But this variable is itself a computational part of their "dependent" variable (change score), and, hence, is not an "independent" variable after all. They derived their primary outcome measure as "the mean change in depressive symptoms from baseline to the quarterly assessments during internship (change in PHQ-9 score = mean PHQ-9 depressive symptoms at 3-, 6-, 9- and 12-month assessments - PHQ-9 depressive symptoms at baseline)."(1), (p.E3) We have a number of issues with adopting this measure as the main outcome variable.įirst, in their analysis, the authors have used "baseline depressive symptoms (PHQ-9 baseline score)" as an independent variable. They used the depression module of 9-item Patient Health Questionnaire (PHQ-9)(2) to score self- reported depressive symptoms at baseline, and at 3-, 6-, 9- and 12-months of internship. The first comment concerns the primary outcome measure adopted by the authors: change in depressive symptoms from baseline to internship, rather than a diagnostic threshold of depression per se. Given the substantive importance of this work, both for providing a heuristic model and for generating significant data, we would like to comment upon two areas which, we believe, merit some discussion to enhance the interpretation, meaningfulness and impact of this work. They have demonstrated the relationship between certain personality traits, pre-internship and within-internship factors, stressful life events, genetic polymorphisms of the serotonin transporter gene and development of depressive symptoms. Srijan Sen and colleagues(1) have shown that the internship year can be a major stressor for medical students and that it can be used as a predictable stress model to prospectively study depression and various biopsychosocial factors associated with it. Shared Decision Making and Communication. Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.
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