Факторная структура шестипунктовой шкалы дистресса Кесслера и ее корреляция со шкалой HADS у пациентов с непсихотическими психическими расстройствами

BackgroundDepressive and anxiety disorders often go unrecognized in distressed primary care patients, despite the overtly psychosocial nature of their demand for help. This is especially problematic in more severe disorders needing specific treatment (e.g. antidepressant pharmacotherapy or specialized cognitive behavioural therapy). The use of a screening tool to detect (more severe) depressive and anxiety disorders may be useful not to overlook such disorders. We examined the accuracy with which the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS) are able to detect (more severe) depressive and anxiety disorders in distressed patients, and which cut-off points should be used.MethodsSeventy general practitioners (GPs) included 295 patients on sick leave due to psychological problems. They excluded patients with recognized depressive or anxiety disorders. Patients completed the 4DSQ and HADS. Standardized diagnoses of DSM-IV defined depressive and anxiety disorders were established with the Composite International Diagnostic Interview (CIDI). Receiver Operating Characteristic (ROC) analyses were performed to obtain sensitivity and specificity values for a range of scores, and area under the curve (AUC) values as a measure of diagnostic accuracy.ResultsWith respect to the detection of any depressive or anxiety disorder (180 patients, 61%), the 4DSQ and HADS scales yielded comparable results with AUC values between 0.745 and 0.815. Also with respect to the detection of moderate or severe depressive disorder, the 4DSQ and HADS depression scales performed comparably (AUC 0.780 and 0.739, p 0.165). With respect to the detection of panic disorder, agoraphobia and social phobia, the 4DSQ anxiety scale performed significantly better than the HADS anxiety scale (AUC 0.852 versus 0.757, p 0.001). The recommended cut-off points of both HADS scales appeared to be too low while those of the 4DSQ anxiety scale appeared to be too high.ConclusionIn general practice patients on sick leave because of psychological problems, the 4DSQ and the HADS are equally able to detect depressive and anxiety disorders. However, for the detection of cases severe enough to warrant specific treatment, the 4DSQ may have some advantages over the HADS, specifically for the detection of panic disorder, agoraphobia and social phobia.

To evaluate the impact of counseling and preoperative education on reducing anxiety in patients undergoing surgery for gynecologic cancer. In this randomized clinical trial, patients with gynecological tumors undergoing surgical treatment between 15 and 60 days preoperatively, were included. The group was randomized to receive preoperative routine orientation plus preoperative counseling and education by nursing (experimental group [EG]) or receive preoperative routine orientation only (control group [CG]). We stratified the groups by surgical approach: open, laparoscopy, and robotic. We excluded patients treated in another service and with the need for an intensive care unit after surgery. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate symptoms of anxiety and depression. The severity of symptoms was evaluated using the Edmonton Symptom Assessment System (ESAS-Br). We analyzed 54 women (CG 27, EG 27). No significant differences were observed regarding ESAS scores (total, physical, emotional, well-being, and anxiety) between preoperative and postoperative evaluation. However, in the EG, comparing the preoperative versus postoperative moments, there was a significant reduction in total, emotional, and anxiety scores of ESAS (p = 0.012; p = 0.003; p = 0.001). No difference in anxiety symptoms by HADS scale was noted between the two groups, comparing preoperative and postoperative moments, CG (40.7% and 22.2%) and EG (37.0% and 25.9%) (p = 0.78; p = 0.75), respectively. Also, in depression symptoms (HADS scale), we found no difference comparing preoperative and postoperative moments (p = 0.34; p > 0.99). When we stratified by surgical approach or time between intervention and surgery ( ≤ 15, > 15 to ≤ 30, and > 30 days), no difference was observed in the anxiety and depression symptoms evaluation, in both groups. The preoperative education by nurse orientation reduced the total, emotional, and anxiety symptoms of ESAS score between preoperative and postoperative moments. However, by the HADS scale, there was no difference in anxiety and depression symptoms.

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease. A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale). Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant. Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia. Frøjd LA, Papageorgiou C, Munkhaugen J, etal. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.

