AACVPR News & Views - May/June 2017 - 9

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of these screeners detect changes
in symptom severity in depressive
symptoms, which is essential
when evaluating the effects of PR
on depressive symptoms. The
questionnaires that are not included
in the updated guide include
the Center for Epidemiologic
Studies Depression (CESD)
Scale, Center for Epidemiologic
Studies Depression Scale Revised
(CESD-R), the 15- and 30-item
versions of the Geriatric Depression
Scale (GDS). The CESD scales
were excluded from the updated
guide because these measures are
epidemiological tools, which have
been used primarily in research
settings to screen for depression at
a population level. The scales are
not designed to examine clinical
changes over time on an individual
level. Thus, programs using the
CESD and CESD-R would be
limited in their ability to detect
changes in symptom severity as a
function of PR in their pulmonary
patients. The two versions of the
GDS were excluded from the
updated guide because this tool is
only appropriate for patients over
the age of 55. Thus, programs
would need to have a second tool
available to evaluate depressive
symptoms in their younger patients.
Given the documentation and
evaluation requirements across
multiple areas of assessment, the
GDS was removed in an effort to
reduce the administrative tasks
of PR staff.
It is imperative for PR programs
to demonstrate the effectiveness
of this intensive, empirically
supported multi-disciplinary model

of patient care. Thus, it is essential
for PR programs to administer
tools that are responsive to
change. Lastly, it is critical
that patients are provided with
appropriate psychological and/or
psychiatric treatment referrals for
follow up should they screen in the
mild or greater range of symptom
severity. Programs must have an
emergency plan in place in order
to immediately respond to patient
endorsement of suicidal ideation in
order to ensure patient safety. 
References

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News&Views MAY/JUNE 2017 9

Table of Contents for the Digital Edition of AACVPR News & Views - May/June 2017