org/10.1037/0022-3514.85.2.348
  • Hensher, D. A., & Johnson, L. W. (1981). Applied discrete-choice modelling (1st Ed.). Routledge. https://doi.org/10.4324/9781351140768
  • Hervada Vidal, X., Santiago Pérez, M. I., Vázquez Fernández, E., Castillo Salgado, C., Loyola Elizondo, E., & Silva Ayçaguer, L. C. (2004). Epidat 3.0. Programa para análisis epidemiológico de datos tabulados [Epidat 3.0. Software for epidemiological analysis of tabulated data]. Revista Española de Salud Pública, 78(2), 277–280. https://doi.org/10.1590/s1135-57272004000200013
  • Hirsch, C. R., Meeten, F., Krahé, C., & Reeder, C. (2016). Resolving ambiguity in emotional disorders: The nature and role of interpretation biases. Annual Review of Clinical Psychology, 12(1), 281–305. https://doi.org/10.1146/annurev-clinpsy-021815-093436
  • Hohls, J. K., König, H.-H., Quirke, E., & Hajek, A. (2021). Anxiety, depression and quality of life—A systematic review of evidence from longitudinal observational studies. International Journal of Environmental Research and Public Health, 18(22), Article 12022. https://doi.org/10.3390/ijerph182212022
  • Hsu, K. J., Beard, C., Rifkin, L., Dillon, D. G., Pizzagalli, D. A., & Björgvinsson, T. (2015). Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control. Journal of Affective Disorders, 188, 22–27. https://doi.org/10.1016/j.jad.2015.08.008
  • Institute for Health Metrics and Evaluation. (2020). 2019 Global burden of disease study. GBD results. http://ghdx.healthdata.org/gbd-results-tool
  • King, M., Bottomley, C., Bellón-Saameño, J. A., Torres-González, F., Švab, I., Rifel, J., Maaroos, H.-I., Aluoja, A., Geerlings, M. I., Xavier, M., Carraça, I., Vicente, B., Saldivia, S., & Nazareth, I. (2011). An international risk prediction algorithm for the onset of generalized anxiety and panic syndromes in general practice attendees: PredictA. Psychological Medicine, 41(8), 1625–1639. https://doi.org/10.1017/S0033291710002400
  • King, M., Marston, L., Švab, I., Maaroos, H.-I., Geerlings, M. I., Xavier, M., Benjamin, V., Torres-Gonzalez, F., Bellon-Saameno, J. A., Rotar, D., Aluoja, A., Saldivia, S., Correa, B., & Nazareth, I. (2011). Development and validation of a risk model for prediction of hazardous alcohol consumption in general practice attendees: The PredictAL Study. PLOS ONE, 6(8), Article e22175. https://doi.org/10.1371/journal.pone.0022175
  • King, M., Walker, C., Levy, G., Bottomley, C., Royston, P., Weich, S., Bellón-Saameño, J. Á., Moreno, B., Švab, I., Rotar, D., Rifel, J., Maaroos, H.-I., Aluoja, A., Kalda, R., Neeleman, J., Geerlings, M. I., Xavier, M., Carraça, I., Gonçalves-Pereira, M., … Nazareth, I. (2008). Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: The PredictD Study. Archives of General Psychiatry, 65(12), 1368–1376. https://doi.org/10.1001/archpsyc.65.12.1368
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ–9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  • Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2010). The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A systematic review. General Hospital Psychiatry, 32(4), 345–359. https://doi.org/10.1016/j.genhosppsych.2010.03.006
  • Lucas-Carrasco, R. (2012). The WHO Quality of Life (WHOQOL) Questionnaire: Spanish development and validation studies. Quality of Life Research, 21, 161–165. https://doi.org/10.1007/s11136-011-9926-3
  • Lyubomirsky, S., Layous, K., Chancellor, J., & Nelson, S. K. (2015). Thinking about rumination: The scholarly contributions and intellectual legacy of Susan Nolen-Hoeksema. Annual Review of Clinical Psychology, 11(1), 1–22. https://doi.org/10.1146/annurev-clinpsy-032814-112733
  • Maji, S. (2018). Society and ‘good woman’: A critical review of gender difference in depression. International Journal of Social Psychiatry, 64(4), 396–405. https://doi.org/10.1177/0020764018765023
  • McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013). The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151(1), 313–320. https://doi.org/10.1016/j.jad.2013.06.014
  • Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6
  • Milanović, S. M., Erjavec, K., Poljičanin, T., Vrabec, B., & Brečić, P. (2015). Prevalence of depression symptoms and associated socio-demographic factors in primary health care patients. Psychiatria Danubina, 27(1), 31–37.
