Anxiety In Outpatients Research Articles

Culturally sensitive and universal measure of resilience for Japanese populations: Tachikawa Resilience Scale in comparison with Resilience Scale 14‐item version

Although scales specific to resilience are available and widely used, qualities of resilience could be culturally sensitive. This study aimed to develop a concise scale of resilience for Japanese populations, and compare its validity to that of the Resilience Scale 14-item version (RS-14), one of the most widely used scales for measuring resilience. The Tachikawa Resilience Scale (TRS) was developed on the basis of data obtained from unstructured interviews with Japanese motor vehicle accident survivors without psychiatric disorder. The reliability and validity of the TRS and RS-14 were then examined in cross-sectional studies performed with 523 company workers and 140 psychiatric outpatients. The TRS and RS-14 were negatively correlated with depressive symptoms in company workers and psychiatric outpatients and with anxiety in psychiatric outpatients, and were positively correlated with social support in company workers. Internal consistency and test-retest reliability of the TRS were high. Construct validity of the TRS was equivalent to that of the RS-14 in company workers, and higher than that of the RS-14 in psychiatric outpatients. The reliability and validity of the TRS and RS-14 in Japanese company workers and patients with psychiatric disorders were acceptable. The validity of the TRS was equivalent to or better than that of the RS-14. Although the TRS cannot be regarded as an established scale due to a lack of theoretical rationale, the results of this study suggest that scales measuring resilience that cover cultural aspects might be more relevant in given populations.

Prevalence and correlations with depression, anxiety, and other features in outpatients with chronic obstructive pulmonary disease in China: a cross-sectional case control study.

BackgroundPatients with chronic obstructive pulmonary disease (COPD) often experience depression and anxiety, but little information is available regarding Chinese patients with these conditions. The present study assessed depression and anxiety in Chinese patients with COPD.MethodsA case–controlled study was designed with 1100 patients with COPD enrolled in the case group and1100 residents without COPD and respiratory symptoms selected as the control group. Anxiety and depression in both groups were evaluated using the Hospital Anxiety and Depression Scale (HADS). The body mass index,degree of airflow obstruction, dyspnea, and exercise capacity (BODE ) index was used to assess COPD severity. Binary logistic regression models were used to test the association between anxiety and depression.ResultsThe patients with COPD were more likely than controls to experience depression (cases, HADS 10.5 ± 3.6, prevalence 35.7%; controls, HADS 8.7 ± 2.7, prevalence 7.2%) and anxiety (cases, HADS 10.4 ± 3.1, prevalence 18.3%; controls, HADS 8.6 ± 2.1, prevalence 5.3%). Subjects with anxious and depressive symptoms had poorer health outcomes including a higher BODE index, a shorter 6-minute-walk distance (6MWD), more dyspnea, and a higher St George’s respiratory questionnaire (SGRQ) score. The prevalence of anxious and depressive symptoms increased with increasing BODE scores. On the basis of binary logistic regression, the BODE index was significantly correlated with anxiety (OR = 1.47, p < 0.001) and depression (OR = 1.51, p < 0.001). Anxious and depressive symptoms were also associated with several factors including younger age, female sex, higher education level, lower household income and history of smoking.ConclusionsThis study confirmed the high prevalence of anxiety and depression in Chinese outpatients with COPD. Patients with COPD who had anxiety and/or depression had a poorer health-related quality of life.Trial registrationChinese Clinical Trials Registration(ChiCTR-TRC-12001958)

Changes in Beliefs about the Social Competence of Self and Others Following Group Cognitive-Behavioral Treatment

The current study examined changes in social anxiety thoughts and beliefs following cognitive-behavioral treatment (CBT). Participants (N = 77) were adults with a principal diagnosis of SAD who received 12, 2-h sessions of group CBT at a hospital-based outpatient anxiety disorders clinic. There were significant decreases from pretreatment to posttreatment in social anxiety symptoms and in symptoms of depression, nonspecific anxiety and tension, as well as significant improvements in social anxiety beliefs, as assessed via the Social Thoughts and Beliefs Scale (STABS; Turner et al., Psychol Assess 15:384–391, 2003). Change in social anxiety beliefs made a significant contribution to the prediction of social anxiety symptoms at posttreatment over and above pretreatment social anxiety symptoms and changes in depression, nonspecific anxiety and tension. A positive change in the belief that others are more socially-competent emerged as a significant unique predictor of social anxiety symptoms at posttreatment. The findings demonstrate that the STABS is sensitive to cognitive-behavioral treatment. The findings also suggest that social comparison processes in particular are a key aspect of improvement in social anxiety symptoms. This is an important direction for future research.

