Anxiety and Depression Among Hepatitis B Inpatients in Shenzhen, China: A Cross-Sectional Study

Background:WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. Ankylosing Spondylitis Disease Activity Score (ASDAS) and Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate AS patients’ disease activity and mental health. All those assessments were mainly performed by health professionals (HCPs) with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-assessments on ASDAS and HADS by mobile terminals.Objectives:To estimate the prevalence of anxiety and depression in Chinese patients with AS and to analyze the potential association between disease activity and mental health.Methods:Under the guidance and training by HCPs, AS patients downloaded SSDM and performed self-assessments bundle of ASDAS and HADS with SSDM. ASDAS<=1.3, 1.3-2.1, 2.1-3.5 and >3.5 are defined as inactive (IDA), moderate (MDA), high (HDA) and very high (VHDA) disease activity, respectively. ASDAS score <=1.3 represents inactive disease status and achievement of T2T. HADS score >=8 can be diagnosed with anxiety or depression.Results:From June 2016 to Jan 2020, 1,931 AS patients (1,118 male, 813 female) with a mean age of 34.09 ± 11.86 (12-82) years and the median disease duration of 2.61 years from 207 hospitals performed bundle self-assessments for 2,477 times in total. According to the HADS and ASDAS assessment results, the prevalence of anxiety and depression in all patients was 36.7% and 39.3% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on T2T was 29% and 71%, respectively. The prevalence of anxiety (A) and depression (D) was 25% and 23% among T2T achievers; and 37% and 32% among T2T failures, respectively (pA<0.05, pD<0.05).According to ASDAS, in IDA, MDA, HDA and VHDA subgroups, the prevalence of anxiety and depression was 27%, 36%, 41%, 52% and 29%, 38%, 45%, 56%, respectively. The correlation coefficients of anxiety (A) and depression (D) with ASDAS were rA=0.9908 and rD=0.9964. It suggested that with the increase of disease activity, the proportion of AS patients with anxiety and depression increased significantly. (Figure 1)Figure 1.The prevalence of anxiety and depression according to ASDAS.Conclusion:The prevalence of anxiety and depression in AS patients was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. Higher prevalence of anxiety and depression were associated with higher levels of disease activity. SSDM is an effective mobile interface to monitor and study entanglement of disease activity and mental health in AS patients, which build a foundation for proactive interventions in future.Acknowledgments:Smart system of disease management (SSDM) was developed by Shanghai Gothic Internet Technology Co., Ltd.Disclosure of Interests:None declared

Letter to the editor. Healthcare workers on the edge of sanity due to COVID-19: Rapid review of the results of systematic reviews and meta-analyzes

Reply to: “Is transient elastography inaccurate in chronic hepatitis B and non-alcoholic fatty liver disease?”

Background:WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. SLEDAI-2K and Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate SLE patients’ disease activity and mental health. All the Assessments were mainly performed by health professionals (HCPs) with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-assessments on SLEDAI-2K and HADS by mobile App.Objectives:To investigate the prevalence of anxiety and depression in Chinese patients with SLE and to analyze the potential association between disease activity of SLE and mental health.Methods:Under the guidance and training by HCPs, SLE patients downloaded SSDM and performed self-assessments bundle of SLEDAI-2K and HADS with SSDM. SLEDAI-2K <=4, 5-9, 10-14 and >=15 are defined SLE inactive, low (LDA), moderate (MDA) and high (HDA) disease activity, respectively. SLEDAI-2K score <= 4 is set as the main criteria for Lupus Low Disease Activity State (LLDAS) and achievement of T2T. HADS score >=8 can be diagnosed with anxiety or depression.Results:From June 2016 to Jan 2020, 3,332 SLE patients (199 male, 3,133 female) with a mean age of 36.34 ± 12.80 (10-91) years and the median disease duration of 3.43 years from 216 hospitals performed bundle self-assessments for 4,967 times in total. According to the HADS and SLEDAI-2K Assessment results, the prevalence of anxiety and depression in all patients was 36.7% and 39.3% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on LLDAS was 53% and 47%, respectively. The prevalence of anxiety (A) and depression (D) was 19% and 27% among LLDAS achievers; 41% and 47% among LLDAS failures, respectively (pA<0.01, pD<0.01).According to SLEDAI-2K, in LLDAS, LDA, MDA and HDA subgroups, the prevalence of anxiety and depression was 19%, 30%, 37%, 54% and 27%, 36%, 44%, 61%, respectively. The correlation coefficients of anxiety (A) and depression (D) with SLEDAI-2K were rA=0.9957 and rD=0.9819. It suggested that with the increase of disease activity, the proportion of SLE patients with anxiety and depression increased significantly. (Figure 1)Conclusion:Conclusion: Higher prevalence of anxiety and depression were Associated with higher levels of disease activity in SLE patients. SSDM is an effective mobile interface to monitor and study entanglement of disease activity and mental health in SLE patients, which build a foundation for proactive interventions physically and mentally in future.

