Baseline Hospital Anxiety And Depression Scale Research Articles

Long-term prospective data on correlation between overall mortality and HADS (Hospital Anxiety and Depression Scale) assessed psychological distress in prostate cancer patients (11 year follow-up data).

12091 Background: We prospectively assessed whether Psychological factors such as anxiety and depression can have a detrimental effect on long term overall survival of prostate cancer patients (pts). Methods: Prostate cancer pts participating in an ethics Committee approved, Prospective study evaluating an Andropause rating scale. All pts had radical radiotherapy with androgen deprivation therapy. Pts completed a baseline HADS questionnaire before any treatment was initiated & at 3mths & after completion of hormone therapy. Patient characteristics: Median age: 69 yrs (50 to 78 yrs). Charlson Comorbidity Index (CCI) prevalence at baseline as follows CCI-I 6.1%; CCI-II: 33.8%; CCI-III: 37.2%; CCI-IV: 14.2%; CCI-V: 6.1% and CCI-VI: 2.7%.; At the survival update in Feb 2023, 49.3% of patients have died [n = 148]; Gleeson grade was Low risk in 7.2%; Intermediate in 53.4% and high risk in 39.2%; Baseline PSA was < 10 ug/L in 45.3%; 10-20 ug/L in 33.1% and > 20 ug/L in 21.6% ; Tumour stage was T1 in 8.1% ; T2 in 63.5% and T3 in 28.4%. Baseline Median serum testosterone was 11.9 nmol/l (min 2.6 and max 26.7). Hormone duration was < 3 mths in 22.3%; 3-6mths in 35.8% ; 6 to < 36mths in 19.6% and > 36mths in 22.3%. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) of overall mortality, while controlling for the following covariates (Age, T stage, Gleeson risk category, PSA Category, Baseline Serum Testosterone, ADT duration category and Charlson Comorbidity index). Results: Higher anxiety at time of diagnosis had a statistically significant adverse effect on overall survival (table); Higher depression symptoms at baseline did not affect survival but depressive symptoms after completing cancer treatment did affect all-cause mortality in this mature dataset with a median follow up of more than 11 years. Conclusions: Higher anxiety and depression symptoms in prostate cancer patients are associated with significantly higher long-term all-cause mortality. [Table: see text]

Abstract 11426: Signs of Depression Predict Mortality Among Swedish Heart Failure Patients

Introduction: Anxiety and depression are common comorbid conditions in heart failure (HF), and there is growing evidence that they increase the risk of adverse outcomes, including rehospitalization and functional decline. Hypothesis: We aimed to determine if symptoms of anxiety and depression would predict mortality and rehospitalization in a Swedish prospective HF patient cohort. Methods: 387 patients hospitalized for HF (mean age 75 years; 32% women) were assessed using the Hospital Anxiety and Depression Scale (HADS) to measure symptoms of anxiety (HADS Anxiety) and depression (HADS Depression). The median follow-up time to death and rehospitalization was 665 (range,1737; interquartile range, 811) and 316 (range, 2069; interquartile range, 348) days, respectively. Relations between baseline HADS scores, mortality and rehospitalization risk were analyzed using multivariable Cox regression analysis adjusted for age, sex, body- mass index, smoking, prevalent atrial fibrillation, educational level, prevalent diabetes, NYHA-class at hospitalization and systolic blood pressure. Results: A total of 30 patients (8%) had signs of depression according to HADS Depression score >11 points. In the fully adjusted Cox regression model using continuous standardized values per 1 SD change, higher score on HADS Depression scale (HR,1.42; CI, 1.16-1.75; p=0.001) yielded significant associations with increased mortality whereas no associations were found for HADS Anxiety scale (HR, 1.04; CI, 0.86-1.26; p=0.719). Rehospitalization risk (n = 246; 64%) was not significantly associated with higher scores on HADS Depression scale (HR, 1.08; CI, 0.94-1.25; p=0.274) or HADS Anxiety scale (HR, 0.95; CI, 0.82-1.09; p=0.449). Conclusions: Higher scores on HADS Depression scale indicated increased mortality risk in hospitalized HF patients, independently of traditional risk factors. However, higher scores on HADS Anxiety scale did not herald increased risk of mortality or rehospitalization.