Effectiveness of computerised cognitive behaviour therapy for anxiety disorders in secondary care

This study aimed to compare the effectiveness of computerised cognitive behaviour therapy (CCBT) with a wait list control (WLC) for the treatment of patients with an anxiety disorder (social phobia, panic disorder, generalised anxiety disorder) referred to a specialist, publically funded, outpatient anxiety service. Patients with social phobia (n = 37), panic disorder (n = 32) or generalised anxiety disorder (n = 14) were randomised to treatment with either CCBT (n = 40) or WLC (n = 43). Self-report rating scale assessments were conducted at baseline, 12 and 24 weeks. Compared with WLC, the CCBT group improved significantly on approximately half of the self-report primary (the Work and Social Adjustment Scale) and approximately half of the secondary measures at both 12 and 24 weeks (the Liebowitz Social Anxiety Scale, the Penn State Worry Questionnaire, the Generalised Anxiety inventory and the Fear Questionnaire). Effect sizes in this study were moderate. This is one of the few studies to investigate CCBT for anxiety disorders in patients in a secondary care service. The results show that CCBT in this secondary care setting has the potential to be beneficial and confirms and extends the findings from previous studies of self-referral or primary care settings.

Determinants of social anxiety and social avoidance in psoriasis outpatients

Psychological stressors can contribute to the first manifestation and to later exacerbations of psoriasis. As a result of the visible and disfiguring skin lesions, psoriasis patients often develop feelings of social anxiety and stigmatization and consecutive social avoidance, which can in turn affect employment and social activities and lead to psychological distress and impairment of quality of life. However, great differences regarding social anxiety and social avoidance can be observed between different individuals, even if their disfigurement appears comparable. We intended to assess the joint impact of disease severity, mood, coping strategies, perceived social support and personal resources on social anxiety and social avoidance in psoriasis outpatients. Forty-nine psoriasis outpatients filled in self-report questionnaires (Adjustment to Chronic Skin Diseases Questionnaire, Sense of Coherence scale, Social Support Questionnaire). The PASI score was assessed by the patients' dermatologist. Social fear/avoidance showed a high and significant correlation to impairment in quality of life (0.58, P ≤ 0.001). In regression analysis, disease severity, feelings of helplessness and perceived social support jointly explained 74% of the variance of social anxiety/avoidance. Physicians treating patients with psoriasis must be aware of physical, psychological and social aspects of the disease and need to use a multidimensional approach.

Can levels of a general anxiety-prone cognitive style distinguish between various anxiety disorders?

BackgroundThe question of whether certain anxiety disorders are especially related to a cognitive style characterized by an exaggerated perception of threat and appraisal of the future as excessively unpredictable (general anxiety-prone cognitive style) remains open. ObjectivesThis study aimed to compare patients with generalized social anxiety disorder (SAD), generalized anxiety disorder (GAD), panic disorder with agoraphobia (PDA), and panic disorder without agoraphobia (PD) in terms of the levels of general anxiety-prone cognitive style when the severity of general distress and psychopathology is controlled for and to ascertain whether a co-occurring depressive disorder contributes substantially to the levels of this cognitive style. MethodsThe Anxious Thoughts and Tendencies Scale, a measure of a general anxiety-prone cognitive style, and Symptom Checklist 90—Revised were administered to 204 patients with various anxiety disorders who attended an outpatient anxiety disorders clinic and were diagnosed based on a semistructured diagnostic interview. ResultsPatients with principal diagnoses of SAD and GAD had a more prominent general anxiety-prone cognitive style than patients with principal diagnoses of PD and PDA when the severity of general distress and psychopathology was controlled for. The presence or absence of a co-occurring depressive disorder had no bearing on this finding. ConclusionsThe general cognitive component characterizes SAD and GAD more than it does PD and PDA, and a co-occurring depressive disorder does not affect this finding. These results have implications for distinguishing between various anxiety disorders.