Background WHO survey showed that the prevalence of anxiety and depression in Chinese population and Chinese patients with chronic diseases were between 3.1% - 4.2% and 3.1% - 7.3%, respectively. DAS28, HAQ, Hospital Anxiety and Depression Scale (HADS) are commonly used to evaluate RA patients’ disease activity, physical function and mental health. All of those evaluations were mainly conducted by health professionals with paper questionnaire previously. SSDM is a novel smart disease management tool that allows patients to do self-evaluation on DAS28, HAQ and HADS by mobile terminal. Objectives To estimate the prevalence of anxiety and depression in Chinese patients with RA and to analyze the potential association between disease activity and mental health. Methods Under the guidance and training by health professionals, RA patients downloaded SSDM and performed self-evaluation bundle of DAS28, HAQ and HADS with SSDM. DAS28 =8 can be diagnosed with anxiety or depression. Results From June 2016 to Jan 2019, 2,635 RA patients (461 male, 2,174 female) with a mean age of 49.94 ± 14.23 (11-88) years and the median disease duration of 25.37 months from 175 hospitals performed bundle self-evaluation for 7,455 times in total. According to the HADS and DAS28 assessment results, the prevalence of anxiety and depression in all patients was 33.30% and 39.04% respectively, which was significantly higher than that in the WHO survey in Chinese population and chronic disease patients. The proportion of patients achieved and failed on T2T was 29% and 71%, respectively. The prevalence of anxiety and depression was 20% and 25% among T2T achievers; and 31% and 38% among T2T failures, respectively (PA According to DAS28, the prevalence of anxiety was 19%, 20%, 27% and 41% in Remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) subgroups respectively, the prevalence of depression was 24%, 26%, 33% and 49% respectively. The correlation coefficients of anxiety (A) and depression (D) with DAS28 were rA=0.9318 and rD=0.9334, respectively. It suggested that with the increase of disease activity, the proportion of RA patients with anxiety and depression increased significantly. Combined with physical function evaluation results, the overall prevalence of anxiety (23.65%) and depression (33.20%) in the normal HAQ group was significantly lower than that in the abnormal HAQ group (A: 36.37%, D: 43.19%, xA2 = 4.52, xD2 = 6.21, pA Conclusion Higher prevalence of anxiety and depression were associated with higher levels of disease activity and worse physical function. Rheumatic comorbidity and adverse events (ADEs) were potentially associated with depression in the Rem subgroup patients with normal physical function. SSDM is an effective mobile interface to monitor and study entanglement of disease activity, physical function and mental health in RA patients, which build a foundation for proactive interventions in future. Disclosure of Interests None declared

ObjectivesTo determine the level and prevalence of anxiety and depression in men being investigated for prostate cancer (CaP) and also to identify those aspects of the diagnostic pathway that induces the most stress.MATERIALS AND METHODSAll patients undergoing transrectal ultrasound-guided biopsy (TRUS-B) of the prostate for suspected CaP at our institute between June 2008 and April 2009 were enrolled in this prospective study. All patients completed two questionnaires, prior to their biopsy (HADS1) and before receiving results (HADS2), containing the Hospital Anxiety and Depression Scale (HADS). The data were analyzed and the differences in HADS were compared.ResultsA total of 112 men were included in the trial. Two patients could not complete the second part of HADS (HADS2) and were excluded from the study. Prevalence of anxiety among the 110 patients was 43/110 (39.1%). Mean score for anxiety in these 43 patients before biopsy (HADS A1) was 10.74 and score just before receiving the biopsy report (HADS A2) was 11.55. Prevalence of depression before TRUSB (HADS D1) was 21/110 (19.1%) with a mean score of 10.59. Prevalence of depression while awaiting the biopsy report (HADS D2) was 22/110 (20%) with mean score of 10.62.ConclusionThere was a high prevalence of anxiety and depression in our study population and waiting for biopsy results was the most stressful event. Questionnaires such as HADS can identify patients with psychological distress. Minimizing the stress while waiting for a diagnosis should help optimize patient care.

