Center For Psychology

The Patient Health Questionnaire-9 (PHQ-9) is a brief tool to assess the presence and severity of depressive symptoms. This study aimed to validate and calibrate the PHQ-9 to determine appropriate cut-off points for different degrees of severity of depression in Argentina.

We conducted a cross-sectional study on an intentional sample of adult ambulatory care patients with different degrees of severity of depression. All patients who completed the PHQ-9 were further interviewed by a trained clinician with the Mini International Neuropsychiatric Interview (MINI) and the Beck Depression Inventory-II (BDI-II). Reliability and validity tests, including receiver operating curve analysis, were performed.

One hundred sixty-nine patients were recruited with a mean age of 47.4 years (SD = 14.8), of whom 102 were females (60.4%). The local PHQ-9 had high internal consistency (Cronbach’s alpha = 0.87) and satisfactory convergent validity with the BDI-II scale [Pearson’s correlation = 0.88 (p < 0.01)]. For the diagnosis of Major Depressive Episode (MDE) according to the MINI, a PHQ-9 ≥ 8 was the optimal cut-off point found (sensitivity 88.2%, specificity 86.6%, PPV 90.91%). The local version of PHQ-9 showed good ability to discriminate among depression severity categories according to the BDI-II scale. The best cut off points were 6–8 for mild cases, 9–14 for moderate and 15 or more for severe depressive symptoms respectively.

The Argentine version of the PHQ-9 questionnaire has shown acceptable validity and reliability for both screening and severity assessment of depressive symptoms.

The Assimilation model argues that therapists should work responsively within the client's therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES).

Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not.

As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client's TZPD. However, Julia's therapist used a balance of supporting and challenging interventions, whereas Afonso's therapist used mainly supporting interventions. Setbacks were common in both cases.

This study supports the theoretical expectation that EFT therapists work mainly within their client's TZPD. Therapeutic exchanges involving challenging interventions may foster client change if they occur in an overall climate of safety.

In neurodegenerative disorders such as dementia of the Alzheimer's type the person gradually loses skills and aspects of everyday living. Does that indicate that he/ she lose the self? In the past it was widely accepted that the self diminishes in dementia, until it is lost in the latest stage, yet in the recent years this premise has been challenged. Accepting that the self is "lost" can be problematic theoretically in the approach of self-hood, and practically in the care of individuals. Currently a novel perspective is "gaining ground" supporting the existence of the self in dementia, and the importance of enhancing the self-hood, in order to improve the life of the person. A case study is presented where the self emerged along with a need to target it in order to improve the life of the person. A man with Alzheimer's disease was expressing rapid cognitive decline, along with emotional agitation and behavioral disturbances, and began having sessions. An intervention was structured that used all art modalities as a stimulus, and focused on the existing skills, on the narrative of the person, and on self- qualities, in order to improve life quality. It was composed of activities, each of which had a cognitive, an emotional, a behavioral and a somatosensory aspect, all of which were linked to the self in the past, present and future. The intervention appeared to be efficient in delaying the progression of the disorder (as much as possible), in stabilizing the emotional state of the person and in harmonizing the behavior. All the above were made apparent through regular assessments with a Mini Mental State Examination (MMSE), a Geriatric Depression Scale (GDS), and through quantitative and qualitative measures regarding the self, and life quality. More research is required to be able to generalize the results, yet a focus on the self and all its aspects appears to be efficient in the psycho-social treatment of Alzheimer's, and manages to improve life quality.