Implementation of START (STrAtegies for RelaTives) for dementia carers in the third sector: Widening access to evidence-based interventions.

Family members remain the main care providers for the increasing numbers of people with dementia, and often become depressed or anxious. In an implementation research project, we aimed to widen access to Strategies for RelaTives (START), a clinically and cost-effective intervention for the mental health of family carers, by laying the foundations for its implementation in the third sector. We used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide implementation of START, a manual-based, individually-delivered, multicomponent eight-session coping strategy intervention. We interviewed a maximum variation sample of twenty-seven stakeholders from the English Alzheimer’s Society (AS), about possible difficulties in management, training, and delivery of START. We trained and supervised three AS dementia support workers in different locations, to each deliver START to three family carers. Two researchers independently coded pre-intervention interviews for themes. We assessed intervention feasibility through monitoring delivery fidelity, rating audio-recordings from 1–5 (5 being high) and interviewing facilitators, family carers and AS managers about their experiences. We assessed effectiveness on family carers’ mental health using the Hospital Anxiety and Depression Scale (HADS) before and after receiving START (scores 0–42). We changed START’s format by reflecting carer diversity more and increasing carer stories prominence, but core content or delivery processes were unchanged. All carers received START and attended every session. The mean fidelity score was 4.2. Mean HADS-total score reduced from baseline 18.4 (standard deviation 7.4) to follow-up 15.8 (9.7). Six (67%) carers scored as clinically depressed on baseline HADS and 2 (22%) at follow-up. Facilitators and carers rated START positively. Appropriately experienced third sector workers can be trained and supervised to deliver START and it remains effective. This has the potential for widened access at scale.

Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality.

ObjectivesVirtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures.Study DesignRandomized controlled trial.SettingTertiary care center.MethodsAdult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected.ResultsEight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively (P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively (P = .770). Average pain scores were 3.53 and 2.64, respectively (P = .434).ConclusionThis pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia.Level of Evidence1

Male Sex Predicts Higher Depression Scores Among Healthy Collegiate Athletes

ObjectiveTo 1) investigate differences in baseline scores on the Hospital Anxiety and Depression Scale (HADS) between male and female athletes and 2) examine the influence of concussion history on baseline HADS scores.BackgroundAlthough post-concussion differences between sexes have been documented, whether male and female athletes differ in reporting mental health outcomes and how concussion history may influence scores remains to be fully investigated. Since athletes may experience anxiety and depression after a concussion, screening prior to the beginning of an athletic season (baseline) may identify those who are prone to post-concussion mental health disturbances.Design/MethodsOne hundred fifty-two collegiate athletes (86 males, 66 females) completed a HADS assessment during baseline testing. Each participant also reported the number of diagnosed concussions he or she previously sustained. We used independent samples t-tests to compare baseline HADS scores between male and female athletes, and a multiple linear regression to examine the relationship between baseline HADS scores, sex, and concussion history.ResultsFemale athletes reported significantly lower HADS depression scores at baseline compared to males (Females: 0.92 ± 1.49, Males: 1.77 ± 2.22, F = 2.78, p = 0.01). There were no significant sex differences in HADS anxiety scores (Females: 4.53 ± 2.80, Males: 4.51 ± 2.84, F = 0.02, p = 0.97), but both sexes had higher anxiety outcomes than depression. There was an independent association between higher HADS depression scores and male sex (β = −0.84, p = 0.01; 95% CI = −1.47, −0.21), but not concussion history (β = −0.09, p = 0.66, 95% CI = −0.51, 0.33). Neither sex nor concussion history were significantly associated with HADS anxiety scores.ConclusionsFemale athletes reported lower levels of depression at baseline than males. Concussion history did not appear to influence anxiety or depression baseline scores. Psychological measures could be evaluated, both at baseline and prior to post-concussion return to play, to help identify those who may need more focused monitoring of mental health.

Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients.

The aim of this study was to explore the association between baseline social support, functional status, and change in health-related quality of life (HRQoL) in colorectal cancer patients and change in anxiety and depression measured by Hospital Anxiety and Depression Scale (HADS) at 1year after surgery. Consecutive patients who were due to undergo therapeutic surgery for the first time for colon or rectal cancer in 9 hospitals in Spain were eligible for the study. Patients completed the following questionnaires before surgery and 12months afterward: 1 HRQoL instrument, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire; a social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Barthel Index, to assess functional status; the HADS, to assess anxiety and depression; and questions about sociodemographic information. General linear models were built to explore the association between social support, functional status, and change in HRQoL and changes in anxiety and depression 12months after surgery. A total of 947 colorectal cancer patients took part in the study. Patients' functional status, social support, and change in HRQoL were associated with changes in anxiety and depression. Greater social support and improvements in physical, cognitive, and social functioning and in insomnia resulted in improvements in anxiety and depression. No functionally independent patients were associated with lesser improvements in anxiety and depression. Colorectal cancer patients who have more social support, are functionally independent and have higher improvements in HRQoL may have better results in anxiety and depression at 1year after surgery, adjusting for age, gender, location, occupation, and baseline HADS scores.

Effects of high-dose Asian ginseng (Panax ginseng) to improve cancer-related fatigue: Results of a double-blind, placebo-controlled randomized controlled trial.

209 Background: Cancer related fatigue (CRF) is the most common and disabling symptom in cancer.Panax ginseng extract (PG) is frequently used as a nutraceutical treatment for fatigue. There are no well-powered placebo-controlled trials that used validated CRF outcome measures to investigate of PG effects in cancer patients. The primary objective of this trial was to evaluate the effects oral PG versus Placebo (PL) for CRF. Methods: Patients with cancer fatigue ≥ 4/10 on Edmonton Symptom Assessment Scale (ESAS) were eligible. Patients were randomized to either 400mg of standardized PG or matching PL orally twice a day for 28 days. The primary endpoint was change in the Functional Assessment of Chronic Illness-Fatigue (FACIT-F) fatigue subscale from baseline to Day 28. Secondary outcomes were Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression Scale (HADS), and ESAS. Results: Total evaluable patients were 112 (56 for PG and PL groups). No significant differences in baseline characteristics between the two groups except cancer type (p = 0.002). There was significant improvement in FACIT fatigue and ESAS fatigue scores in PG and PL groups at Day 15 and Day 29. The mean (SD) of FACIT-F fatigue scores at baseline, Day 15, and Day 29 were 22.6 (10.4), 29.8(10.7), 30.1 (11.6) and 23.8 (9.1), 30.0 (10.1), 30.4 (11.6) for PG and PL respectively. Mean (SD) improvement in the FACIT-F subscale at Day 29 was not significantly different in PG than in the PL group [7.5 (12.7) vs 6.5 (9.9), P = 0.67]. Mean (SD) improvement in the ESAS fatigue, FACT-G, and HADS at Day 29 were also not significantly different in PG than in the PL group. In a multiple linear model analysis, the change in FACIT-F fatigue from Day 0 to Day 29 was negatively correlated with baseline FACIT-F fatigue (p = 0.0005), baseline HADS score (p = 0.032), and male gender (p = 0.023). There were a significantly higher number of any grade of toxicities in PL group than in PG group (33/62 vs. 28/64, p = 0.024). Conclusions: Both PG and Placebo result in a significant improvement in CRF at Day 15 and Day 29. PG was not significantly superior to placebo after 4 weeks of treatment. Further studies are needed. Clinical trial information: NCT01375114.

An Aggravated Trajectory of Depression and Anxiety Co-morbid with Hepatitis C: A Within-groups Study of 61 Australian Outpatients.

