Purpose The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is regarded as the most acceptable tool for measuring obsessive–compulsive disorder symptom severity. Recently, the Yale–Brown Obsessive Compulsive Scale – Second Edition (Y-BOCS-II) was developed for better measurement. The study reported here aimed to evaluate the psychometric properties of the Thai version of the Yale–Brown Obsessive Compulsive Scale – Second Edition (Y-BOCS-II-T). Patients and methods The original version of the Y-BOCS-II was translated into Thai, which involved forward translation, synthesis of the translation, and back translation. Modification and cross-cultural adaptation were completed accordingly. The developed Y-BOCS-II-T, together with the Hamilton Rating Scale for Depression, was administered to 41 patients who had a primary diagnosis of obsessive–compulsive disorder. The patients then completed the Pictorial Thai Quality of Life instrument and Patient Health Questionnaire. Lastly, the Global Assessment of Functioning (GAF) and the Clinical Global Impression – Severity Scale (CGI-S) of all patients were blindly rated by another experienced psychiatrist who was not the interviewer. Results The mean total score of the Yale–Brown Obsessive Compulsive Scale – Second Edition – Severity Scale (Y-BOCS-II-SS) and the Yale–Brown Obsessive Compulsive Scale – Second Edition – Symptom Checklist (Y-BOCS-II-SC) were 18.44 (standard deviation =10.51) and 15.85 (standard deviation =9.58), respectively. The Y-BOCS-II-T had satisfactory internal consistency (Cronbach’s alpha =0.94 for the Severity Scale, and Kuder–Richardson Formula 20 =0.90 for the Symptom Checklist). Inter-rater reliability was excellent for both the Y-BOCS-II-SS and Y-BOCS-II-SC. Factor analysis of Y-BOCS-II-SS items revealed a two-factor component associated with obsession and compulsion. The Y-BOCS-II-SS correlated highly with the CGI-S and GAF ( r =0.75 and −0.76, respectively), but the Y-BOCS-II-SC correlated moderately ( r =0.42 for CGI-S; r =−0.39 for GAF). The Y-BOCS-II-SS and Y-BOCS-II-SC slightly to moderately correlated with the Hamilton Rating Scale for Depression, Patient Health Questionnaire, and Pictorial Thai Quality of Life, which might indicate the comorbidity depression and its effect on quality of life. Conclusion The Y-BOCS-II-T is a psychometrically reliable and valid measure for the assessment of both severity and characteristics of obsessive–compulsive symptoms in Thai clinical samples.

PurposeResidual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates, and quality of life among patients with depressive disorder.Patients and methodsData were collected during the Thai Study of Affective Disorder (THAISAD) project. The Hamilton Rating Scale for Depression (HAMD) was used to measure the severity and residual symptoms of depression, and EQ-5D instrument was used to measure the quality of life. Demographic and clinical data at the baseline were described by mean ± standard deviation (SD). Prevalence of residual symptoms of depression was determined and presented as percentage. Regression analysis was utilized to predict relapse and patients’ quality of life at 6 months postbaseline.ResultsA total of 224 depressive disorder patients were recruited. Most of the patients (93.3%) had at least one residual symptom, and the most common was anxiety symptoms (76.3%; 95% confidence interval [CI], 0.71–0.82). After 3 months postbaseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (odds ratio [OR] =5.290, 95% CI, 1.42–19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ-5D scores at 6 months postbaseline (B =−2.670, 95% CI, −0.181 to −0.027 and B =−3.109, 95% CI, −0.172 to −0.038, respectively).ConclusionResidual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorder, so that prompt action can be taken to mitigate the risk of relapse.

BackgroundThe Thai Study of Affective Disorders was a tertiary hospital-based cohort study developed to identify treatment outcomes among depressed patients and the variables involved. In this study, we examined the baseline characteristics of these depressed patients.MethodsPatients were investigated at eleven psychiatric outpatient clinics at tertiary hospitals for the presence of unipolar depressive disorders, as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of any depression found was measured using the Clinical Global Impression and 17-item Hamilton Depression Rating Scale (HAMD) clinician-rated tools, with the Thai Depression Inventory (a self-rated instrument) administered alongside them. Sociodemographic and psychosocial variables were collected, and quality of life was also captured using the health-related quality of life (SF-36v2), EuroQoL (EQ-5D), and visual analog scale (EQ VAS) tools.ResultsA total of 371 outpatients suffering new or recurrent episodes were recruited. The mean age of the group was 45.7±15.9 (range 18–83) years, and 75% of the group was female. In terms of diagnosis, 88% had major depressive disorder, 12% had dysthymic disorder, and 50% had a combination of both major depressive disorder and dysthymic disorder. The mean (standard deviation) scores for the HAMD, Clinical Global Impression, and Thai Depression Inventory were 24.2±6.4, 4.47±1.1, and 51.51±0.2, respectively. Sixty-two percent had suicidal tendencies, while 11% had a family history of depression. Of the major depressive disorder cases, 61% had experienced a first episode. The SF-36v2 component scores ranged from 25 to 56, while the mean (standard deviation) of the EQ-5D was 0.50±0.22 and that of the EQ VAS was 53.79±21.3.ConclusionThis study provides an overview of the sociodemographic and psychosocial characteristics of patients with new or recurrent episodes of unipolar depressive disorders.