This study assessed the prevalence, diagnosis, and treatment of major depressive disorder and generalized anxiety disorder among New York City adults. As part of the first community-specific Health and Nutrition Examination Survey in the United States, depression and anxiety were assessed in a representative sample of 1,817 noninstitutionalized adults in 2004. A total of 8% had major depressive disorder and 4% had generalized anxiety disorder. Respondents with depression were more likely to be formerly married, publicly insured, younger, and U.S. born. Only 55% of adults with depression were diagnosed, and 38% of those with depression or anxiety were in treatment; individuals with a diagnosis of depression were more likely to receive treatment than those without a diagnosis (61% versus 7%; p<.001). Immigrants with depression were 60% less likely to be diagnosed than their U.S.-born counterparts; immigrants arriving in this country ten or more years ago had slightly more anxiety than immigrants arriving less than ten years ago (3% versus 2%, not significant). Among respondents with anxiety, 23% reported disability compared with 15% of those with depression. Compared with adults with neither diagnosis, adults with depression or anxiety were twice as likely to smoke tobacco (p<.05), adults with depression were twice as likely to have diabetes (p<.01), and those with anxiety were twice as likely to have asthma (p<.01). Mental disorders are often disabling and inadequately diagnosed and treated. Foreign-born adults experience barriers to diagnosis and treatment despite having less depression; anxiety may increase with time since immigration. Increased awareness of and linkage to mental health services are needed, especially in larger, more diverse urban communities.

Background There are few studies assessing anxiety and depression in newly diagnosed patients with inflammatory bowel disease (IBD). The purpose of this study was to determine the prevalence of anxiety and depression in patients newly diagnosed with Crohn`s disease (CD) and ulcerative colitis (UC), and to compare anxiety and depression with the Norwegian general population. Methods Patients (≥18 years) were included from the Inflammatory Bowel Disease in South-Eastern Norway (IBSEN III) study, a large prospective observational inception cohort. Prevalences of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), where a dimensional sub-score of ≥8 was indicative of possible cases of anxiety (HADS-A) and depression (HADS-D). Data on the general population is retrieved from the Trøndelag Health Study (the HUNT Study), a large, population-based cohort study in Norway (N= 56041). Robust regression analyses were performed to compare HADS scores in the patients with IBD to individuals from the general population, adjusted for age and education. Prevalences of both depression and anxiety are estimated using the dichotomised HADS scores. Results Of the 1509 patients with a verified IBD diagnosis, 938 patients aged ≥ 18 years (62.1%) completed the HADS questionnaire (CD, 297 (31.7%), UC, 641 (68.3%). In the general population there were n= 41242 respondents of the HADS. The prevalence of anxiety in CD was 37.4% (95% CI [0.32; 0.43]) compared with 32.1% in UC (95% CI [0.28; 0.35]) and prevalence of depression was 21.9% in CD (95% CI [0.17; 0.27]), compared with 16.8% in UC (95% CI [0.14; 0.20]). In the general population, the prevalence of anxiety was 17.9 % (95% CI [0.18; 0.18]), and the prevalence of depression was 9.6% (95% CI [0.09; 0.10]), both significantly lower compared with the patients with CD and UC. Compared with the general population, male patients with CD scored significantly higher, 2.9 points higher (95% CI [2.5;3.4]) on HADS-A and 1.3 points higher (95% CI [ 0.9; 1.8]) on HADS-D. Male patients with UC scored significantly higher on HADS-A (B = 2.5, 95% CI [2.1; 2.8]) and HADS-D (B= 0.7, 95% CI [0.4; 1.0]). Female patients with CD scored significantly higher on HADS-D, B= 0.8 (95% CI [0.3;1.3]). No statistically difference between females with UC and females in the general population was found. Conclusion Anxiety and depression are prevalent in patients newly diagnosed with IBD, and significantly more prevalent in patients compared with the general population. Male patients especially, had significantly higher HADS scores compared with the general population. The results indicate considerable psychological impact of IBD in newly diagnosed patients.