The Acceptability of Internet-Based Treatment and Characteristics of an Adult Sample with Obsessive Compulsive Disorder: An Internet Survey

BackgroundObsessive-compulsive disorder (OCD) is a disabling anxiety disorder, but most individuals delay seeking treatment. Internet-based cognitive behavioural therapy (iCBT) is an innovative service delivery method that may help to improve access to care, but the acceptability to consumers of such programs has not yet been established.MethodologyPeople with symptoms of OCD were invited to complete an online survey enquiring about demographic characteristics, symptom severity, and acceptability of Internet-based treatment. Demographic and symptom severity data were compared with people with OCD identified in a national epidemiological survey and with a sample of patients with OCD from a specialist outpatient anxiety clinic.Participants129 volunteers to an online Internet survey, 135 patients at a specialist anxiety disorders outpatient clinic, and 297 cases identified in a national epidemiological survey.Main MeasuresDemographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale, the 12-item World Health Organisation Disability Assessment Schedule - Second Edition and the Yale Brown Obsessive Compulsive Scale - Self Report Version.Principal FindingsThe Internet sample was similar demographically but reported more severe symptoms than the comparison groups, although had similar severity of symptoms of OCD compared with other clinical samples reported in the literature. Participants reported Internet-based treatment for OCD would be highly acceptable.ConclusionsInternet-based treatment may reduce barriers to accessing treatment to people with OCD. Individuals in this study were similar demographically to other samples and had similar severity of symptoms as those identified in other clinical samples, suggesting that Internet-based treatment using techniques employed in face-to-face treatment may be effective in this group. Internet-based treatments for OCD need to be developed and evaluated.

Successful Treatment of Olfactory Reference Syndrome With Cognitive Behavioral Therapy: A Case Study

Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social isolation. Monitoring and systematic reduction of safety behaviors, combined with exposure to anxiety-provoking situations, resulted in elimination of the perceived body odor over the course of ten treatment sessions. Scores on the Overvalued Ideas Scale indicated improvements in the client's insight over the course of treatment, and there was an 82.6% reduction in her preoccupation and compulsive behaviors as measured by the Body Dysmorphic Disorder Yale-Brown Obsessive Compulsive Scale. Indices of depression, anxiety, and stress as measured by the 21-item version of the Depression Anxiety Stress Scales were also reduced from the extremely severe to normal range. These findings suggest further investigation of CBT in the treatment of ORS is warranted.

Factors that Impact Anxiety and Depression in Patients with Chronic Obstructive Pulmonary Disease

[Purpose] There are numerous reports about anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) in the literature. However, the incidence of and the factors that affect anxiety and depression differ depending on cultural backgrounds and assessment methods. In Japan, there is insufficient understanding of the mental and psychological conditions of COPD patients. To examine the comorbidity of anxiety and depression in inpatients and outpatients with COPD and to evaluate the factors affecting anxiety and depression. [Method] Mental and psychological assessments based on medical information, family composition, educational history, occupational history, respiratory function tests and the Hospital Anxiety and Depression Scale (HADS) were conducted with 156 patients with COPD as subject. [Results] The comorbidity of anxiety in all patients with COPD was 26%; moreover, the comorbidity of depression in these patients was 44%. Among inpatients, 42% displayed anxiety and 69% exhibited depression, whereas among outpatients, 18% displayed anxiety and 32% demonstrated depression. Factors causing anxiety included of living alone and hospitalization. Factors causing depression included of hospitalization, low BMI and low education level. [Conclusion] The data suggest that the causes of anxiety and depression in patients with COPD are affected by individual background. Consideration of the factors that cause these effects is important.

Anxiety, depressive symptom and suicidal ideation of outpatients with obsessive compulsive disorders in Taiwan

