Abnormal Hospital Anxiety And Depression Scale Research Articles

Association of Hyperparathyroidism with Depression and Anxiety Among Chronic Hemodialysis Patients in the Al Baha Region, Kingdom of Saudi Arabia.

Introduction Anxiety and depression are prevalent psychological issues among hemodialysis patients, adversely affecting their well-being and treatment response. The study aims to identify the relationship between these mental health concerns and hyperparathyroidism in chronic hemodialysis patients from the Al Baha Region, Kingdom of Saudi Arabia. Methods This retrospective study included 143 chronic hemodialysis patients aged 18-85 years. Monthly laboratory records for parathyroid hormone (PTH) levels and the Hospital Anxiety and Depression Scale (HADS) for mental health assessment were utilized. Demographic information and the primary causes of end-stage renal disease were obtained through patient interviews. Statistical analyses, including chi-square tests, odds ratio, and significance tests, were performed to assess associations. Results Elevated PTH levels were associated with increased anxiety and depression in hemodialysis patients. Patients with PTH levels >400 pg/ml exhibited higher rates of abnormal HADS scores for anxiety and depression than those with PTH levels <400 pg/ml. Gender differences were evident, with women showing a higher predisposition to anxiety disorders and men having depression. Additionally, patients with PTH levels <150 pg/ml had a significantly higher proportion of the "normal" depression score than those with PTH levels >800 pg/ml. Conclusion The study underscores the association between hyperparathyroidism and adverse mental health outcomes in chronic hemodialysis patients. Maintaining optimal PTH levels plays a crucial role in mitigating anxiety and depression. Gender differences in mental health outcomes highlight the need for tailored interventions. Routine mental health assessments, utilizing tools such as the HADS, are important in the comprehensive care of hemodialysis patients.

Effects of Stress-Induced Glucocorticoids on Reproductive Dysfunction in Men

There are different factors affecting the reproductive fitness of organisms, such as the ecological and environmental factors, resource availability, and stress within their habitat. The challenging incidents in the organism’s environment result in activation of the response system of central stress mediated with the hypothalamic-pituitary-adrenal (HPA) axis. This axis’s regulatory function controls such items as immune and cardiovascular functions, metabolisms, and reproductive system. Its activation shows reproductive function through various stressors. Through up-regulating glucocorticoids, stress can adversely influence fertility. Clinical studies and experimental data have demonstrated that stress signaling can have a mediatory effect during direct actions in gonads and reproductive system. The focus of this review is on the stress mechanisms via up-regulating glucocorticoids on male reproductive dysfunction. The individuals with abnormal Hospital Anxiety and Depression Scale (HADS) had higher serum FSH and LH and lower serum total testosterone compared to those with normal HADS. Besides, it was observed that in individuals with abnormal HADS, morphologically normal spermatozoa, sperm count, and motility are lower. For infertility of male cases, stress management is needed.

Diagnosing and Treating Depression and Anxiety in Patients with Cardiovascular Disorders and Diabetes Mellitus in Primary Healthcare: Is Training of Physicians Enough for Improvement?

INTRODUCTION: Common mental disorders anxiety and depression are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation.&#x0D; AIM: To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist).&#x0D; METHODS: Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS 7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples.&#x0D; RESULTS: The proportions of patients with borderline abnormal and abnormal HADS scores (7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS 7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS 7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS 7 met a psychiatrist through PCPh referral.&#x0D; CONCLUSIONS: Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

Decreased gray matter volume and increased white matter volume in patients with neovascular age-related macular degeneration: a voxel-based morphometry study.