Globally, cardiovascular diseases (CVDs) are the major leading cause of death. Medical literature shows an association between CVDs and depressive symptoms, anxiety, low social support, and optimism. Also, cardiac surgery, even if the progress in extracorporeal circulation (ECC) ensures the patient's recovery “ad integrum”, can provoke strong emotional processes, including states of anxiety and fear, leading to true depression disorders. The aim of this study is to identify the degree of anxiety and depression detected by means of the validated Hospital Anxiety and Depression Scale (HADS) following cardiac surgery with ECC. This is a single-center, cross-sectional, observational study that was conducted from 26/04/2023 to 23/10/2024. It involved patients who had undergone ECC for several reasons (coronary bypass, valve replacement, aortic root and arch replacement, trans-apical transcatheter aortic valve implantation) at Marche’s Polytechnic University Hospital, who were subsequently admitted to the Rehabilitation Cardiology Unit of the “Madonna del Soccorso” Hospital in San Benedetto del Tronto. The study procedure involved the administration of the HADS questionnaire by a registered psychologist. We enrolled 100 patients with an average age of 71±4 years, predominantly male (64%) rather than female (35%). The results show that at the first administration of the HADS scale questionnaire (T0), the overall mean score is 14.54±5.86. In detail, the first subscale relating to anxiety reveals a mean value of 7.18±3.54, while the second subscale relating to depression shows a mean value of 7.36±3.09. At the second administration of the HADS scale questionnaire (T1), after a medium time interval of 22 days, the overall mean score is 4.09±4.11. In detail, the first subscale relating to anxiety reveals a mean value of 2.03±2.25, while the second subscale relating to depression shows a mean value of 2.87±2.39. A two-tailed test (t-test) was performed and showed a significant reduction of HADS values between the first (T0) and the second (T1) questionnaire administration [p&lt;0.05 (df=99) (t-stat=25)]. The study shows a significant reduction of anxiety and depressive status in patients who underwent ECC and were subsequently admitted to a short-term psycho-educational intervention by a registered psychologist included in a multi-professional team of a Rehabilitation Cardiology Unit.

Assessment of vision-related quality of life and depression and anxiety rates in patients with neovascular age-related macular degeneration.

Evaluación de la calidad de vida y la presencia de síntomas de depresión y ansiedad en pacientes con degeneración macular asociada a la edad neovascular

Hospital Anxiety and Depression Scale (HADS): Validation in Mexican patients with inflammatory bowel disease

Introduction: Psycho-Oncology as a subspecialty, which studies cancer patients and their physical, emotional, and psychological suffering. Such a state of anguish, when impactful, can lead to the development of mental disorders, such as anxiety and depression. Thus, with negative interference in daily life and worsening of quality of life, there may be difficulty in adhering to treatment, worsening the prognosis and survival of the patient. Objective: To analyze common mental disorders in cancer patients using the HADS scale. Methodology: The study consists of an integrative review of the scientific literature. The guiding question of the research determined by the PICO method was "What are the findings of the assessment of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS) in patients undergoing cancer treatment?". Articles were searched in the following databases: LILACS, SciELO, PUBMED, Science Direct and CAPES Journals. The Health Sciences Descriptors used were: depression, anxiety, psycho-oncology, oncology and neoplasia. The included studies were full texts in English, Portuguese or Spanish, published between 2012 and October 2022. The use of the Hospital Scale for Anxiety and Depression (HADS) was used as a selection criterion. The data surveys were carried out in October and November 2022. The keywords were combined and the data found were read at the title level and, consequently, abstract. The articles selected by two independent evaluators were read in full and evaluated. In the end, the corpus consisted of 22 articles. Results and Discussion: The results of the review were subdivided into: symptoms of anxiety and depression, patients' perception of care, and the sociodemographic profile of cancer patients with psychiatric disorders. There is a higher prevalence of anxiety and depression in female cancer patients when compared to the general population. Anxiety symptoms were more prevalent in the immediate aftermath of diagnosis, and lower levels of anxiety were found throughout the course of the course and treatment. In addition, the need for a multidisciplinary approach and early application of Palliative Care is emphasized, in order to alleviate the suffering of those involved, corroborating the improvement of mental health. Conclusion: Psychiatric anxiety and depression disorders in patients undergoing cancer treatment are relevant pathologies to be researched due to their impact on cancer treatment adherence. Thus, the importance of a comprehensive approach to the patient, whether in the physical or emotional aspects through multidisciplinary follow-up, is noted, enabling greater well-being for the patient, resulting in the best treatment according to the need. Thus, we emphasize the need for further research on the subject, in order to update the findings according to the presence of new articles.