The major aims of this study were to explore the differences in anxiety, depressive symptoms and suicidal ideation between high and low obsessive compulsive symptom groups, as well as predictors for suicidal ideation among outpatients with obsessive compulsive disorder. Obsessive compulsive disorder is often accompanied by anxiety, depression and even suicidal ideation. However, there have been very few studies exploring the inter-relationships among anxiety, depressive symptoms and suicidal ideation for patients with obsessive compulsive disorder. This study employed a cross-sectional comparative research design. A sample of 128 outpatients with obsessive compulsive disorder was recruited from a medical teaching hospital in Northern Taiwan. The major study instruments included the Beck Anxiety Inventory, Beck Depression Inventory II, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Beck Scale for Suicide Ideation. We divided outpatients into two groups: outpatients with Y-BOCS scores higher than 15 were placed in the high obsessive compulsive symptom group, while outpatients with Y-BOCS score lower than or equal to 15 were placed in the low obsessive compulsive symptom group. Statistical methods included Pearson's product-moment correlation, independent samples t-test, chi-square test and multiple regressions. Results revealed that obsessive compulsive disorder outpatients with high Y-BOCS scores also had higher rates of being single and having an earlier onset age, poorer disease control, higher levels of anxiety, depressive symptoms and suicidal ideation. The predictors for suicidal ideation were anxiety and depressive symptoms. Obsessive compulsive disorder patients with higher obsessive compulsive symptoms are at greater risk of higher levels of anxiety, depressive symptoms and suicidal ideation. In addition to depression, anxiety symptoms contribute significantly to suicidal ideation among patients with obsessive compulsive disorder. Standard nursing care of patients with obsessive compulsive disorder should incorporate assessing levels of obsessive compulsive symptoms to identify the severity of anxiety, depressive symptoms and suicidal ideation more accurately.

Hoarding among patients seeking treatment for anxiety disorders

The aim of the present study was to examine the prevalence of hoarding symptoms among individuals presenting for treatment of anxiety symptoms. Participants included 130 adults who were seeking treatment at an outpatient anxiety disorders clinic between January 2004 and February 2006. During their initial assessment, participants (31 with panic disorder, 15 specific phobia, 27 social phobia, 36 obsessive-compulsive disorder, 21 generalized anxiety disorder, mean age 37 years, 57% female, 88% White) completed the Saving Inventory-Revised, a self-report measure of hoarding symptoms, and several measures of anxiety symptoms, depressive symptoms, and functional impairment. Approximately 12–25% of anxious patients reported significant hoarding symptoms. Patients diagnosed with generalized anxiety disorder and obsessive-compulsive disorder were more likely to report significant hoarding symptoms than were those with panic disorder or specific phobia. Hoarding symptoms were positively correlated with trait anxiety, depressive symptoms, and functional impairment. These findings suggest that hoarding symptoms may be associated with anxiety disorders other than obsessive-compulsive disorder. The findings further suggest that hoarding symptoms may be underreported by anxious populations since typical intake assessments do not include specific questions about hoarding and individuals with hoarding symptoms may be unlikely to spontaneously report them.

Characteristics of Adults with Anxiety or Depression Treated at an Internet Clinic: Comparison with a National Survey and an Outpatient Clinic

BackgroundThere is concern that people seeking treatment over the Internet for anxiety or depressive disorders may not resemble the general population or have less severe disorders than patients attending outpatient clinics or cases identified in community surveys. Thus the response to treatment in Internet based trials might not generalize.MethodologyWe reviewed the characteristics of applicants to an Australian Internet-based treatment clinic for anxiety and depression, and compared this sample with people from a national epidemiological survey and a sample of patients at a specialist outpatient anxiety and depression clinic. Participants included 774 volunteers to an Internet clinic, 454 patients at a specialist anxiety disorders outpatient clinic, and 627 cases identified in a national epidemiological survey. Main measures included demographic characteristics, and severity of symptoms as measured by the Kessler 10-Item scale (K-10), the 12-item World Health Organisation Disability Assessment Schedule second edition (WHODAS-II), the Penn State Worry Questionnaire (PSWQ), the Body Sensations Questionnaire (BSQ), the Automatic Cognitions Questionnaire (ACQ), the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS).Principal FindingsThe severity of symptoms of participants attending the two clinics was similar, and both clinic samples were more severe than cases in the epidemiological survey. The Internet clinic and national samples were older and comprised more females than those attending the outpatient clinic. The Internet clinic sample were more likely to be married than the other samples. The Internet clinic and outpatient clinic samples had higher levels of educational qualifications than the national sample, but employment status was similar across groups.ConclusionsThe Internet clinic sample have disorders as severe as those attending an outpatient clinic, but with demographic characteristics more consistent with the national sample. These data indicate that the benefits of Internet treatment could apply to the wider population.