Objective: To measure white and gray matter volume (WMV, GMV) in patients with neovascular age-related macular degeneration (nAMD) using voxel-based morphometry (VBM).Material: Eighteen patients (9 men, 9 women) with nAMD and 18 (9 men, 9 women) healthy controls (HCs) aligned were recruited. Functional magnetic resonance imaging (fMRI) and VBM of three-dimensional T1 brain images were analyzed. And we also apply t-tests to look for GMV and WMV differences between groups. Correlation analysis was utilized to probe the connection between observational GMV and WMV values of diverse brain areas and the severity of HADS (hospital anxiety and depression scale). Also, distinctions between nAMD and HCs in GMV can be presented with the help of a ROC (receiver operating characteristic) curve.Results: Compared with HCs, GMV values were significantly lower in patients with neovascular age-related macular degeneration in the right inferior frontal gyrus, temporal pole of left superior temporal gyrus, left superior temporal gyrus, left middle frontal gyrus, left anterior cingulate and para cingulate gyrus. While WMV was slightly increased in these areas. HADS (hospital anxiety and depression scale) scores portrayed a non-linear correlation with the GMV value of the right inferior frontal gyrus, left middle frontal gyrus, left anterior cingulate and paracingulate gyrus of the nAMD group (r=-0.6629, P=0.0027)(r=-0.9451, P<0.0001)(r=-0.6183, P=0.0062). Moreover, the ROC curve analysis of the mean VBM values for altered brain regions indicated high diagnostic accuracy.Conclusion: These results indicated that patients with nAMD have abnormal GMV and WMV and formed a basis for future research on pathological mechanisms in this disease. Moreover, decreased gray matter volume in particular brain regions might be associated with choroidal neovascularization and abnormal HADS score. It might help to explain the pathological mechanism of anxiety and depression in patients with nAMD.

Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes.

Cognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. To assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. Prospective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. 43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. Cognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.

Anxiety and depression in inherited channelopathy patients with implantable cardioverter-defibrillators.

BackgroundImplantable cardioverter-defibrillators (ICDs) are an effective treatment in some patients with inherited heart disease, including inherited channelopathies, yet they have also been shown to impact patients’ psychological health.ObjectiveWe sought to improve understanding of the level of anxiety and depression as well as device acceptance among inherited channelopathy patients with an ICD.MethodsEligible patients seen at Johns Hopkins Hospital were sent a survey, which included the Hospital Anxiety and Depression Scale (HADS), Cardiac Anxiety Questionnaire (CAQ), and the Florida Patient Acceptance Survey (FPAS). Student t tests and χ2 tests were used to identify associations with abnormal anxiety and depression scores.ResultsAmong eligible patients (n = 65), 32 individuals (49%) completed the survey. The rate of device-related complications was 34%, and 41% of patients experienced 1 or more ICD shocks. Twelve patients (38%) had an abnormal HADS anxiety subscore and 5 patients (16%) had an abnormal HADS depression subscore (score ≥ 8). Secondary-prevention ICDs were associated with an abnormal HADS anxiety subscore (P = .03). Experiencing ICD shock(s), device complications, age, sex, and family history of sudden cardiac death were not statistically associated with anxiety or depression. Overall, respondents demonstrated high device acceptance by FPAS (79.9 ± 2.9, maximum total score 100) and moderately high cardiac-specific anxiety by CAQ total score (1.53 ± 0.12).ConclusionA high prevalence of generalized anxiety was identified among inherited channelopathy patients with ICDs. High device acceptance and lack of association with ICD shocks or complications indicate that further research is necessary to understand this increased incidence.

Heart and brain interactions in heart failure: Cognition, depression, anxiety, and related outcomes

BackgroundCognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood. ObjectivesTo assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact. MethodsProspective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6th and 12th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death. Results43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA. ConclusionsCognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.

Factors That Impact the Psychological Wellbeing of Airborne Isolated Patients.

BackgroundLower respiratory tract infections are one of the international leading causes of lost disability-adjusted years, and hence prevention measures, including isolation of high-suspect patients, were established to reduce the risk of transmission. However, isolation can negatively affect the psychological health of isolated patients, leading to anxiety or depression. The study aim was to investigate the association between types of isolation and the levels of anxiety and depression. Other factors that negatively influence the psychological status were identified.MethodsThis was an observational analytical cross-sectional study. The study included patients aged 18 years and above who had been isolated for at least 48 hours at King Abdulaziz Medical City in Jeddah, in the western region of Saudi Arabia. The data was gathered by interviewing the patients using the Hospital Anxiety and Depression Scale (HADS). ResultsAmong the included 97 isolated patients, 52 (53%) were men, and 45 (47%) were women with a mean age of 49.39 ± 1.87. Among all participants, 70% were married, and 72% had children. The means of anxiety and depression scores were 5.08 ± 0.39 and 7.48 ± 0.40, respectively. There was no significant association between HADS and types of isolation (P=0.550). Female gender was significantly associated with abnormal HADS (36% vs. 17%; P=0.040). On the other hand, the frequency of physician follow-up visits reduced the risk for abnormal HADS (22% vs. 50%; P=0.040)ConclusionJust over one-fourth of the isolated patients had raised anxiety or depression scores. A trend to higher HADS was observed in airborne isolated patients. We found also that females were more susceptible to anxiety and depression, while frequent physician visits improved the psychological wellbeing of isolated patients.

