Hospital Anxiety And Depression Scale Anxiety Subscale Research Articles

Prognostic impact of self-reported health on clinical outcomes in patients with heart failure.

An in-depth understanding of the prognostic value of patient-reported outcomes (PRO) is essential to facilitate person-centred care in heart failure (HF). This study aimed to clarify the prognostic role of subjective mental and physical health status in patients with HF. Patients with HF were identified from the DenHeart Survey (n = 1499) and PRO data were obtained at hospital discharge, including the EuroQol five-dimensional questionnaire (EQ-5D), the HeartQoL, and the Hospital Anxiety and Depression Scale (HADS). Clinical baseline data were obtained from medical records and linked to nationwide registries with patient-level data on sociodemographics and healthcare contacts. Outcomes were all-cause and cardiovascular (CV) mortality, CV events, and HF hospitalization with 1- and 3-year follow-up. Analysing the PRO data on a continuous scale, a worse score in the following were associated with risk of all-cause and CV mortality after 1 year: the HeartQoL (adjusted hazard ratios (HRs) 1.91, 95% confidence interval (CI) 1.42-2.57 and 2.17, 95% CI 1.50-3.15, respectively), the EQ-5D (adjusted HRs 1.26, 95% CI 1.15-1.38 and 1.27, 95% CI 1.13-1.42, respectively), the HADS depression subscale (adjusted HRs 1.12, 95% CI 1.07-1.17 and 1.11, 95% CI 1.05-1.17, respectively), and the HADS anxiety subscale (adjusted HRs 1.08, 95% CI 1.03-1.13 and 1.09, 95% CI 1.04-1.15, respectively). Three-year results were overall in concordance with the 1-year results. A similar pattern was also observed for non-fatal outcomes. Health-related quality of life and symptoms of anxiety and depression at discharge were associated with all-cause and CV mortality at 1- and 3-year follow-up.

Incidence of contralateral neurosensitive changes and persistent postoperative pain 6 months after mastectomy: A prospective, observational investigation.

Mirror image sensory dysfunction (MISD) after breast surgery has not yet been studied. This prospective observational study aimed to determine the incidence of MISD, persistent postoperative pain (PPP) and mirror image pain (MIP) during 6 months after total unilateral mastectomy.Visual analogue scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Life orientation test (LOT) and Quantitative Sensory Testing (QST) (in ipsi and contralateral breast, axilla and thigh) were recorded. VAS > 3 at 1, 3, and 6 postoperative months was considered PPP. Contralateral changes of QST at any time was considered indicative of MISD and spontaneous contralateral VAS ≥ 1 as MIP.Sixty-four patients were included. PPP at 1, 3 and 6 months was 18.8%, 56.2%, and 21.3%, respectively Ten patients presented MIP. MISD was detected in 79.7% patients in contralateral breast and 62.5% in contralateral axilla. Furthermore, changes in QST were present in 39.1% of patients in thigh. Electronic Von Frey (EVF) changes in both contralateral breast and axilla, and in thigh significantly diminished at all postoperative times. Changes of postoperative EVF ≥ 20% in contralateral breast were associated to higher VAS values. NPSI scores were significantly higher at all postoperative times. At 1 month, PCS, depression HADS subscale and LOT scores were significantly worse than all the other periods.MISD incidence was almost 80%, and 15.6% of patients showed spontaneous contralateral VAS ≥ 1. At 6 months 21.3% of patients manifested PPP. The worst alteration of factors related to PPP occurred at 1 postoperative month. Most consistent QST was EVF.

Influence of DISC behavioral profile on the short- and long-term outcomes of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