Type I interferon receptor (IFNAR) has been involved in the progression of chronic hepatitis B (CHB). Oxidative stress is also associated with hepatitis B virus (HBV) infection and might contribute to the structure and function of protein synthesis including the IFNAR family. This study was aimed to determine the possible associations between oxidative stress and peripheral IFNAR expression in chronic HBV infection. Fifty-four CHB patients and 31 liver cirrhosis (LC) patients were consecutively collected, as well as 11 healthy subjects as controls. Expression levels of IFNAR1 and IFNAR2 in peripheral blood lymphocytes and monocytes were measured by flow cytometry. IFNAR1 and IFNAR2c mRNA were detected by real-time reverse transcription-polymerase chain reaction. Levels of plasma-soluble IFNAR and oxidative stress parameters, including xanthine oxidase (XOD), malondialdehyde (MDA), glutathione (GSH), glutathione S-transferase (GST), and glutathione peroxidase (GSH-Px) were detected by enzyme linked immunosorbent assay (ELISA). The frequencies of IFNAR1 and IFNAR2 in lymphocytes and monocytes were significantly increased in CHB and LC patients than in healthy controls. Expression levels of IFNAR1 and IFNAR2c mRNA and plasma-soluble IFNAR level in CHB and LC patients were upregulated compared with healthy controls. Mean fluorescence intensity (MFI) of IFNAR2 in monocytes of CHB patients was higher than that in LC patients. Levels of plasma XOD, MDA, and GST were significantly increased in CHB and LC patients compared with healthy controls. Meanwhile, GSH and GSH-Px in CHB and LC patients were decreased than that in healthy controls. Furthermore, plasma MDA, GSH, and GST levels in CHB patients were higher than that in LC patients. In CHB patients, plasma GST level was negatively correlated with MFI of IFNAR2 in lymphocytes. Our results suggested that oxidative stress play an important role in the regulation of IFNAR in chronic HBV infection.

Introduction: Acute febrile illnesses (AFI) such as dengue, leptospirosis, and influenza result in large numbers of hospitalisation in the tropics. These illnesses may negatively impact patients’ mental health. The prevalence of anxiety and depression and risk factors associated with these conditions were evaluated in patients hospitalised with AFI. Methods: From July- October 2017, a cross-sectional study was conducted on consecutive patients ≥12 years of age admitted with AFI to a tertiary care hospital in Sri Lanka. The validated Sinhala translation of Hospital Anxiety and Depression Scale (HADS) was administered to identify the presence and severity of anxiety and depression. The prevalence of anxiety and depression was identified and the association with sociodemographic and clinical characteristics was determined using Chi square and t-tests and multivariable logistic regression. Results: Of 193 enrolled, 44.6% were male. AFI included dengue (62.7%), viral fever (10.4%), urinary tract infection (6.2%), leptospirosis (4.7%), pneumonia (3.1%) and typhus (0.5%). Overall, 41.4% patients had anxiety and 42.5% had depression. On multivariable analysis, anxiety was associated with awareness of diagnosis (OR=4.3, CI 1.3-13.76, p=.03), lower satisfaction score (OR=0.73, CI 0.58-0.92, p=0.008) and lower income (OR=1.92, CI 1.03-3.57, p=0.03). Depression was associated with anorexia (OR=2.8, CI 1.33-5.87, p=0.006) and diarrhoea (OR=2.29, CI 1.17-4.47, p=0.01).Conclusions: Patients hospitalised with AFI had a high prevalence of anxiety and depression. Gastrointestinal symptoms, lower socioeconomic status, and awareness of diagnosis of illness were all associated with anxiety. Our findings may be helpful in developing interventions to counteract anxiety and depression among patients hospitalised with AFI.

The COVID-19 pandemic has impacted the well-being of millions of people around the globe. The evidence has shown that during the COVID-19 pandemic, the mental health of the population was affected, which means that there is an extra demand to implement different actions to mitigate and treat mental health disorders result of the pandemic. According to the literature it was expected that the prevalence of mental health disorders, such as anxiety and depression increased by 25 per cent worldwide, and Colombia was not the exception. However, there is not clear evidence on how much this increase might be. This study aims to estimate the prevalence of anxiety and depression for female and male adolescents and adults in Colombia before and during the COVID-19 pandemic. It estimated the potential increase of the prevalence in each group as a result of the COVID-19 pandemic in 2020. We used the Individual Registry of Health Services Delivery data from 2015-2021 to estimate the observed prevalence of anxiety and depression in Colombia for female and male adults. In addition, using the National Mental Health Survey 2015, we simulated the prevalence of anxiety and depression for adolescents (12 to 17 years) and adults (18 or older) in 2015 and using a static Monte Carlo simulation process we estimated the expected prevalence of depression and anxiety for each group from 2016 to 2021. The results of the analysis using revealed an important increase in the observed prevalence of depression and anxiety for adults and adolescents and men and women between 2015 and February 2020. When we simulated different scenarios using as a base line the National Mental Health Survey and estimated the prevalence of depression and anxiety for female and male adults and adolescents, we found that the prevalence of depression and anxiety has had an important increase in the last five years for all groups and had an important increase during 2020. This increase was greater for women compared to men, and adolescents than adults. Our results show the number of people who need potential attention from the health system in Colombia and highlight the importance to think about how to avoid and detect potential cases of anxiety and depression especially in female adolescents.