Anxiety and depression in reproductive age women with rheumatic diseases.

Women in reproductive age with rheumatic diseases (RD) are especially vulnerable for depression and anxiety which negatively impacts the pregnancy, birth, and RD. The purpose of this study is to describe the frequency of anxiety and depression symptoms employing the Hospital Anxiety and Depression Scale (HADS) in women in reproductive age. We conducted an observational, single-center, cross-sectional, and descriptive study in reproductive-age, non-pregnant women without a prior psychiatric diagnosis. Differences between disease groups, subscale results, and disease activity were analyzed with the Chi square, Mann-Whitney U test, or Kruskal-Wallis test. A total of 100 women were included. Mean age was 35.3 years (SD = 10.07). The most frequent diagnosis was rheumatoid arthritis (RA) with 48, followed by systemic lupus erythematosus (SLE) with 30. A total of 66 (66%) patients had an abnormal HADS score (probable or possible cases) in either subscale. More than 50% of RA patients had an abnormal HADS score. We found an association between RA disease activity groups and total HADS score (p = 0.003). Furthermore, we found a statically significant association between RA activity groups and HADS anxiety subscales group classification (p = 0.01). No differences between disease activity groups of SLE or other diseases and HADS classification or total score was found (p = 0.277). A high frequency of probable or possible cases of depression and anxiety were recognized in reproductive-age women with RD. A high RA disease activity was associated with a high total HADS score and an increased presence of anxiety symptoms.

Bi-directionality of Brain–Gut Interactions in Patients With Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD) are associated with mood disorders, such as anxiety or depression, but it is not clear whether one contributes to development of the other, or if the interaction is bi-directional (anxiety or depression contributes to the progression of IBD, and IBD affects psychological health). We performed a 2-year longitudinal prospective study of patients in secondary to care investigate the bi-directionality of IBD and mood disorders. We collected data from 405 adult patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) from November 2012 through June 2017. Demographic features, subtypes of IBD, treatments, symptoms, somatization, and fecal level of calprotectin were recorded at baseline. IBD activity was determined at baseline and after the follow-up period (2 years or more) using the Harvey-Bradshaw Index for CD and the Simple Clinical Colitis Activity Index for UC (scores ≥5 used to define disease activity). Anxiety and depression data were collected using the Hospital Anxiety and Depression Scale (HADS), at baseline and after the follow-up period. Objective markers of disease activity, including glucocorticosteroid prescription or flare of disease activity, escalation of therapy, hospitalization secondary to IBD activity, and intestinal resection during follow-up were assessed via case note review. A brain-gut direction of disease activity was defined as development of new IBD activity in patients with quiescent IBD and abnormal HADS scores at baseline. A gut-brain direction of disease activity was defined by subsequent development of abnormal HADS scores in patients with active IBD and normal HADS scores at baseline. We performed multivariate Cox regression controlling for patient characteristics and follow-up duration. Baseline CD or UC disease activity were associated with an almost 6-fold increase in risk for a later abnormal anxiety score (hazard ratio [HR], 5.77; 95% CI, 1.89-17.7). In patients with quiescent IBD at baseline, baseline abnormal anxiety scores were associated with later need for glucocorticosteroid prescription or flare of IBD activity (HR, 2.08; 95% CI, 1.31-3.30) and escalation of therapy (HR, 1.82; 95% CI, 1.19-2.80). These associations persisted when normal IBD activity index scores and fecal level of calprotectin <250 μg/g were used to define quiescent disease at baseline. In a 2-year study of patients with CD or UC, we found evidence for bi-directional effects of IBD activity and psychological disorders. Patients with IBD should be monitored for psychological well-being.