The application of relax training to improve the anxiety and sleep quality of outpatients with chronic disease

Objective To explore methods that could improve the anxiety level and sleep disturbance in outpatients who were suffering from chronic diseases. Methods A total of 60 outpatients who had been receiving intravenous infusion as their current treatment and showed high levels of anxiety and sleep disturbance were recruited and randomized to 2 groups: Experimental Group ( n = 30 ) and Control Group ( n = 30 ). Patients in the Experimental Group were trained 4 weeks relaxation program by nurses, while patients in the Control Group received regular intravenous infusion following prescriptions. The Self-rating Anxiety Scale (SAS) and Athens Insomnia Scale (AIS) were administered pre and post intervention. Results The results revealed that there were statistically lower in Experimental Group than in Control Group with respect to anxiety level and sleep disturbance. Conclusions Relaxation training could improve anxiety level and sleep disturbance in outpatients of chronic diseases. Key words: Relaxation training; Anxiety; Sleep disturbance; Chronic disease patient

Do Symptom Interpretations Mediate the Relationship Between Panic Attack Symptoms and Agoraphobic Avoidance?

There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD

Previous research indicates a high prevalence of untreated anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). The current study examined the effect of cognitive behavioral therapy (CBT) in groups for co-morbid, clinically significant anxiety and depression in COPD outpatients of both sexes. In a randomized, controlled trial, CBT (n = 25) was compared with enhanced standard care (n = 26). Participants in both conditions were followed up at 2 and 8 months from baseline. Main outcome measures comprised the Beck Anxiety Inventory and the Beck Depression Inventory-II. Measures of health status and sleep were included as secondary outcomes. The effects of sex and age were also investigated. CBT resulted in improvement in symptoms of anxiety and depression, with effect sizes of 1.1 and 0.9 at post-treatment, respectively. The improvement was maintained at the 8-month follow-up, with effect sizes of 1.4 and 0.9. In the control group, there was no significant change. Compared to men, women had higher symptom levels throughout the whole study period. Younger patients had more anxiety and depression, age had also differential effects in the two groups on change in depressive symptoms. Changes in sleep and health status were small in both groups. The findings indicate that CBT may provide rapid symptom relief for COPD patients with clinically significant anxiety and depression, and underline the need for integrating mental health care into the overall medical regimen for COPD.

Anxiety and depression in head and neck out-patients

To investigate the prevalence of psychological distress in head and neck out-patients. We used the Hospital Anxiety and Depression Scale to screen 106 patients for mood disorders in a London head and neck ENT out-patient clinic. Queen's Hospital, Romford, UK. One hundred and six patients attending a head and neck out-patient clinic. Hospital Anxiety and Depression Scale score. Approximately 39 per cent of patients had a possible anxiety disorder (10 per cent were rated as severe), and 27 per cent had possible depression (10 per cent were rated as severe). We recommend that a member of the head and neck multidisciplinary team should be trained to identify and correctly refer psychologically distressed patients to appropriate existing psychiatric services.

Influence of nursing intervention on anxiety and pains of out-patients who had accepted operation

Objective To know the correlation of anxiety and pains of out-patients who had accept-ed operation and the effect of nursing intervention. Methods Divided 173 out-patients with operation in-to the intervention group(83 cases) and the control group(90 cases) randomly. Routine nursing cares was used in the control group, preoperative health education was used in the intervention group in addition. Us-ing the Me-Gill and SF-MPQ to evaluate pains between the 2 groups. Using the S-AI and the T-AI to evaluate the emotional condition between the 2 groups. Results The indexes which can indicated the pains and emotional condition in the intervention group after the health education were significant better than those of in the control group and themselves before the nursing intervention. Conclusions Preoperative pains and emotional condition should be evaluated among out-patients, and then carry out certain counter nursing measures to release patients' pain and negative emotion. Key words: Out-patient; Anxiety; Pains; Relevance; Nursing

P01-280 - Depression, anxiety and vital exhaustion are associated in outpatients with bronchial asthma