Background: This study aimed to explore the course of depression and anxiety in chronic hepatitis C patients. Methods: Data were combined from two studies: (1) Hospital Anxiety and Depression Scale (HADS) scores in 395 consecutive Australian outpatients from 2006 to 2010 formed the baseline measurement; and (2) Depression Anxiety Stress Scales (DASS) scores in a survey of a sub-sample of these patients in 2011 formed the follow-up measurement. After converting DASS to HADS scores, changes in symptom scores and rates of case-ness (≥8), and predictors of follow-up symptoms were assessed. Results: Follow-up data were available for 61 patients (70.5% male) whose age ranged from 24.5 to 74.6 years (M=45.6). The time to follow-up ranged from 20.7 to 61.9 months (M=43.8). Baseline rates of depression (32.8%) and anxiety (44.3%) increased to 62.3% and 67.2%, respectively. These findings were confirmed, independent of the conversion, by comparing baseline HADS and follow-up DASS scores with British community norms. Baseline anxiety and younger age predicted depression, while baseline anxiety, high school non-completion, and single relationship status predicted anxiety. Conclusion: This study demonstrated a worsening trajectory of depression and anxiety. Further controlled and prospective research in a larger sample is required to confirm these findings.

The effect of smokeless tobacco “Maras powder” on treatment outcomes of anxiety disorder: a longitudinal study

Objective: We aimed to investigate the effects of Maras powder (smokeless tobacco) on treatment outcomes of patients with anxiety.Method: Patients between 18 and 65 years old diagnosed as generalized anxiety disorder and anxiety disorder not otherwise specified were enrolled. The patients were categorized into two groups: Maras powder using group (30 patients) and Maras powder free group (30 patients). All the participants were administered the Turkish version of Hospital Anxiety and Depression Scale (HADS) at baseline and the 1 and 2 months after the treatment. All patients were given standard pharmacological treatments for their psychiatric diagnosis.Results: There was a significant decrease of HADS scores within the groups after treatment. The mean baseline HADS scores of both groups were not significantly different. However, mean HADS scores of the groups were significantly different at the first and second months after the treatment.Conclusion: Maras powder use may negatively affect the treatment of anxiety disorders.

Depression, Anxiety, and Moods of Hospitalized Patients under Contact Precautions

To determine the association between contact precautions and depression or anxiety as well as feelings of anger, sadness, worry, happiness, or confusion. Prospective frequency-matched cohort study. The University of Maryland Medical Center, a 662-bed tertiary care hospital in Baltimore, Maryland. A total of 1,876 medical and surgical patients over the age of 18 years were approached; 528 patients were enrolled from January through November 2010, and 296 patients, frequency matched by hospital unit, completed follow-up on hospital day 3. The primary outcome was Hospital Anxiety and Depression Scale (HADS) scores on hospital day 3, controlling for baseline HADS scores. Secondary moods were measured with visual analog mood scale diaries. Patients under contact precautions had baseline symptoms of depression 1.3 points higher (P<.01) and anxiety 0.8 points higher (P=.08) at hospital admission using HADS. Exposure to contact precautions was not associated with increased depression (P=.42) or anxiety (P=.25) on hospital day 3. On hospital day 3, patients under contact precautions were no more likely than unexposed patients to be angry (20% vs 20%; P=.99), sad (33% vs 38%; P=.45), worried (51% vs 46%; P=.41), happy (58% vs 67%; P=.14), or confused (23% vs 24%; P=.95). Patients under contact precautions have more symptoms of depression and anxiety at hospital admission but do not appear to be more likely to develop depression, anxiety, or negative moods while under contact precautions. The use of contact precautions should not be restricted by the belief that contact precautions will produce more depression or anxiety.

Relationships Among Pain and Depressive and Anxiety Symptoms in Clinical Trials of Pregabalin in Fibromyalgia