Assessment of sleepiness, fatigue, and depression among Gulf Cooperation Council commercial airline pilots.

No studies have assessed the prevalence of fatigue, depression, sleepiness, and the risk of obstructive sleep apnea (OSA) among commercial airlines pilots in the Gulf Cooperation Council (GCC). This was a quantitative cross-sectional study conducted among pilots who were on active duty and had flown during the past 6months for one of three commercial airline companies. We included participants with age between 20 and 65years. Data were collected using a predesigned electronic questionnaire composed of questions related to demographic information in addition to the Fatigue Severity Scale (FSS), the Berlin Questionnaire, the Epworth Sleepiness Scale (ESS), and the Hospital Anxiety and Depression Scale (HADS). The study included 328 pilots with a mean age±standard deviation of 41.4±9.7years. Overall, 224 (68.3%) pilots had an FSS score ≥36 indicating severe fatigue and 221 (67.4%) reported making mistakes in the cockpit because of fatigue. One hundred and twelve (34.1%) pilots had an ESS score ≥10 indicating excessive daytime sleepiness and 148 (45.1%) reported falling asleep at the controls at least once without previously agreeing with their colleagues. One hundred and thirteen (34.5%) pilots had an abnormal HADS depression score (≥8), and 96 (29.3%) pilots were at high risk for OSA requiring further assessment. Fatigue, sleepiness, risk of OSA, and depression are prevalent among GCC commercial airline pilots. Regular assessment by aviation authorities is needed to detect and treat these medical problems.

Screening for depression and anxiety in childhood neurogenic bladder dysfunction

Patients with chronic illnesses are known to have anxiety disorders and are likely to be depressed. Anxiety and depression (A/D) has been studied in adults with spina bifida (SB), however, no study has directly screened for A/D in pediatric patients with neurogenic bladder (NB) and their caregivers. The aims of our study were to determine the prevalence of A/D in caregivers of all children with SB and other NB dysfunction and in adolescents with validated screening measures. This was a preliminary cross-sectional screening investigation for A/D in pediatric patients with NB and their caregivers and adolescents with NB. Pediatric patients were defined as ages birth to 19 years and adolescents as ages 10 years-19 years. A caregiver was self-defined as a primary parent/guardian who took care of the pediatric patient for a majority of their time on a daily basis. We contacted 75 families by mail, of which 15 returned the consent and completed the questionnaires. Subsequently, 25 consecutive families whose children were seen for routine office appointments by the pediatric urology service at the Albany Medical Center in New York participated in person. 22 adolescents completed the Hospital Anxiety and Depression Scale (HADS). 47 caregivers completed both the HADS and the Center for Epidemiologic Studies Depression Scale (CES-D). Depression among adolescents: Of the 22 adolescents who completed the HADS, the median HADS score was 5.5 (Inter-quartile range (IQR): 1.75-8.75) for anxiety and 1.5 (IQR: 0-4.25) for depression; both scores were within the normal range (<8/21). Individual abnormal HADS scores (≥8/21) were seen in 6/22 (27%) for anxiety and 1/22 (5%) for depression. Anxiety and depression among caregivers: Of the 47 caregivers who completed the HADS and CES-D, the median HADS score was 7 (IQR: 4-11) for anxiety and 4 (IQR: 1-7) for depression; both scores were within the normal range. Individual abnormal HADS scores were seen in 23/47 (49%) for anxiety and 10/47 (21%) for depression. Abnormal CES-D scores (>15) were seen in 15/47 (32%). The median CES-D scores were 8 (IQR: 3-19). In this preliminary screening study, we found considerable anxiety in adolescents with NB and both A/D in caregivers. When screening by two validated surveys, adolescents with NB had median scores for A/D that were normal; yet 27% of these patients exhibited scores for anxiety that outwit the normal range. For the caregivers, the median scores were also normal; yet 49% and 32% had scores for A/D, respectively, that were abnormal. SB among pediatric patients has been shown to result in alterations in daily functioning and to increase the dependency on adult care, factors that are associated with altered self-concept, psychological distress, including A/D. Our findings underscore such results from previous studies. In caregivers, we observed a higher prevalence of anxiety than adolescents; similar findings have been reported for caregivers of other chronic conditions. Surprisingly, in caregivers, a lower percentage of scores for depression was observed. Although we have no data on the cause of this finding this may be related to a caregiver's ability to adapt to the demands of the situation in chronic illness or perhaps, lower expectations. The cross-sectional nature of our study limited us to draw any causal relationships for anxiety or depression between neurogenic patients and their caregivers. Despite our study limitations, the prevalence of anxiety in adolescents and in the caregivers is striking. Our data highlight that clinicians should screen for A/D more aggressively in pediatric patients with NB dysfunction and in their caregivers.