PurposeWhether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found.Patients and methodsThis was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months.ResultsAmong the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet’s AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD.ConclusionThe level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances.

This study aimed to examine the reliability and validity of the Thai version of the FOCI (FOCI-T), which is a brief self-report questionnaire to assess the symptoms and severity of obsessive-compulsive disorder (OCD). Forty-seven OCD patients completed the FOCI-T, the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL). They were then interviewed to determine the OCD symptom severity by the Yale-Brown Obsessive-Compulsive Scale-Second Edition (YBOCS-II) and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D), together with the Global Assessment of Functioning (GAF) and the Clinical Global Impression-Severity Scales (CGI-S). The result showed that the FOCI-T had satisfactory internal consistency reliability on both the Symptom Checklist (KR-20 = 0.86) and the Severity Scale (α = 0.92). Regarding validity analyses, the FOCI-T Severity Scale had stronger correlations with the YBOCS-II and CGI-S than the FOCI-T Symptom Checklist. This implied the independence between the FOCI-T Symptom Checklist and the Severity Scale and good concurrent validity of the FOCI-T Severity Scale. Our results suggested that the FOCI-T was found to be a reliable and valid self-report measure to assess obsessive-compulsive symptoms and severity.

PurposeDespite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders.Participants and methodsAn analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36), the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed.ResultsPerceived stress, self-sacrificing interpersonal style, and cognitive function were found to significantly mediate the relationship between depression and pain, while controlling for demographic variables. The total effect of depression on pain was significant. This model, with an additional three mediators, accounted for 15% of the explained variance in pain compared to 9% without mediators. For the alternative model, after controlling for the mediators, a nonsignificant total direct effect level of self-sacrificing was found, suggesting that the effect of self-sacrificing on pain was based only on an indirect effect and that perceived stress was found to be the strongest mediator.ConclusionSerial mediation may help us to see how depression and pain are linked and what the fundamental mediators are in the chain. No significant, indirect effect of self-sacrificing on pain was observed, if perceived stress was not part of the depression and/or cognitive function mediational chain. The results shown here have implications for future research, both in terms of testing the model and in clinical application.

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PurposeThe self-report version of the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) has been developed to overcome the limitations of the clinician-administered version, which needs to be executed by trained personnel and is time consuming. The second edition of the Y-BOCS (Y-BOCS-II) was developed to address some limitations of the original version. However, there is no self-report version of the Y-BOCS-II at the moment. This study aimed to evaluate the psychometric properties of the developed Thai self-report version of the Yale–Brown Obsessive–Compulsive Scale-Second Edition (Y-BOCS-II-SR-T).Patients and methodsY-BOCS-II-SR-T was developed from the Thai version of the Yale–Brown Obsessive–Compulsive Scale-Second Edition (Y-BOCS-II-T). The Y-BOCS-II-SR-T, the Y-BOCS-II-T, the Thai version of the Florida Obsessive–Compulsive Inventory (FOCI-T), the Hamilton Rating Scale for Depression (HAM-D), the nine-item Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL) instrument were administered to 52 obsessive–compulsive disorder (OCD) patients. Internal consistency for the Y-BOCS-II-SR-T was calculated with Cronbach’s alpha coefficient (α), and the factor analyses were completed. Pearson’s correlation was used in determining convergent and divergent validity among the other measures.ResultsThe mean score of the Y-BOCS-II-SR-T total score was 20.71±11.16. The internal consistencies of the Y-BOCS-II-SR-T total scores, the obsession subscale, and the compulsion subscale scores were excellent (α=0.94, α=0.90, and α=0.89, respectively). The correlation between each item and the Y-BOCS-II-SR-T total score showed strong correlation for all items. Confirmatory factor analysis with model modification showed adequate fit for obsession and compulsion factor models. The Y-BOCS-II-SR-T had strong correlation with the YBOCS-II-T and the FOCI-T (rs>0.90) and weaker correlation with the HAM-D, PHQ-9, and PTQL (rs<0.60), which implied good convergent and divergent validity.ConclusionThe Y-BOCS-II-SR-T is a psychometrically sound and valid measure for assessing obsessive–compulsive symptoms.