Depression and anxiety are common complaints in patients with multiple sclerosis (MS). The study objective was to investigate the factor structure, internal consistency, and correlates of the Croatian version of the Hospital Anxiety and Depression scale (HADS) in patients with MS. A total of 179 patients with MS and 999 controls were included in the online survey. All subjects completed the HADS and self-administered questionnaires capturing information of demographic, education level, disease-related variables, and the Multiple Sclerosis Impact Scale-29 (MSIS-29). Psychometric properties were examined by estimating the validity, reliability, and factor structure of the HADS scale in patients with MS. The two HADS subscales (anxiety and depression) had excellent internal consistencies (Cronbach’s α value .82 to .83), and factor analysis confirmed a two-factor structure. The convergent validity of the HADS subscales appeared to be good due to the significant correlations between HADS and MSIS-29. ROC analysis indicates that the HADS subscales have a significant diagnostic validity for group differentiation. Hierarchical regression analysis using MSIS-29 subscales as criterion variables showed consistent evidence for the incremental validity of the HADS scale. The HADS is a reliable and valid self-assessment scale in patients with MS and is suggested to be used in clinical monitoring of the psychiatric and psychological status of patients with MS.

Methodological artifacts in dimensionality assessment of the Hospital Anxiety and Depression Scale (HADS)

BackgroundThe hospital anxiety and depression scale (HADS) is a widely used instrument for evaluating psychological distress from anxiety and depression. HADS has not yet been validated in Ethiopia. The aim of this study was to evaluate the reliability and validity of the Amharic (Ethiopian language) version of HADs among HIV infected patients.MethodsThe translated scale was administered to 302 HIV/AIDS patients on follow up for and taking anti-retroviral treatment. Consistency assessment was conducted using Cronbach's alpha, test-retest reliability using intra-class correlation coefficients (ICC). Construct validity was examined using principal components analysis (PCA). Parallel analysis, Kaiser's criterion and the scree test were used for factor extraction.ResultsThe internal consistency was 0.78 for the anxiety, 0.76 for depression subscales and 0.87 for the full scale of HADS. The intra-class correlation coefficient (ICC) was 80%, 86%, and 84% for the anxiety and depression subscales, and total score respectively. PCA revealed a one dimensional scale.ConclusionThis preliminary validation study of the Ethiopian version of the HADs indicates that it has promising acceptability, reliability and validity. The adopted scale has a single underlying dimension as indicated by Razavi's model. The HADS can be used to examine psychological distress in HIV infected patients. Findings are discussed and recommendations made.

The fertility quality of life (FertiQoL) measure specifically evaluates the impact of fertility problems in various life areas. The aim of this study was to examine the relationship between FertiQoL and the hospital anxiety and depression scale (HADS) in the Turkish population. All female patients who underwent various fertility treatments in our infertility clinic from May 2011 to May 2014 were approached to participate in the study and 389 completed the questionnaires. Our results showed that the four core scales of the FertiQoL measure had a Cronbach’s α value that was between 0.70 and 0.89. Two scales (anxiety and depression) of HADS both had a Cronbach’s α value of 0.80. These values present a reliable usage of FertiQoL and HADS measures (α > 0.60). Significant negative correlations were found between the FertiQoL scales and HADS scales, ranging from −0.27 (between relational scale of FertiQoL and anxiety scale of HADS) to −0.65 (between mind–body scale of FertiQoL and depression scale of HADS). The results of this study provide supportive data to confirm that the Turkish version of FertiQol can accurately evaluate QoL in women who seek fertility treatment in Turkey.

Proposal for Improvement of the Hospital Anxiety and Depression Scale for the Assessment of Emotional Distress in Patients With Chronic Musculoskeletal Pain: A Bifactor and Item Response Theory Analysis

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Revisiting the dimensionality of the Hospital Anxiety and Depression Scale in an international sample of patients with ischaemic heart disease