Mo1382 Inflammatory Bowel Disease Characteristics Among Ethiopian Jews: A Multicenter Study

Background: Many patients with inflammatory bowel disease (IBD) face multiple problems, including medical, surgical, nutritional, social, psychiatric related to their disease and require a holistic approach to care. To address this need, a multidisciplinary, prompt access IBD clinic was established at McMaster University Medical Centre, Hamilton, Canada. The prevalence of anxiety and depression among the patients attending the clinic is not known. Methods: Interdisciplinary team members consisting of gastroenterologists, surgeon, psychiatrists, nurse practitioner and dietitian providing prompt access holistic care for patients with IBD. All patients with IBD were assessed for demographic characteristics, quality of life using the Short Form-12 (SF-12), and psychological morbidity using the Hospital Anxiety and Depression Scale (HADS). The SF-12 has two components; physical composite score (PCS) and mental composite score (MCS); if either score is ,50 it was considered abnormal. HADS score can range from 0-42 and a score of .11 was considered abnormal. Results: The mean (SD) age of the 67 patients (males, 36%) was 35 (13) yrs. The majority (63%) had received college education. Of them, 40% had full-time employment, 18% had parttime employment, 24% were unemployed and 18% were on disability/sick leave. Of the 67 patients, 45% were in a stable marital relationship, 43% were single and 10% were either divorced or separated. The mean (SD) PCS was 41 (11) and MCS was 43 (12). The PCS was abnormal in 73% and MCS in 65% of the patients. HADS scores indicated that 75% were anxious/ depressed, while 8% had borderline anxiety/depression and 17% had normal scores. HADS scores showed a high degree of correlation with MCS (r=-0.717; p ,0.001) but no relationship to PCS, ESR or CRP. HADS scores were lower in those with higher income (.60,000$/yr) than those with lower income (15±8 vs 21±6; p=0.037); and in those who had full time employment compared to those without (13±7.6 vs 17±8; p=0.05). The PCS showed a negative correlation with ESR (rho=-0.25; p=0.048) and CRP (rho=-0.25; p= 0.05). Only 27% (13/49) of the patients with abnormal HADS score received professional psychiatric help. Conclusions: Patients with IBD have a high prevalence of anxiety and depression. Anxiety and depression was found more often in those with lower income and no full time employment.. HADS score did not show any relationship to disease activity or physical functional capability. Patients with IBD need active evaluation for presence of underlying anxiety or depression.

Mo1378 Psychosocial Characteristics of Patients With IBD: Experience From the Mcmaster Interdisciplinary Clinic