IntroductionPulmonary rehabilitation (PR) programs are commonly prescribed for patients with severe respiratory disorders, but little is known about how the patient's personality traits influence PR outcomes. We analyzed the response of patients with chronic obstructive pulmonary disease (COPD) to a home-based PR program according to their predominant behavioral profiles using the Dominance – Influence – Steadiness – Conscientiousness (DISC) tool. MethodsThis was a retrospective observational study of 335 COPD patients referred by their pulmonologists between January 2010 and December 2015. The DISC behavioral profile was determined at the beginning of the program. Patients received individual supervised sessions at home once a week for 8 weeks, which consisted of exercise training and psychosocial, motivational, and educational support, all tailored to the participant's DISC profile. Exercise tolerance (6-minute stepper test, 6MST), anxiety and depression (Hospital anxiety and depression scale, HADS), and quality of life (Visual simplified respiratory questionnaire, VSRQ) were evaluated immediately before and after the PR program (T0 and T2, respectively) and then 6 and 12 months later (T8 and T14, respectively). Responders were defined as patients who exhibited at least minimal clinically important differences (improvements) from baseline. ResultsOf the 335 COPD patients, 102 (30.4%), 98 (29.3%), 82 (24.5%), and 53 (15.8%) were classified as having predominant D, I, S, and C behavioral traits, respectively. All four patient groups showed significantly (P<0.01) improved performance in the 6MST, HADS, and VSRQ evaluations at T2 (n=300), T8 (n=262), and T14 (n=231) compared with T0, and the proportion of responders in all groups at T8 and T14 was high (∼60%). The percentage of responders differed significantly between groups only at T2, when the S group contained fewer responders on the HADS anxiety subscale. Most patients who did not complete the study were classified as D type (42/102, 41.2%), followed by I (28/98, 28.6%), S (22/82, 26.8%), and C (12/53, 22.6%) types. ConclusionThe personality profile of COPD patients influenced their adherence to, but not their benefit from, a home-based PR program. The high proportion of patients in all personality groups showing significant improvements in outcomes supports a personalized approach to the design of PR programs.

Adherence to Physiotherapy-Guided Web-Based Exercise for Persons with Moderate-to-Severe Multiple Sclerosis: A Randomized Controlled Pilot Study.

Options to support adherence to physical activity in moderate-to-severe multiple sclerosis (MS) are needed. The primary aim was to evaluate adherence to a Web-based, individualized exercise program in moderate-to-severe MS. Secondary aims explored changes in 29-item Multiple Sclerosis Impact Scale, Hospital Anxiety and Depression Scale (HADS), grip strength, Timed 25-Foot Walk test, and Timed Up and Go (TUG) results. Participants were randomized (2:1) to a physiotherapist-guided Web-based home exercise program or a physiotherapist-prescribed written home exercise program. The primary outcome was adherence (number of exercise sessions over 26 weeks). Secondary outcomes were described in terms of means and effect sizes. There were 48 participants: mean ± SD age, 54.3 ± 11.9 years; disease duration, 19.5 ± 11.0 years; and Patient-Determined Disease Steps scale score, 4.4 ± 1.6. There was no significant difference in mean ± SD adherence in the Web-based group (38.9 ± 28.1) versus the comparator group (34.6 ± 40.8; U = 198.5, P = .208, Hedges' g = 0.13). Nearly 50% of participants (23 of 48) exercised at least twice per week for at least 13 of the 26 weeks. Adherence was highest in the Web-based subgroup of wheelchair users. Medium effect sizes were found for the HADS anxiety subscale and in ambulatory participants for TUG. There were no adverse events. There was no difference in exercise adherence between the Web-based and active comparator groups. There was no worsening of secondary outcomes or adverse events, supporting the safety of Web-based physiotherapy. More research is needed to determine whether wheelchair users might be most likely to benefit from Web-based physiotherapy.

Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

Background and purposeEarly supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied.The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine.MethodsA randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation.The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS).ResultsNo significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke.ConclusionsThe VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit.Trial registrationClinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

Unintended consequences of screening for anxiety and depression among survivors of pediatric, adolescent, and young adult (P-AYA) cancer.

148 Background: Screening for psychosocial issues has been mandated to identify survivors in need of assistance and improve outcomes. Although screening identifies some individuals at risk for difficulties, many who screen positively ultimately decline intervention. Moreover, screening has the potential to "miss" patients who desire intervention but screen negatively for psychosocial need. We explored these issues among a sample of adult survivors of P-AYA cancer. Methods: Survivors of P-AYA cancer &gt; 2 years from end of treatment completed an assessment including the Hospital Anxiety and Depression Scale (HADS) and desire for assistance with Anxiety and Depression following a survivorship visit. HADS subscale scores of &gt; 8 indicated at least mild symptoms. Results: Participants (N = 237) were predominately white (89%), college educated (76%), single (63%), and had an annual income of &gt; $60,000 (69%). A plurality had diagnoses of leukemia (30%) or Hodgkin's lymphoma (29%) treated 17 years previously. Treatment included surgery (35%), chemotherapy (91%), XRT (59%), and BMT (17%). Anxiety (M = 6.02; SD = 3.07) and depression (M = 2.54; SD = 2.85) scores were low and below the cutpoint of 8 (all t &lt; -7.8; p &lt; .001 ), although 21% and 9% screened positively for anxiety or depression, respectively. Screening positive for anxiety was associated with a desire for intervention (X2 = 20.77; p &lt; .001 ), while screening positively for depression was not (p &gt; 0.05). Among those screening positively for anxiety, 50% desired intervention, while among those screening positively for depression only 38% desired intervention. Moreover, among those desiring intervention for anxiety or depression, 36% and 68% screened negatively for symptoms, respectively. Conclusions: Many P-AYA survivors screening positively for anxiety or depression do not desire intervention. As well, screening would exclude between 36%-68% of those desiring intervention, representing a missed opportunity to potentially improve outcomes. Screening without assessing desire for intervention likely over identifies individuals who do not desire help while missing a relatively large number of those who do wish for assistance.