Background: Psychosocial stress is a common comorbidity in chronic hepatitis B (CHB) patients. A diagnosis of CHB, the primary risk factor for liver cancer among Asian Americans, can be a significant source of psychological and emotional stress. Although the disease can be life-changing, there is a paucity of research on psychosocial stress in CHB patients. The purpose of this study is to examine the prevalence of serious psychological distress (SPD) and factors associated with SPD in Asian CHB patients. Method: It is a prospective study design with subjects identified from an existing patient cohort that were enrolled and then subsequently followed up. Information was gathered from the CHB patients using face-to-face interviews in Korean or English. Serious psychological distress was measured by the Kessler Scale (K6). Measures of stressful life events and Hepatitis B Quality of Life (HBQOL) (e.g., psychological well-being, anticipation anxiety, stigma) were used. A multivariate logistic regression model (including gender, age, level of education) was conducted for analysis. Results. Of 50 CHB patients 18 years and older, the 12-month prevalence of SPD was estimated at 20% using the optimal cut-off (&amp;gt;=13). In adjusted regression analysis, stressful life events and HBQOL-stigma were related to serous psychological distress: Those who had stressful life events (aOR=3.10, 95% CI 1.26-7.64) and those who had high scores of stigma (aOR=1.19, 95% CI 0.97-1.44, p=.08) had higher psychological distress. Those with more than a college education had decreased psychological distress (aOR=0.09, 95% CI 0.01-0.82). Conclusion: The finding indicates CHB patients had a higher prevalence of serious psychological distress than the general Asian population (2.6% from California Health Interview Survey). Stigma connected to hepatitis B diagnosis and stressful life events were important factors associated with mental health. This suggests that disease burden caused by hepatitis B infection may lead to poor mental health. Future studies will identify those who are at a high likelihood of developing a mental disorder and develop effective interventions for early detection of mental illness. Citation Format: Hee-Soon Juon, Grace Park, Klassen Ann, Hie-Won Hann. Factors associated with psychological distress among chronic hepatitis B patients [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A102.

Introduction: Anxiety, depression and stress can cause negative impacts on the foetus and pregnancy. The COVID19 pandemic provides a unique stressor requiring an assessment of its impact in the Indian set up. Objectives:1. To assess prevalence of anxiety and depression among antenatal women attending the antenatal OP at a tertiary care centre during COVID 19 pandemic using Hospital Anxiety and Depression Scale (HADS). 2. To determine stress perceived by antenatal women using the Perceived Stress Scale (PSS). Method: Antenatal women attending the outpatient clinic between November 2020 and January 2021 were consecutively enrolled into the study after obtaining consent and a semi-structured interviewer administered questionnaire was used to collect data. The outcome variables, including sociodemographic details, HADS and PSS scores, were analysed using SPSS software, and results expressed appropriately, with quantitative variables expressed as mean and standard deviation, and qualitative variables as proportions. Results: Prevalence of anxiety among antenatal mothers was estimated to be 39%, of which 87.8 % had income below the poverty line. Prevalence of depression was estimated to be 11.4 %. Stress levels were high in 41.9 % of the women. Anxiety showed a positive correlation with stress (correlation coefficient of 0.711). Conclusion: High prevalence of anxiety and stress among antenatal women, especially from poor income backgrounds, points to an urgent need for reassurance and counselling.

Reliability of transient elastography for the detection of fibrosis in Non-Alcoholic Fatty Liver Disease and chronic viral hepatitis

Background: Depression and anxiety had negative effects on the quality of life of cancer patients, thus hospital anxiety and depression scale (HADS) is a useful instrument for screening these problems. This research was performed to assess the prevalence of their anxiety and depression.Methods: From 2012-2013, one hundred fifty patients with recent diagnosis of different cancers in Babol, Iran were assessed. A presumptive diagnosis of anxiety and depression was based on a four point 14-item HADS. The score of 0-7 means without clinical symptoms of anxiety or depression, 8-10 mild and 11-21 symptomatic anxiety or depression. The data were collected and analyzed.Results: Forty-four (29.3%) patients had mild anxiety, 25 (16.7%) symptomatic anxiety but mild and symptomatic depression were seen in 40 (26.7%) and 32 (21.3%) patients, respectively. There were significant relationships between anxiety, depression and the age group of the patients with higher frequency in older ages. There were significant relationships between anxiety and depression with the type of cancer and type of treatment. Breast and stomach cancer patients had the highest prevalence of anxiety and depression and the higher prevalence was observed in the patients who received chemotherapy as the single treatment.Conclusion: The results show that patients with breast and stomach cancer had the highest prevalence of anxiety and depression among all others cancer patients.