Background: Many patients with inflammatory bowel disease (IBD) face multiple problems, including medical, surgical, nutritional, social, psychiatric related to their disease and require a holistic approach to care. To address this need, a multidisciplinary, prompt access IBD clinic was established at McMaster University Medical Centre, Hamilton, Canada. The prevalence of anxiety and depression among the patients attending the clinic is not known. Methods: Interdisciplinary team members consisting of gastroenterologists, surgeon, psychiatrists, nurse practitioner and dietitian providing prompt access holistic care for patients with IBD. All patients with IBD were assessed for demographic characteristics, quality of life using the Short Form-12 (SF-12), and psychological morbidity using the Hospital Anxiety and Depression Scale (HADS). The SF-12 has two components; physical composite score (PCS) and mental composite score (MCS); if either score is ,50 it was considered abnormal. HADS score can range from 0-42 and a score of .11 was considered abnormal. Results: The mean (SD) age of the 67 patients (males, 36%) was 35 (13) yrs. The majority (63%) had received college education. Of them, 40% had full-time employment, 18% had parttime employment, 24% were unemployed and 18% were on disability/sick leave. Of the 67 patients, 45% were in a stable marital relationship, 43% were single and 10% were either divorced or separated. The mean (SD) PCS was 41 (11) and MCS was 43 (12). The PCS was abnormal in 73% and MCS in 65% of the patients. HADS scores indicated that 75% were anxious/ depressed, while 8% had borderline anxiety/depression and 17% had normal scores. HADS scores showed a high degree of correlation with MCS (r=-0.717; p ,0.001) but no relationship to PCS, ESR or CRP. HADS scores were lower in those with higher income (.60,000$/yr) than those with lower income (15±8 vs 21±6; p=0.037); and in those who had full time employment compared to those without (13±7.6 vs 17±8; p=0.05). The PCS showed a negative correlation with ESR (rho=-0.25; p=0.048) and CRP (rho=-0.25; p= 0.05). Only 27% (13/49) of the patients with abnormal HADS score received professional psychiatric help. Conclusions: Patients with IBD have a high prevalence of anxiety and depression. Anxiety and depression was found more often in those with lower income and no full time employment.. HADS score did not show any relationship to disease activity or physical functional capability. Patients with IBD need active evaluation for presence of underlying anxiety or depression.

P321 Vitamin D level doesn't correlate with disease extent and severity in Hungarian patients with inflammatory bowel disease

Background: Many patients with inflammatory bowel disease (IBD) face multiple problems, including medical, surgical, nutritional, social, psychiatric related to their disease and require a holistic approach to care. To address this need, a multidisciplinary, prompt access IBD clinic was established at McMaster University Medical Centre, Hamilton, Canada. The prevalence of anxiety and depression among the patients attending the clinic is not known. Methods: Interdisciplinary team members consisting of gastroenterologists, surgeon, psychiatrists, nurse practitioner and dietitian providing prompt access holistic care for patients with IBD. All patients with IBD were assessed for demographic characteristics, quality of life using the Short Form-12 (SF-12), and psychological morbidity using the Hospital Anxiety and Depression Scale (HADS). The SF-12 has two components; physical composite score (PCS) and mental composite score (MCS); if either score is ,50 it was considered abnormal. HADS score can range from 0-42 and a score of .11 was considered abnormal. Results: The mean (SD) age of the 67 patients (males, 36%) was 35 (13) yrs. The majority (63%) had received college education. Of them, 40% had full-time employment, 18% had parttime employment, 24% were unemployed and 18% were on disability/sick leave. Of the 67 patients, 45% were in a stable marital relationship, 43% were single and 10% were either divorced or separated. The mean (SD) PCS was 41 (11) and MCS was 43 (12). The PCS was abnormal in 73% and MCS in 65% of the patients. HADS scores indicated that 75% were anxious/ depressed, while 8% had borderline anxiety/depression and 17% had normal scores. HADS scores showed a high degree of correlation with MCS (r=-0.717; p ,0.001) but no relationship to PCS, ESR or CRP. HADS scores were lower in those with higher income (.60,000$/yr) than those with lower income (15±8 vs 21±6; p=0.037); and in those who had full time employment compared to those without (13±7.6 vs 17±8; p=0.05). The PCS showed a negative correlation with ESR (rho=-0.25; p=0.048) and CRP (rho=-0.25; p= 0.05). Only 27% (13/49) of the patients with abnormal HADS score received professional psychiatric help. Conclusions: Patients with IBD have a high prevalence of anxiety and depression. Anxiety and depression was found more often in those with lower income and no full time employment.. HADS score did not show any relationship to disease activity or physical functional capability. Patients with IBD need active evaluation for presence of underlying anxiety or depression.

Pain, sleep disturbance, and fatigue symptom cluster in patients suffering from chronic chemotherapy-induced neuropathic pain (CINP).