1811P - Accuracy of distress thermometer to measure cancer-related mood disorders in Chinese patients with cancer

BackgroundScreening and management of distress are essential. The Distress thermometer (DT) is a common screening tool. However, it’s cutoff score and the accuracy properties such as sensitivity and specificity is still unclear in Chinese cancer patients. MethodsIn this cross-sectional study, DT was compared against the Hospital Anxiety and Depression Scale (HADS) in 784 heterogeneous cancer inpatients. The HADS cutoff score ≥15, ≥6, and ≥9 were used to define distress, anxiety, and depression respectively. Receiver operating characteristic (ROC) analysis was applied to determine the discriminative accuracy of DT against each scale. ResultsWhen DT was compared against HADS-T, ROC showed an excellent area under the curve (AUC) of 0.903. The optimal cutoff score of 4 yielded sensitivity (SE)=89.3%, specificity (SP)=85.8%, positive predictive value (PPV)=89.9%, negative predictive value (NPV)=85.0%, screening utility (UI-)=.729, and case-finding utility (UI+)=.802. Furthermore, compared With HADS subscales, AUC=0.801 with a cutoff score 3 on DT optimally detected SE=80.7%, SP=64.5% PPV=89.4%, NPV=47.3%, UI-=.369, andUI+=.721 for anxiety and AUC=0.802 with a cutoff score of 4 on DT optimally detected SE=88.3%, SP=65.3%, PPV=66.4%, NPV=87.8%, UI-=.573 and UI+=.586 for depression respectively. DT Scores were moderately correlated with HADS-Total, HADS-Anxiety, andHADS-Depression. Female gender, low education level, advanced cancer stage, no exercise habit, suicidal ideation and months since diagnosis more than 12 were found to be associated with distress. ConclusionsFor Chinese patients with cancer, DT is an efficacious screening and case finding a tool for distress. Among the subscales, DT performed well in both screening and case finding for depression, however, although the case finding was good it carried a poor screening ability for anxiety. Legal entity responsible for the studyThe author. FundingHas not received any funding. DisclosureThe author has declared no conflicts of interest.

No Differences in HADS Scores Between Acutely Concussed and Healthy Collegiate Student-Athletes

ObjectiveTo investigate differences in Hospital Anxiety and Depression Scale (HADS) scores between acutely concussed collegiate student-athletes and healthy, matched group of collegiate athletes.BackgroundMood disturbances have been documented acutely following concussion. The presence of anxiety and/or depression may complicate and prolong concussion recovery among some athletes. Therefore, it is important to examine acute post-injury anxiety and depression to facilitate proper management decisions.Design/MethodsTwenty-six student-athletes (54% female, 19.92 ± 5.56 years of age) with a diagnosed concussion completed the HADS questionnaire within a week of injury. Twenty-six healthy student-athletes (54% female, 18.82 ± 0.54 years of age) completed the HADS during pre-season baseline testing, individually matched by sex and sport. Independent samples t-tests were used to explore differences in HADS scores between groups.ResultsThere was no significant difference (p = 0.50) between total HADS scores of the concussion group (6.77 ± 6.17) and healthy cohort (5.81 ± 3.85). There were also no significant differences between concussion and uninjured groups on the HADS Anxiety subscale (4.38 ± 4.24 vs. 4.50 ± 2.83; p = 0.91) or HADS Depression subscale (2.38 ± 2.82 vs. 1.31 ± 1.67; p = 0.10).ConclusionsHADS scores obtained among collegiate student athletes acutely following concussion did not significantly differ relative to matched healthy control participants. It is possible that one week post-injury was not enough time to observe measurable effects of anxiety or depression, as those are commonly seen in cases of prolonged recovery.

