Occupational Medicine 2016;66:421–422
LETTERS TO THE EDITOR doi:10.1093/occmed/kqw034
Psychosocial work stressors and depressive symptoms in bank employees Dear Sir, Valente et al. investigated the association between exposure to psychosocial work stressors and depressive symptoms in bank employees [1]. The authors used the Patient Health Questionnaire-9 (PHQ-9), and two levels of depressive symptoms: major depressive symptoms (MDS) and other forms of depressive symptoms (ODS) were specified. A logistic regression model was used to estimate associations between the level of depressive symptoms and scores from the two job stress models (Demand-Control-Support and Effort-Reward Imbalance). I have a query on their study. The authors analysed 1046 participants from 2806 eligible subjects (37%) and concluded that psychosocial conditions in bank employees with high strain, low social support at work, high effort with low reward and over-commitment represented possible risk factors for MDS and/or ODS. They adopted PHQ-9 as a screening tool for depression according to Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Allgaier et al. reported the screening ability of PHQ-9 by two procedures—the ‘categorical scoring procedure’ and the ‘dimensional scoring procedure’ by using cutoff values—and concluded that there was an advantage to using the ‘dimensional scoring procedure’ for PHQ-9 screening for clinical depression in children [2]. Recent reports also specified the advantage of ‘dimensional scoring procedure’ by setting the cut-off value of 10 [3,4]. I previously reported the relationship between overtime work and depression by using the PHQ-9 [5], and I found that half the number of subjects with two to four of nine depressive symptom criteria were not categorized as subjects with ODS, because they lacked depressed mood and/or anhedonia. Valente et al. adopted a ‘categorical scoring procedure’, and the screening procedure should be taken into account for their study outcome. Relating to the first query, the discrepancy of odds ratios of effort-reward imbalance for ODS and MDS should be considered precisely. Although the authors speculated the interaction between psychosocial factors and other work-related variables, there is space for making a final conclusion. The authors described in the footnote of Tables 2 and 3 that they adopted multivariate multinomial logistic regression model and this model handles two or more dependent variables. I suppose that the statistical model would clarify the
U-shaped relationship between three levels of depressive symptom and psychosocial factors. Anyway, I recommend the authors specify the non-linear relationship between depressive symptoms by PHQ-9 and psychosocial factors. Tomoyuki Kawada Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan e-mail: [email protected]
References 1. Valente MS, Menezes PR, Pastor-Valero M, Lopes CS. Depressive symptoms and psychosocial aspects of work in bank employees. Occup Med (Lond) 2016;66:54–61. 2. Allgaier AK, Pietsch K, Frühe B, Sigl-Glöckner J, SchulteKörne G. Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care. Depress Anxiety 2012;29:906–913. 3. Gelaye B,Williams MA, Lemma S et al.Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res 2013;210:653–661. 4. Manea L, Gilbody S, McMillan D. A diagnostic meta analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 2015;37:67–75. 5. Kawada T. Overtime working hours and depression: questionnaire survey using the Patient Health Questionnaire (PHQ-9). Chronobiol Int 2011;28:474–475.
doi:10.1093/occmed/kqw058
Re: Response to ‘Depressive symptoms and psychosocial aspects of work in bank employees’ Dear Sir, We thank Prof. Kawada for his comments on our study. His first concern was about the use of the 9-item Patient Health Questionnaire (PHQ-9) algorithm to define major depression and other depression. According to Kroenke et al. [1], the PHQ-9 is a brief self-report questionnaire corresponding to the depression module of the Primary Care Evaluation of Mental Disorders (PRIME-MD) diagnostic instrument, used in clinical and research settings. For each PHQ-9 item, there are four response options, from 0 (never) to 3 (almost
© The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]
LETTERS TO THE EDITOR doi:10.1093/occmed/kqw034
Psychosocial work stressors and depressive symptoms in bank employees Dear Sir, Valente et al. investigated the association between exposure to psychosocial work stressors and depressive symptoms in bank employees [1]. The authors used the Patient Health Questionnaire-9 (PHQ-9), and two levels of depressive symptoms: major depressive symptoms (MDS) and other forms of depressive symptoms (ODS) were specified. A logistic regression model was used to estimate associations between the level of depressive symptoms and scores from the two job stress models (Demand-Control-Support and Effort-Reward Imbalance). I have a query on their study. The authors analysed 1046 participants from 2806 eligible subjects (37%) and concluded that psychosocial conditions in bank employees with high strain, low social support at work, high effort with low reward and over-commitment represented possible risk factors for MDS and/or ODS. They adopted PHQ-9 as a screening tool for depression according to Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Allgaier et al. reported the screening ability of PHQ-9 by two procedures—the ‘categorical scoring procedure’ and the ‘dimensional scoring procedure’ by using cutoff values—and concluded that there was an advantage to using the ‘dimensional scoring procedure’ for PHQ-9 screening for clinical depression in children [2]. Recent reports also specified the advantage of ‘dimensional scoring procedure’ by setting the cut-off value of 10 [3,4]. I previously reported the relationship between overtime work and depression by using the PHQ-9 [5], and I found that half the number of subjects with two to four of nine depressive symptom criteria were not categorized as subjects with ODS, because they lacked depressed mood and/or anhedonia. Valente et al. adopted a ‘categorical scoring procedure’, and the screening procedure should be taken into account for their study outcome. Relating to the first query, the discrepancy of odds ratios of effort-reward imbalance for ODS and MDS should be considered precisely. Although the authors speculated the interaction between psychosocial factors and other work-related variables, there is space for making a final conclusion. The authors described in the footnote of Tables 2 and 3 that they adopted multivariate multinomial logistic regression model and this model handles two or more dependent variables. I suppose that the statistical model would clarify the
U-shaped relationship between three levels of depressive symptom and psychosocial factors. Anyway, I recommend the authors specify the non-linear relationship between depressive symptoms by PHQ-9 and psychosocial factors. Tomoyuki Kawada Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan e-mail: [email protected]
References 1. Valente MS, Menezes PR, Pastor-Valero M, Lopes CS. Depressive symptoms and psychosocial aspects of work in bank employees. Occup Med (Lond) 2016;66:54–61. 2. Allgaier AK, Pietsch K, Frühe B, Sigl-Glöckner J, SchulteKörne G. Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care. Depress Anxiety 2012;29:906–913. 3. Gelaye B,Williams MA, Lemma S et al.Validity of the Patient Health Questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res 2013;210:653–661. 4. Manea L, Gilbody S, McMillan D. A diagnostic meta analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 2015;37:67–75. 5. Kawada T. Overtime working hours and depression: questionnaire survey using the Patient Health Questionnaire (PHQ-9). Chronobiol Int 2011;28:474–475.
doi:10.1093/occmed/kqw058
Re: Response to ‘Depressive symptoms and psychosocial aspects of work in bank employees’ Dear Sir, We thank Prof. Kawada for his comments on our study. His first concern was about the use of the 9-item Patient Health Questionnaire (PHQ-9) algorithm to define major depression and other depression. According to Kroenke et al. [1], the PHQ-9 is a brief self-report questionnaire corresponding to the depression module of the Primary Care Evaluation of Mental Disorders (PRIME-MD) diagnostic instrument, used in clinical and research settings. For each PHQ-9 item, there are four response options, from 0 (never) to 3 (almost
© The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]