  • Muñoz-Navarro, R., Cano-Vindel, A., Medrano, L. A., Schmitz, F., Ruiz-Rodríguez, P., Abellán-Maeso, C., Font-Payeras, M. A., & Hermosilla-Pasamar, A. M. (2017). Utility of the PHQ–9 to identify major depressive disorder in adult patients in Spanish primary care centers. BMC Psychiatry, 17, Article 291. https://doi.org/10.1186/s12888-017-1450-8
  • Muñoz-Navarro, R., Cano-Vindel, A., Moriana, J. A., Medrano, L. A., Ruiz-Rodríguez, P., Agüero-Gento, L., Rodríguez-Enríquez, M., Pizà, M. R., & Ramírez-Manent, J. I. (2017). Screening for generalized anxiety disorder in Spanish primary care centers with the GAD–7. Psychiatry Research, 256, 312–317. https://doi.org/10.1016/j.psychres.2017.06.023
  • Muñoz-Navarro, R., Cano Vindel, A., Schmitz, F., Cabello, R., & Fernández-Berrocal, P. (2021). Emotional disorders during the COVID–19 outbreak in Spain: The role of sociodemographic risk factors and cognitive emotion regulation strategies. Health Education & Behavior, 48(4), 412–423. https://doi.org/10.1177/10901981211014101
  • Muñoz-Navarro, R., Medrano, L. A., González-Blanch, C., Carpallo-González, M., Olave, L., Iruarrizaga, I., Ruiz-Rodríguez, P., Moriana, J. A., & Cano-Vindel, A. (2021). Validity of brief scales for assessing transdiagnostic cognitive emotion regulation strategies in primary care patients with emotional disorders. European Journal of Psychological Assessment, 37(2), 86–94. https://doi.org/10.1027/1015-5759/a000584
  • National Institute for Health and Care Excellence. (2011). Common mental health problems: Identification and pathways to care (CG123). www.nice.org.uk/guidance/cg123
  • Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110. https://doi.org/10.1016/j.cpr.2015.06.002
  • Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121. https://doi.org/10.1037/0022-3514.61.1.115
  • Organisation for Economic Cooperation and Development. (2014). Making mental health count: The social and economic costs of neglecting mental health care. OECD Publishing. https://doi.org/10.1787/9789264208445-en
  • Ramsawh, H. J., & Chavira, D. A. (2016). Association of childhood anxiety disorders and quality of life in a primary care sample. Journal of Developmental & Behavioral Pediatrics, 37(4), 269–276. https://doi.org/10.1097/DBP.0000000000000296
  • Revicki, D. A., Brandenburg, N., Matza, L., Hornbrook, M. C., & Feeny, D. (2008). Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Quality of Life Research, 17(10), 1285–1294. https://doi.org/10.1007/s11136-008-9406-6
  • Rickerby, N., Krug, I., Fuller-Tyszkiewicz, M., Forte, E., Davenport, R., Chayadi, E., & Kiropoulos, L. (2022). Rumination across depression, anxiety, and eating disorders in adults: A meta-analytic review. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000110
  • Riihimäki, K., Vuorilehto, M., Jylhä, P., & Isometsä, E. (2016). Response style and severity and chronicity of depressive disorders in primary health care. European Psychiatry, 33(1), 1–8. https://doi.org/10.1016/j.eurpsy.2015.12.002
  • Rocha, N. S., Power, M. J., Bushnell, D. M., & Fleck, M. P. (2012). Cross-cultural evaluation of the WHOQOL-BREF domains in primary care depressed patients using Rasch analysis. Medical Decision Making, 32(1), 41–55. https://doi.org/10.1177/0272989X11415112
  • Rogers, A. H., Short, N. A., Robles, Z., Bakhshaie, J., Viana, A., Schmidt, N. B., Garza, M., Ochoa-Pérez, M., Lemaire, C., Bogiaizian, D., Medvedeva, A., & Zvolensky, M. J. (2018). Identifying the role of sociodemographic factors in major depressive disorder and suicidality among Spanish-speaking Latino patients in a federally qualified health center. Cognitive Behaviour Therapy, 47(5), 397–411. https://doi.org/10.1080/16506073.2018.1445123
  • Runkewitz, K., Kirchmann, H., & Strauss, B. (2006). Anxiety and depression in primary care patients: Predictors of symptom severity and developmental correlates. Journal of Psychosomatic Research, 60(5), 445–453. https://doi.org/10.1016/j.jpsychores.2005.09.003
  • Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review, 57, 141–163. https://doi.org/10.1016/j.cpr.2017.09.002
  • Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD–7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
  • Sun, X., Zhu, C., & So, S. H. W. (2017). Dysfunctional metacognition across psychopathologies: A meta-analytic review. European Psychiatry, 45, 139–153. https://doi.org/10.1016/j.eurpsy.2017.05.029
  • Tabachnick, B. G., & Fidell, L. S. (2014). Using multivariate statistics (6th Ed.). Pearson Education Limited.
  • Talavera, D. C., Paulus, D. J., Garza, M., Ochoa-Perez, M., Lemaire, C., Valdivieso, J., Bogiaizian, D., Robles, Z., Bakhshaie, J., Manning, K., Walker, R., Businelle, M., & Zvolensky, M. J. (2018). Subjective social status and rumination in relation to anxiety and depressive symptoms and psychopathology among economically disadvantaged Latinos in primary care. American Journal of Orthopsychiatry, 88(2), 169–179. https://doi.org/10.1037/ort0000223
  • Taylor, M. M., & Snyder, H. R. (2021). Repetitive negative thinking shared across rumination and worry predicts symptoms of depression and anxiety. Journal of Psychopathology and Behavioral Assessment, 43(4), 904–915. https://doi.org/10.1007/s10862-021-09898-9
  • The World Health Organization Quality of Life Group Group. (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667
  • Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.
  • Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C. J. L., & Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6
  • Yapan, S., Türkçapar, M. H., & Boysan, M. (2022). Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. Current Psychology, 41(9), 5896–5912. https://doi.org/10.1007/s12144-020-01086-4
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