ObjectivesMany studies have attempted to delineate the positive relationship between anxiety and depressive symptomatology in outpatients with bronchial asthma. However, do not exist reports on the relation between the depression, anxiety and vital exhaustion in these patients.Aim of the study is to investigate the levels and the associations between anxiety, depression and vital exhaustion in outpatients with bronchial asthma.MethodsThe study was performed in one of the largest hospitals of chest diseases in Greece. Forty (14 men και 26 women) outpatients with bronchial asthma participated in the study. Using the BDI (Beck Depression Inventory), the STAI (Spielberger Anxiety Trait Inventory) and the Maastricht Questionnaire (MQ) we assessed depression, anxiety and vital exhaustion, respectively. Age and duration of the disease were also recorded.ResultsMeans of age and of duration of the disease were 43.22±13.05 and 9.24±6.01 years, respectively. The mean STAI score was 42.47±9.9, mean BDI score was 14,16±7,54, and the mean MQ score was 21.02±11.05. Percentages of 29% and 60% of the sample were presented with significant anxiety and depressive symptoms, respectively. No correlation was observed between the demographics (age and duration of disease) and the STAI's and MQ's scores. In contrary, a positive correlation was observed between the levels of depression, anxiety and vital exhaustion (pearson correlation p&lt; 0.001).ConclusionsThe study confirms the coexistence of the depressive symptomatology with anxiety and vital exhaustion in outpatients with bronchial asthma. Therefore, this comorbidity should be taken into account in order to develop specific supportive psychological interventions.

Prevalence of Depression and Anxiety in Outpatients with Chronic Airway Lung Disease

Background/AimsPatients with chronic airway lung diseases often experience depression and anxiety, but little information is available regarding Koreans with these conditions. We thus assessed depression and anxiety in Korean patients with chronic airway lung diseases.MethodsThe degree of depression and anxiety in 84 outpatients with chronic obstructive pulmonary disease (COPD), 37 with asthma, 33 with bronchiectasis, and 73 healthy controls were evaluated by the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI).ResultsThe patients with COPD and bronchiectasis had higher BDI scores and were more likely than controls to experience depression ([COPD, 17; range, 0 to 42; prevalence, 55%], [bronchiectasis, 16; range, 3 to 51; prevalence, 55%], [controls, 13; range, 0 to 31; prevalence, 30%], p < 0.05). The state-anxiety scores of the patients were higher than those of the controls, but only the bronchiectasis group demonstrated a higher frequency of state-anxiety compared with the controls (39 vs. 16%, patients vs. controls, p = 0.015). Among all patients, 22% presented with concomitant depression and state-anxiety, and 25% demonstrated depression and trait-anxiety. Depression was positively correlated with both state-anxiety (r = 0.644) and trait-anxiety (r = 0.597, p < 0.0001). Irrespective of individual diagnosis, post-bronchodilator FEV1 (odds ratio [OR], 0.972; p = 0.027) and smoking history (OR, 3.894; p = 0.018) were independent risk factors for depression in patients with chronic airway lung diseases.ConclusionsChronic airway lung diseases are associated with depression and/or anxiety, particularly in those with a higher airflow limitation and/or history of smoking.

Actigraphic assessment of daily sleep–activity pattern abnormalities reflects self‐assessed depression and anxiety in outpatients with advanced non‐small cell lung cancer

We measured subjectively evaluated depression and anxiety, and objectively measured daily sleep-activity patterns in inpatients and outpatients with advanced non-small cell lung cancer (NSCLC) and determined whether cancer-associated depression and anxiety are accompanied by characteristic circadian rhythm abnormalities. Equal numbers of inpatients (n=42) and outpatients (n=42) with advanced NSCLC were studied. Baseline depression and anxiety, assessed by the Hospital Anxiety and Depression Scale (HADS), and actigraphy were recorded before chemotherapy initiation. The effects of the presence and severity of chronic obstructive pulmonary disease (COPD) on depression, anxiety, and actigraphy were assessed only among the 42 outpatients. Anxiety occurred in 40% and depression in 25% of these lung cancer patients, equally among inpatients and outpatients. All patients suffer extremely disturbed daily sleep-activity cycles but each patient also maintains some degree of circadian organization. Outpatients maintain more robust daily activity patterns and longer, more consolidated nighttime sleep compared with inpatients. The more disrupted the daily sleep-activity rhythm, the worse the depression and/or anxiety scores for outpatients. These relationships are obscured among inpatients. COPD has no independent measurable effects on the daily organization of sleep-activity, depression, or anxiety. Lung cancer patients whose diurnal activity is disturbed by prolonged and frequent sedentary episodes and whose sleep is disturbed by frequent and prolonged waking are most anxious and depressed. These findings and relationships are masked by hospitalization. Since diurnal exercise improves both sleep and mood, it is reasonable to test whether enhancing daytime activity and nighttime sleep can diminish cancer-associated depression.