Adaptation and validation of the memorial anxiety scale for prostate cancer (MAX-PC) in a sample of French men

IntroductionThe Memorial Anxiety Scale for Prostate Cancer (MAX-PC, 18 items) was developed to assess anxiety in prostate cancer patients. In the absence of a French version of this scale, we adapted the original English scale and evaluated its psychometric properties in a sample of French men diagnosed with prostate cancer in the previous 12 months.MethodsThe MAX-PC was translated from English to French and distributed online by two non-profit organizations (Seintinelles and ANAMACaP). The French questionnaire, which also included the Hospital Anxiety and Depression Scale (HADS) and a measure of health-related quality of life (SF12), was intended for adults diagnosed with prostate cancer in the previous 12 months. Factor structure was assessed using exploratory factor analysis (EFA) on data from 56.2% of the sample (n = 104, Seintinelles subsample) and confirmed using confirmatory factor analysis (CFA) on data from the rest of the sample (n = 81, ANAMACaP subsample). The reliability of the scale was measured using Cronbach’s alpha coefficient. Construct validity was assessed by calculating the correlation of the MAX-PC total score and subscale scores with the HADS total score and subscale scores and with the SF12 total score and subscale scores.ResultsOf the 185 respondents, 168 (90.8%) had complete data on all MAX-PC items. The average age of participants was 65.1 years (SD: 7.7). The three-factor structure defined in the original validation study was very similar in EFA and then confirmed by CFA. The MAX-PC showed good reliability, as Cronbach’s alpha coefficients for the scale and for its three subscales were 0.92, 0.90, 0.68, and 0.87, respectively. It also showed good construct validity. As expected, the MAX-PC total score was positively correlated with the HADS-Anxiety subscale score (r = 0.68, p < 0.001) and negatively correlated with the SF12-MCS subscale score (r = − 0.35, p < 0.001).ConclusionThe French version of the MAX-PC shows adequate psychometric properties among French men with prostate cancer. This scale may be used in future studies and in routine clinical care to help health care providers identify patients who need psychological support due to prostate-cancer related anxiety.

The Correlation Between the Level of Anxiety According to the Hospital Anxiety and Depression Scale-Anxiety Subscale with the Duration of Illness, the Age of the Caregiver, and the Age of First Illness in the Biological Mother Who Takes Care of Boys with Schizophrenia.

BACKGROUND:Caregivers are often described as forgotten patients, and adverse effects are often reported by family caregivers, including anxiety in treating schizophrenic patients. In most cases, it is the mother who takes almost all responsibilities for caring for the patient with schizophrenia. From another study, Mothers showed the highest-burden, followed by fathers and other caregivers.AIM:To find out the correlation between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) with the duration of illness, the age of the caregiver, and the age of first illness in the biological mother who take care of boys with schizophreniaMETHODS:This study is an Observational Analytical study with a cross-sectional approach. By interviewing 68 mothers who take care of boys with schizophrenia at the Prof Ildrem Mental Hospital Medan using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A).RESULTS:This study found a significant association between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and the age of caregivers in biological mothers who care for boys with schizophrenia (p = 0.019), odds ratio (OR) 12,073 (95 %CI 2.252-64.715). This study also found no association between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and the duration of illness in the biological mother who cared for boys with schizophrenia (p = 0.736). There was no association between the level of anxiety according to the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) with age of first illness schizophrenia in the biological mother who cared for boys with schizophrenia (p = 0.068).CONCLUSION:Possibility (odds) is found that the age of caregiver < 45 years old is more likely to have anxiety level according to the Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A) 12,073 worse compared to the age of caregiver ≥ 45 years old.

Evolution Of Exercise-related Dyspnea In Response To Anxiety-provoking Or Relaxing Situations In Healthy Subjects

Exertional dyspnea, characterized as a symptom of discomfort or difficulty in breathing, is a common complaint in healthy individuals and in many pathologies. Previous studies have shown that emotions including anxiety and stress influenced the perceived unpleasantness of dyspnea. PURPOSE: The aim of this study was to investigate the effects of relaxing and anxiety-provoking situations on exercise-related dyspnea, heart and respiratory rates, blood pressure, mood state, anxiety and depression in healthy subjects. METHODS: Twenty-two healthy adults were included in this randomized cross-over study. Each participant performed three submaximal cycling exercise for 30 minutes on three separate days in a randomized order: a neutral condition (NC) with no particular effect, a relaxing condition (RC) where each subject listened to relaxing music and an anxiety-provoking condition (APC) where a horror movie was broadcast. Heart and respiratory rates, blood pressure, dyspnea using the Multidimensional Dyspnea Profile (MDP) and modified Borg scales, mood state using the Profile of Mood States (POMS), anxiety and depression using the Hospital Anxiety and Depression scale (HADS) were evaluated before and 5 minutes after each intervention. In addition, heart and dyspnea rates were measured throughout the intervention. RESULTS: Dyspnea and heart rates increased more with APC than NC (1.68±0.15 vs 1.32±0.12 RPE, p<0.01 and 138±2 vs 119±1 bpm, p<0.001). In addition, submaximal exercise with APC showed a higher increase than NC in the subscales “breathing discomfort” (2.50±0.18 vs 1.86±0.11, p=0.02) and “emotional response domain” (6.82±1.55 vs 0.95±0.34, p<0.001) of MDP, global POMS score (11.73±3.58 vs -4.64±2.3, p<0.001) and HADS-Anxiety subscale (8.59±1.27 vs 3.27±0.61, p<0.001) and the dyspnea rates (0.64±0.12 vs 0.14±0.07 RPE, p<0.001). No significant difference were observed between NC and RC. CONCLUSION: Exercise-related dyspnea and anxiety increased with APC in healthy subjects. In contrast, results did not show difference in any parameters with RC. Many activities and daily life situations can lead the patient with a chronic disease to experience dyspnea. Future studies should investigate strategies to reduce dyspnea in chronic diseases and in fine, improve quality of life of these patients.