9113 Background: Various symptom cluster combinations of pain, fatigue, sleep disturbance (SD), and depression have been identified in cancer patients. The presence of symptom clusters has not been assessed in patients with persistent CINP. This exploratory analysis aimed to determine which symptoms statistically clustered with pain in cancer survivors with CINP. Methods: The University of Rochester Cancer Center Community Clinical Oncology Program recruited 461 patients with CINP &gt; 4 (on a 0-10 scale) who had completed chemotherapy (median 7 months ago) for a pain intervention trial. At baseline, groups of highly associated symptoms that included pain were identified empirically using factor and cluster analyses of the 11 symptoms in the University of Rochester Symptom Inventory plus the Hospital Anxiety and Depression Scale (HADS) scores. To investigate if associated symptoms track together over time, multiple linear regression (MLR) analysis was performed using changes in symptom severity between baseline and week 6, controlling for gender, age, education, race, and marital status. Results: Subjects were 88% white and 71% female, and on average 61 years old. Mean (standard deviation) baseline pain, fatigue, and SD were 5.7 (2.8), 5.0 (2.7), and 4.2 (3.1), respectively; 26% of subjects had borderline or abnormal HADS scores. Factor analysis identified 3 factors that accounted for 88% of the variance. One factor included pain, fatigue, SD, but not HADS, and accounted for 37% of the variance. Variable clustering also identified pain, SD, and fatigue as 1 symptom cluster. Changes in severity of SD and fatigue (p &lt; 0.0001), but not HADS, were associated with changes in pain (adjusted R2 = 0.168) in MLR analysis. Conclusions: Pain, fatigue, and SD were identified as a symptom cluster by factor and cluster analyses, and were found to track together over time by MLR. Since these data suggest that pain is associated with sleep quality and fatigue in patients with persistent CINP, targeting one of these symptoms may lead to reductions in the others. Future research should investigate interventions that target pain, fatigue, and SD concurrently in cancer survivors suffering from CINP.

Sa1421 The Effect of Comorbid Psychological Distress on Baseline Irritable Bowel Syndrome With Constipation Symptoms and Response to Linaclotide Treatment

Introduction: There is evidence to suggest that comorbid psychological distress can influence symptoms and the response to therapy in IBS patients. Linaclotide is a guanylate cyclaseC agonist that has been shown to improve the symptoms of IBS with constipation (IBS-C). Aim: To assess the influence of comorbid anxiety and depression on baseline IBS-C symptom severity and response to therapy with linaclotide using the Hospital Anxiety and Depression Scale (HADS). Methods: HADS consists of 14 statements that patients rate based on their experience over the previous week: 7 related to anxiety (HADS-A) and 7 related to depression (HADS-D). Based on possible scores of 0-21, patients from 2 Phase 3 IBS-C trials of linaclotide (pooled data) were categorized as normal (0-7), borderline (8-10), or abnormal (11-21) for HADS-A and HADS-D. Analyses by HADS category included percent of patients in each category (baseline and post-treatment), demographics, baseline symptom scores, efficacy, and treatment-emergent adverse events (TEAEs). P-values comparing linaclotide vs placebo were determined using an analysis of covariance (ANCOVA) model. A logistic analysis using stepwise variable selection was performed to identify demographic and baseline characteristics that are associated with an abnormal HADS score. Results: At baseline, 25% and 22% of patients were categorized as Borderline and Abnormal for anxiety and 10% and 6% were similarly categorized for depression; proportions of patients with comorbid anxiety and depression were similar between treatment groups. Of the demographic and baseline characteristics evaluated, only IBS severity, McGill subscale of affective descriptors, and age >65 (HADS-A only) were associated with abnormal HADS-D and HADS-A (Table 1). Patients with abnormal HADS tended to have higher baseline abdominal symptom scores vs patients categorized as normal, particularly for HADS-D. Mean changes from baseline to week 12 in all abdominal and bowel symptoms were statistically significant for linaclotide vs placebo in all HADS categories, except abdominal symptoms in patients categorized as abnormal for HADS-D (which had similar treatment differences but notably smaller subgroup sample size; Table 2). Diarrhea was the most common TEAE among linaclotide patients in all HADS categories, ranging from 16-26%. Conclusions: Almost half of the study population had some degree of anxiety but only 16% had evidence of depression. Baseline anxiety had little effect on the end of treatment score or magnitude of response for abdominal symptoms. Though patients with baseline depression tended to have higher abdominal symptom scores at baseline and at the end of treatment with linaclotide, the magnitude of response was not influenced by comorbid depression. Baseline anxiety or depression did not influence the response to linaclotide for bowel symptoms. Table 1. Demographics and Baseline Characteristics Associated with Abnormal HADS (IBS-C Patients)

