Washington Group/Budapest Initiative Questions for Measuring Depression and Anxiety

Transcription

1 Washington Group/Budapest Initiative Questions for Measuring Depression and Anxiety Jennifer Madans, Ph.D. U.S. National Center for Health Statistics Steering Committees Chairperson, Washington Group on Disability Statistics and Budapest Initiative Meeting of OECD Health Data National Correspondents Paris, France 3-4 October 2011

2 Background Purpose of the Washington Group (WG) and Budapest Initiative (BI) To develop question sets to be used as components of population surveys, as supplements to surveys, or as the core of a disability/health survey WG first developed a short question set: vision, hearing, cognition, mobility, self care, and communication Extended sets now being developed, including: affect (anxiety and depression)

3 Approach Interest in functioning without accommodation, not symptoms or medical diagnoses Preference for consistent question formats within domains and across domains if possible. Emphasis on parsimony. Multiple rounds of cognitive testing conducted in multiple countries across many regions. Early cognitive tests showed that a single question (similar in design to the short set questions) was not an option for anxiety and depression. Cognitive interviews demonstrated consistency in how the core concepts were interpreted.

4 Approach Two key dimensions identified: frequency and intensity Information from the cognitive interviews was used to develop probe questions for use in field tests. Target questions, along with the probes, were included in field tests in multiple countries. Analyses of field test data provide evidence of how questions work.

5 Final Rounds of Standardized Testing WG/BI/UNESCAP Testing 2009 Cognitive tests in 9 countries (Mongolia, Maldives, Sri Lanka, Philippines, Cambodia, Kazakhstan, United States, Canada, South Africa) Field tests in 6 countries (Mongolia, Maldives, Sri Lanka, Philippines, Cambodia, Kazakhstan) WG/BI European Testing 2010 Cognitive tests in 7 countries (France, Germany, Italy, Portugal, Spain, Switzerland, United States) Question added to the 2010 U.S. National Health Interview Survey

6 Question Evaluation: Cognitive Interviewing Illustrates what the question captures. Allows for refinement of the construct. Data analysis provides understanding to improve the question.

7 Question Evaluation: Cognitive Interviewing Q-Notes: On-line data entry and analysis tool of qualitative interviews (in-depth analysis of narratives) Allows for continuous oversight Facilitates quick but thorough analysis Designed around analysis principles.

8 Depression Measures 1. How often do you feel depressed? Daily, Weekly, Monthly, A few times a year, Never 2. Do you take medication for these feelings? Yes, No 3. Thinking about the last time that you felt depressed, how depressed did you feel? A little, A lot, Somewhere in between a little and a lot

9 Table 1. ESCAP Distribution of Depression Frequency Percent Never 61.2 A few times a year 21.8 Monthly 6.9 Weekly 5.6 Daily 4.2 DK/REF 0.3 TOTAL (N) 6309

10 Table 2. ESCAP Distribution of Depression Intensity Percent of Total Percent of not nevers Not asked (never 61.2 to frequency) A little Closer to a little In between Closer to a lot A lot DK/REF TOTAL (N) 6309

11 Table 3. ESCAP Joint Distribution of Depression Frequency and Intensity Never A few Monthly Weekly Daily times a year Not asked A little Closer to a little In between Closer to a lot A lot Total N=6286

12 Probe Analysis: Depression 1. My feelings are caused by the death of a loved one. 2. Sometimes the feelings can be so intense that I cannot get out of bed. 3. The feelings sometimes interfere with my life, and I wish I did not have them. 4. If I had more money or a better job, I would not have these feelings. 5. Everybody has these feelings; they are part of life and normal. 6. I have been told by a medical professional that I have depression.

13 ESCAP results (Depression): Significant relationships with respondent location based on bivariate logistic regression models in each cell (models run for cases NOT taking medication). N=2208 A little Intensity Frequency A few times a year Monthly Weekly Daily Death** Clinical*** Intense** Death** Intense*** Intense** Interfere*** Economic** Clinical*** Closer to a little Interfere** In between Limited** Death** Economic** Closer to a lot A lot Economic*** Death*** Interfere** Interfere** Economic** Limited** Intense*** Interfere*** Clinical*** Interfere*** Intense** Death** Intense*** Interfere*** Clinical*** Note. Negative associations shown in red text. Positive associations shown in black text. **p<.05,*** p<.005 Interfere** Limited** Intense*** Interfere*** Clinical***

14 Depression Severity How often do you feel depressed? Thinking about the last time you felt depressed, how depressed did you feel? A few times a year Monthly Weekly Daily Total A little In between A lot Total

15 Anxiety Measures 1. How often do you feel worried, nervous or anxious? Daily, Weekly, Monthly, A few times a year, Never 2. Do you take medication for these feelings? Yes, No 3. Thinking about the last time that you felt worried, nervous or anxious, how would you describe the level of these feelings? A little, A lot, Somewhere in between a little and a lot

16 Table 1. ESCAP Distribution of Anxiety Frequency Percent Never 47.3 A few times a year 23.0 Monthly 10.1 Weekly 9.7 Daily 9.3 DK/REF 0.6 TOTAL (N) 6309

17 Table 2. ESCAP Distribution of Anxiety Intensity Percent of total Percent of not nevers Not asked (never 47.4 to frequency) A little Closer to a little In between Closer to a lot A lot DK/REF 0.8 TOTAL (N) 6309

18 Table 3. ESCAP Joint Distribution of Depression Frequency and Intensity Never A few Monthly Weekly Daily times a year Not asked A little Closer to a little In between Closer to a lot A lot Total N=6273

19 Probe Analysis: Anxiety 1. My feelings are caused by the type and amount of work I do. 2. Sometimes the feelings can be so intense that my chest hurts and I have trouble breathing. 3. These are positive feelings that help me to accomplish goals and be productive. 4. The feelings sometimes interfere with my life, and I wish that I did not have them. 5. If I had more money or a better job, I would not have these feelings. (economic) 6. Everybody has these feelings; they are a part of life and are normal. 7. I have been told by a medical professional that I have anxiety. (clinical)

20 ESCAP results (Anxiety): Significant relationships with respondent location based on bivariate logistic regression models in each cell (Models run for cases NOT taking medication). A little Intensity Frequency A few times a year Monthly Weekly Daily Work*** Clinical** Chest hurts*** Normal*** Chest hurts*** Interfere*** Interfere*** Interfere*** Work*** Work*** Limited** Economic*** Economic** Clinical*** Closer to a little In between Normal** Positive** Work*** Limited** Economic** Chest hurts*** Closer to a lot Interfere** Interfere** Economic*** A lot Work*** Economic** Normal** Chest hurts*** Interfere** Clinical*** Positive** Chest hurts*** Interfere** Clinical*** Chest hurts*** Interfere*** Clinical*** Note. Negative associations shown in red text. Positive associations shown in black text. **p<.05,*** p<.005 Interfere*** Economic** Chest hurts** Limited** Positive*** Chest hurts*** Interfere*** Clinical***

21 Anxiety Severity How often do you feel worried, nervous or anxious? Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings? A few times a year Monthly Weekly Daily Total A little In between A lot Total

22 Conclusions WG/BI questions underwent extensive cognitive and field testing in multiple cultures and languages Test results support that the questions are interpreted comparably and interpretations are consistent with the intent of the question Questions are parsimonious Questions are not diagnosis based Questions can be used to create a continuum of functioning in the affect domain