The relationship between alcohol use and anxiety and retrospective attendance of primary care visits among women with human immunodeficiency virus

ABSTRACTIn this retrospective study, we sought to determine the associations between alcohol use and anxiety and RIC among WHIV. Alcohol use was assessed using the Timeline Follow-back to measure use over the 90 days preceding the interview. Anxiety symptoms scores, assessed with the Hospital Anxiety and Depression Scale- Anxiety Subscale (HADS-A). Primary care visits over twelve months prior to the interview were collected from clinic registration records. We used three logistic mixed models, adjusting for age, race, education, cocaine use, depression, viral load, and antiretroviral therapy (ART) status. Among 364 WHIV, mean attendance of primary care visits was 63.9%. Every one-day increase in drinking days (OR = 0.99, 95% CI 0.99, 1.00) or heavy drinking days (OR = 0.99, 95% CI 0.90, 1.00) was associated with decreased odds of attending primary care visits (P = 0.02). Moderate/severe anxiety scores, compared to minimal anxiety scores, were associated with decreased odds of attending primary care visits (OR = 0.69, 95% CI 0.50, 0.97). Cocaine use was associated with decreased odds of attending primary care visits (OR 0.56, 0.57). Our findings indicate that identifying and treating WHIV with alcohol use (especially heavy drinking), moderate/severe anxiety symptoms and/or cocaine use could potentially improve their RIC.

Randomized Trial of a Tailored Cognitive-Behavioral Therapy Mobile Application for Anxiety in Patients with Incurable Cancer.

The aim of this study was to test the efficacy of a tailored cognitive-behavioral therapy (CBT) mobile application (app) to treat anxiety in patients with incurable cancer. Patients with incurable cancers (n = 145) who reported elevated anxiety symptoms at two cancer centers were randomized to receive either the CBT mobile app for anxiety or a mobile health education program (control) delivered via tablet computers, which patients self-administered over 12 weeks. To assess anxiety, depression symptoms, and quality of life (QOL), we used the Hamilton Anxiety Rating Scale (HAM-A, primary outcome), Clinical Global Impression Scale, Hospital Anxiety and Depression Scale (HADS), Patient Health Questionnaire-9, and Functional Assessment of Cancer Therapy-General at baseline and 12 weeks. Analysis of covariance models were calculated to assess intervention effects on patient outcomes. Patients (73.8% female; 91.0% white; mean age = 56.45 years, SD = 11.30) in both study groups reported improvements in anxiety, depression symptoms, and QOL from baseline to postassessment, with no significant differences in any outcome measure between groups. Secondary analyses showed that, among the subgroup of patients with severe baseline anxiety, those randomized to the CBT app had greater improvements on the HAM-A (Mean Difference = 7.44, standard error [SE] = 3.35, p = .037) and HADS-Anxiety Subscale (Mean Difference = 4.44, SE = 1.60, p = .010) compared with the control group. Both the tailored CBT app for anxiety and the health education program were associated with improvements in anxiety, mood, and QOL, but these outcomes did not differ between study groups. The CBT app was more beneficial than health education for patients with severe baseline anxiety. A cognitive-behavioral therapy mobile application tailored to treat anxiety in patients with advanced cancer helps improve access to evidence-based supportive care in a convenient, private, and timely manner.

Single Questions for the Screening of Anxiety and Depression in Hemodialysis.