The Effect of the Psychological Status of Breast Cancer Patients on the Shortterm Clinical Outcome after Mastectomy

Purpose: to analyze the effect of anxiety and depression on the postoperative complications and length of hospitalization of patients with breast cancer.Beck’s Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were filled out by the patients pre-operatively. Patients were asked to rate their pain by the visual analogue scale (VAS) after surgery. Age, seroma volume, day of drain withdrawal, complications, and pathological stages were noted.The median age of 49 patients with the diagnosis of breast cancer was 51 (36–80). There was a significant correlation between the pain score and Beck, HADS, HADS (anxiety) and HADS (depression) (8 hours; p = 0.021, 0.001, 0.004, 0.005 and 24 hours; p = 0.005, 0.012, 0.006, 0.120). The mean HADS depression score in those patients with complications was 9.1 ± 4.2 and that of patients with no complications was 6.6 ± 3.1 (p = 0.047). The mean hospital stay of patients with a normal HADS score (< 19) was 2.9 ± 1.1 days, whilst that of patients with an abnormal HADS score was 3.8 ± 1.2 days (p = 0.016). Patients with abnormal HADS anxiety and abnormal HADS (total) scores had an earlier stage of breast cancer (p = 0.077, p = 0.063).The psychological status of breast cancer patients effects their postoperative recovery period and it is easy to diagnose these patients by some brief questionnaires.

Prevalence and effects of depressive and anxiety symptoms in internal medicine inpatients during the first year after hospital discharge

In a prospective follow-up study the German version of the Hospital Anxiety and Depression Scale (HADS) was used to determine the prevalence of anxiety and depressive symptoms in internal medicine inpatients. From a total cohort of 376 admitted study patients questionnaires were completed at admission and after one year follow-up. The data demonstrated that the mean HADS score on the anxiety subscale decreased significantly from 6.7 3.5 at study inclusion to 5.8 3.8 after one year (p < 0.0005) while the mean HADS score on the depression subscale was relatively stable (5.3 3.6 versus 5.4 4.3, p = n.s.). Odds ratios for the prediction of positive HADS results at follow-up were 4.1 (95%-CI 2.0-8.4) for anxiety symptoms and 8.2 (95%-CI 4.6-14.6) for depressive symptoms. Patients with abnormal HADS anxiety scores were significantly more frequently rehospitalized (Odds ratio 1.9; p = 0.028) and also more frequently reported pain symptoms (Odds ratio 2.0; p = 0.019). These results demonstrate the persistence of depressive symptoms and the frequent utilization of health care in internal medicine inpatients with psychiatric disorders in the first year after hospital discharge.

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Background: In a cross-sectional study we investigated associations between self-ratings of anxiety and depression, physical factors and physicians’ assessments of patients’ medical status. Methods: Hospital inpatients (n = 574) consecutively admitted to internal medical wards were evaluated for the presence of anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Physicians were asked for their perception of psychiatric problems in their patients and for their assessments of patients’ severity of illness, functional impairment and 1-year prognosis on 3-point ranking scales. Detailed somatic data including comorbidity and accepted risk factors were taken from the patients’ records. Results: Almost two thirds of all patients with abnormal HADS scores (65.2%) were not identified by their attending physicians as suffering from psychiatric problems. Using multiple-regression models, HADS scores for depression, but not for anxiety, proved to be an independent predictor for the clinicians’ judgements of disease severity [exp(β) = 1.08; 95% confidence interval (CI) 1.03–1.13; p < 0.01] and functional impairment [exp(β) = 1.11; 95% CI 1.05–1.17; p < 0.01]. The estimation of prognosis, however, was only related to physical predictors and showed no association with depressive symptoms or other psychosocial factors. Conclusions: Our data demonstrate that internists’ ratings of severity of illness and functional impairment, but not prognosis, are associated with HADS depression scores, whereas there is no such association with self-rated anxiety.