Background:Depression and anxiety are common and underrecognized in end-stage renal disease (ESRD), are associated with poor outcomes and reduced health-related quality of life, and are potentially treatable. Simple, accurate screening tools are needed.Objective:We examined the operating characteristics of single questions for anxiety and depression from the Edmonton Symptom Assessment System (ESAS) in hemodialysis.Design:Cross-sectional study.Setting:Two outpatient hemodialysis units (1 tertiary, 1 community) in Hamilton, Canada.Patients:Adult prevalent hemodialysis patients.Measurements:ESAS and Hospital Anxiety and Depression Scale (HADS).Methods:Participants were asked the degree to which they experienced anxiety and depression using the ESAS. ESAS single questions for anxiety and depression were compared with the reference standard of the HADS using dialysis population specific cutoffs (HADS anxiety subscale ≥6 and HADS depression subscale ≥7). Logistic regression was used to create receiver operating characteristics (ROC) curves.Results:We recruited 50 participants with a mean age of 64 (SD = 12.4) years, of whom 52% were male and 96% were on ≥3× weekly hemodialysis. Using the reference standards, 28 (56%) had a diagnosis of anxiety and 27 (54%) had a diagnosis of depression. Areas under the ROC curves were 0.83 for anxiety and 0.81 for depression using ESAS scores of ≥2.Limitations:Sample size and the lack of a reference gold standard.Conclusions:The ESAS single questions for anxiety and depression have reasonable discrimination in a hemodialysis population. The use of more complex and time-consuming screening instruments could be reduced by adopting the ESAS questions for anxiety and depression in hemodialysis.

Reliability and validity of the Depression and Somatic Symptoms Scale among patients with chronic low back pain.

BackgroundThe Depression and Somatic Symptoms Scale (DSSS), which is a free scale that includes a depression subscale (DS) and a somatic subscale (SS), was developed to evaluate depression and somatic symptoms simultaneously. This study aimed to examine the reliability and validity of the DSSS among patients with chronic low back pain (CLBP).MethodsTwo-hundred and twenty-five patients with CLBP were enrolled. Psychiatric diagnoses were made based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. The DSSS, Oswestry Disability Index, Hospital Anxiety and Depression Scale (HADS), and Short Form 36 (SF-36) were administered. Cronbach’s alpha was used to test internal consistency. Receiver operating characteristic (ROC) analysis was used to identify cutoff scores for a major depressive episode (MDE).ResultsSubjects with an MDE (N=21) had greater severities of depression, anxiety, somatic symptoms, and disability as compared with those without an MDE. The Cronbach’s alpha values of the DS and SS were 0.90 and 0.83, respectively. The DS and SS were significantly correlated with the Oswestry Disability Index, the HADS, and the SF-36 subscales. The DS had the greatest area under the receiver operating characteristic curve (0.96) as compared with the SS and the HADS subscales. The cutoff score for an MDE was a DS score ≥15 (sensitivity and specificity: 100% and 88.7%, respectively).ConclusionThe DSSS subscales were of acceptable reliability and validity. The DS can be used as a tool for evaluating the severity of depression and detecting an MDE in patients with CLBP.

Effect of Wellness Education on Quality of Life of Patients With Non-Small Cell Lung Cancer Treated With First-Line Icotinib and on Their Family Caregivers.

Objective: To examine the effects of a wellness-education intervention on quality of life (QOL) of patients with NSCLC treated with icotinib and on their caregivers. Methods: This feasibility study was a prospective pilot randomized controlled trial to evaluate a wellness-education intervention in NSCLC patients and caregivers undergoing icotinib treatment. The participants in the wellness-education group were provided with well-being information over 8 weeks. The Family Environment Scale (FES), Functional Assessment of Cancer Therapy–Lung (FACT-L), Caregiver QOL Index–Cancer Scale (CQOLC), and Hospital Anxiety and Depression Scale (HADS) were measured at baseline prior to randomization and after 8 weeks. Patients completed the FACT-L and HADS, caregivers completed the CQOLC and FES. Results: 67 patients/caregivers in the wellness-education group and 71 in the control group could be analyzed. Feasibility targets were the following: (1) >70% study enrollment of eligible patients; (2) >90% of participants completing this study; (3) <10% missing data. Wellness-education group had better change scores at 8 weeks for the emotional well-being subscale of FACT-L (12.8 vs 15.6, P = .014), anxiety subscale of HADS (6.1 vs 6.7, P = .030), adaptation (66.0 vs 54.7, P = .037) and financial subscales of CQOLC (70.8 vs 69.8, P = .044), and the cohesion (7.3 ± 1.8 vs 5.7 ± 1.7, P= .021) and conflict (3.4 ± 1.9 vs 4.5 ± 1.7, P = .031) subscales of the FES. Conclusion: Wellness-education in patients/caregivers with NSCLC treated with icotinib are feasible and could improve patients’ QOL and their relationship with caregivers.

Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory (STAI) accuracy for anxiety disorders detection in drug-resistant mesial temporal lobe epilepsy patients.

Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) is the most prevalent type ofsurgically remediable epilepsy and highly associated with psychiatric comorbidities. This study aimed to evaluate Hospital anxiety and depression scale-anxiety subscale (HADS-A) and The State-Trait Anxiety Inventory - Trait subscale (STAI-T) accuracy for detection of anxiety disorders in patients with drug-resistant MTLE-HS. One hundred three consecutive patients with drug-resistant MTLE-HS were enrolled. Diagnosis was based on the anamnesis, neurological examination, video-electroencephalogram (VEEG) analyses, and magnetic resonance imaging (MRI). Psychiatric interviews were based on DSM-IV-TR criteria and ILAE Commission of Psychobiology classification as a gold standard; HADS-A and STAI-T were used as psychometric diagnostic tests, and receiver operating characteristic (ROC) curves were used to determine the optimal threshold scores. The areas under the curve (AUCs) were higher than 0.7 (0.6-0.8) for both scales. The STAI-T cutoff point of ˃53 and the HADS-A cutoff point of ˃7 showed both around of 80% (44.4-97.7) sensitivity and 80% (66.9-86.9) and 60% (46.5-68.6) of specificity, respectively. In this sample the prevalence of anxiety disorders was 11.7% and both scales showed a high negative predictive value such as 96% (87.1-99.0) but low positive predictive value such as 30% (22.1-45.2) and 20% (15.0-27.2) respectively. The small number of cases in the diagnostic population; the results are only applied to drug resistant MTLE-HS; the psychiatric diagnosis were not based on a structured psychiatric interview; possible observer bias in 7 illiterate patients; the antidepressant treatment was not controlled. In MTLE-HS, STAI-T and HADS-A had a similar and low positive predictive value and high negative predictive value. The implications for the HADS-A and STAI-T usefulness for anxiety disorders screening in patients with other epilepsies types deserve further investigations. If replicated in other populations, these findings may have important relevance for the presurgical screening of anxiety disorders in MTLE-HS patients who are candidates to epilepsy surgery.

Socio-demographic characteristics as correlates of psychological distress

PurposeThe purpose of this paper is to assess the level of psychological distress of offenders newly brought into prison custody in a Nigerian prison and investigate the relationship with socio-demographic and penal characteristics.Design/methodology/approachA cross-sectional study involving 236 new prison entrants who were assessed for psychological distress using the 12-item General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS).FindingsA total of 267 prison inmates were newly brought to prison custody over a three-month period. Out of this, 236 (88.4 per cent) of them participated in the study. Majority of the inmates were males 225 (95.3 per cent), awaiting-trial inmates 208 (88.1 per cent), single 144 (61 per cent), Christian 224 (94.9 per cent), first time offenders 218 (92.4 per cent) and charged with violent offences 136 (57.6 per cent). Majority of the inmates scored above cut-off points on the GHQ-12 and the HADS. In total, 157 (66.5 per cent) on HADS anxiety subscale, 201 (85.2 per cent) on HADS depression subscale and 199 (84.3 per cent) on GHQ-12. Significant relationship was observed between GHQ-12 “caseness”, prison category and type of offence. Prison situation and type of offence were significantly associated with HADS depression subscale, whereas age was associated with HADS anxiety subscale.Research limitations/implicationsSome limitations were encountered in the course of the study. First, the study relied on self-report questionnaires for collection of data. Second, information given by the respondents could neither be corroborated by family members, who were not present during the interview, nor by the officers and men of the Nigeria Prisons Service, who knew little or nothing about the respondents. Participants in this study had spent maximum of three days in prison during the interview, thus certain levels of distress within three days after incarceration may not entail “caseness” in the sense of the presence of a psychiatric disorder. Therefore assessment over a longer period is needed.Practical implicationsScreening prison inmates on reception into prison custody provides a vista of opportunity to identify mental health problems and socio-demographic and forensic correlates of psychological distress among new entrants into prison custody. This will facilitate early identification and management of prison inmates with health needs. Health screening on reception will also help in identifying the various penal or forensic characteristics of prison inmates, which will be put into consideration during selection of appropriate rehabilitation and reformation activities that best fit a particular prison inmate. Early screening of prison inmates upon reception in the prison will also help in identifying prison inmates who have high risk of suicide and self-harm, thus preventing cases of death that may arise as a result of these mental health problems. Findings from this study will also enrich the body of knowledge on mental health problems of prison inmates entering the prison; this will also help the criminal justice system in decision making, especially with emphasis on psychological evaluation of prison inmates before dispensing judgment. On the part of the prison authority, the prison inmates identified to have psychological distress and some forensic characteristics can be properly classified, and kept in cells that will not aggravate their distress. Finally, this is the first study of prison inmates on reception into Enugu Maximum Security Prison, Enugu State Nigeria. The implication of this is that findings from this research will form a baseline on which further research on prison inmates upon reception in the prison can be conducted.Originality/valueThis study demonstrated that prison inmates are faced with high level of psychological distress during their early days in prison, and that some socio-demographic and forensic variables had significant association with psychological distress as itemised in Tables III and IV. Therefore, screening new inmates on prison reception will help in early identification and treatment of vulnerable groups. This will also help in proper classification and allocation into appropriate cells of prison inmates by the prison authority.

Mental Health Symptoms and Work-Related Stressors in Hospital Midwives and NICU Nurses: A Mixed Methods Study.

Hospital midwives and neonatal intensive care (NICU) nurses frequently encounter work-related stressors and are therefore vulnerable to developing mental health problems, such as secondary traumatic stress, burnout, anxiety, and depression. However, so far, the exact nature of these work-related stressors (traumatic vs. non-traumatic stressors) has not been investigated. This concurrent triangulation mixed methods cross-sectional study aimed to compare mental health symptoms in hospital midwives and NICU nurses, and to identify and compare work-related traumatic and non-traumatic stressors for both professional groups. 122 midwives and 91 NICU nurses of two Swiss university hospitals completed quantitative measures (Secondary Traumatic Stress Scale, STSS; Hospital Anxiety and Depression Scale, HADS; Maslach Burnout Inventory, MBI) and one qualitative question in an online survey. When controlling for socio-demographic variables, NICU nurses had a higher STSS total score and higher STSS subscales scores and less HADS anxiety subscale scores than hospital midwives. Work-related stressors were classified into five themes: “Working environment,” “Nursing/midwifery care,” “Dealing with death and dying,” “Case management” and “Others.” Forty-six (46.3%) percent of these were classified as traumatic work-related stressors. NICU nurses reported more traumatic stressors in their working environment but no other differences between professional groups regarding the total number of work-related traumatic vs. non-traumatic stressors were found. Measures, such as teaching strategies to amend the subjective appraisal of the traumatic stressors or providing time to recover in-between frequently occurring work-related traumatic stressors might not only improve the mental health of professionals but also decrease sick leave and improve the quality of patient care.

Test Performance Characteristics of the AIR, GAD-7, and HADS-Anxiety Screening Questionnaires for Anxiety in Chronic Obstructive Pulmonary Disease.

Rationale: Anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD) that is associated with higher morbidity and mortality. We evaluated three anxiety screening questionnaires: the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and the Anxiety Inventory for Respiratory Disease (AIR).Objectives: To evaluate and compare the test performance characteristics of three anxiety screening questionnaires, using the Mini-International Neuropsychiatric Interview (MINI), version 7.0, as the "gold standard."Methods: Individuals with COPD were recruited at 16 centers. The MINI and questionnaires were administered by trained research coordinators at an in-person visit and readministered by telephone 2-4 weeks later. A composite score for the presence of any Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) anxiety disorder was computed, based on the MINI as the gold standard, compared with a participant screening positive on self-report measures for these analyses.Results: Two hundred and twenty eligible individuals with COPD were enrolled; 219 completed the study. Eleven percent were identified as having a DSM-V anxiety disorder, based on the MINI. Elevated anxiety symptoms based on questionnaires were 38% for the AIR, 30% for the GAD-7, and 20% for the HADS-A. Area under the receiver operating characteristic curve (AUC) was highest for the GAD-7 (0.78; 95% confidence interval [CI], 0.69-0.87), followed by the HADS-A (0.74; 95% CI, 0.64-0.84) and the AIR (0.66; 95% CI, 0.56-0.76). The AUC for the GAD-7 was significantly greater than for the AIR (P = 0.014). Sensitivity was not statistically different among the questionnaires: 77% for the GAD-7, 63% for the HADS-A, and 66% for the AIR. The HADS-A had the highest specificity, 85%, which was significantly higher than that of the GAD-7 (77%; P < 0.001) and the AIR (65%; P < 0.001); GAD-7 specificity was higher than AIR specificity (P < 0.001).Conclusions: Symptoms of anxiety among patients with COPD as identified by screening questionnaires were common and significantly higher than the prevalence of anxiety disorder meeting DSM-V criteria. The GAD-7, the HADS-A and the AIR questionnaires had fair to moderate psychometric properties as screening tools for anxiety in individuals with COPD, indicating the need for improved measures for this patient population.