Fibromyalgia, as defined by the American College of Rheumatology, is characterized by widespread pain lasting for at least 3 months, with pain in at least 11 out of 18 tender points when palpated with digital pressure. The authors investigated the relationship between changes in pain and symptoms of anxiety and depression, using data from pregabalin clinical trials. Results from three double-blind, placebo-controlled trials of pregabalin monotherapy in fibromyalgia (8-14 weeks) were pooled, and baseline to end-point changes in pain and Hospital Anxiety and Depression Scale (HADS) scores were analyzed. Path-analysis evaluated the association between improvements in anxiety and depression and pain relief. Baseline HADS scores indicated moderate-to-severe anxiety in 38% of patients and moderate-to-severe depressive symptoms in 27%. The improvement in pain was not related to baseline levels of anxiety or depression. The correlation between changes in pain and depressive or anxiety symptoms was low-to-moderate. Path-analysis showed that most of the pain relief observed with pregabalin treatment was a direct analgesic effect and was not explained by improvement in mood. Response to treatment of pain in the pregabalin trials did not depend on baseline levels of anxiety or depressive symptoms, and pregabalin improved pain in fibromyalgia patients with or without depressive or anxiety symptoms. Changes in the level of anxiety or depression had a low-to-moderate impact on pain reduction. Pain reduction with pregabalin treatment appeared to result mostly from a direct treatment effect, rather than an indirect effect mediated through improvement in anxiety or depressive symptoms.

Analysis of longitudinal changes in the psychological status of patients with asthma

Significant relationships between the psychological status and poor asthma outcomes are often reported. However, most of these studies are cross-sectional and none have evaluated how the psychological status progresses over time during the management of asthma patients. Therefore, we examined the longitudinal changes in the psychological status of asthma patients, and compared them with changes in other clinical measurements. Eighty-seven outpatients with stable asthma after 6 months of treatment were enrolled in this study. The psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS), the health status using the Asthma Quality of Life Questionnaire (AQLQ) and the St. George's Respiratory Questionnaire (SGRQ). The patient's pulmonary function, peak expiratory flow values and airway hyperresponsiveness were measured at entry and every year thereafter over a 5-year period. Using mixed effects models to estimate the slopes, the HADS anxiety and depression scores did not change significantly over time (p=0.71 and 0.72, respectively). The changes in the HADS scores correlated noticeably with changes in the AQLQ and SGRQ scores, but not with changes in the physiological measurements. The baseline HADS anxiety and depression scores were significantly correlated to the subsequent annual changes in each measurement. The psychological status remained clinically stable over the 5-year study period in patients with stable asthma. Changes in the psychological status were significantly correlated to changes in the health status. The baseline HADS scores were a useful indicator in detecting patients who would show subsequent deterioration in their psychological status.

The effect of depression on survival in patients with newly diagnosed advanced non-small cell lung cancer (NSCLC)

8511 Background: The impact of emotional distress on cancer-related mortality is unclear. Divergent results in studies are due, in part, from heterogeneous populations in terms of type of cancer, stage of disease, and time of emotional assessment. This study examined the effect of depression and anxiety on a well-defined cohort of patients with newly diagnosed advanced NSCLC. Methods: 46 patients with advanced NSCLC were recruited within eight weeks of diagnosis to participate in a feasibility study of early palliative care. Participants completed the Hospital Anxiety and Depression Scale (HADS) at baseline and were followed for six months. The primary study endpoint was survival at six months. The effects of depression and anxiety were evaluated first by Kaplan-Meier survival analysis and then by Cox regression to control for other variables. Results: Three patients (6%) had stage IIIB with effusions and the remaining 43 (93%) had stage IV disease. The median age of patients was 65.5 years and 28 of the 46 (61%) were women. 34 patients had a PS 1 (74%), 11 (24%) had PS 0 and one (2%) had PS 2. 96% of the patients completed the baseline HADS. 23% met HADS criteria for probable cases of depression (8 or greater) at baseline and 34% met HADS criteria for probable cases of anxiety (8 or greater). Using Kaplan-Meier survival analysis, patients with depression were less likely to have survived at 6 months than non-depressed patients (50% versus 80%, log rank p=0.01). Baseline anxiety did not appear to impact survival. Using Cox proportional hazard regression analyses to control for stage, ECOG performance status, age, and gender, the effect of depression remained significant at p=0.03. Conclusion: Depression in newly diagnosed advanced NSCLC patients was associated with inferior survival in this well-defined patient population. Conversely, anxiety did not appear to be associated with mortality. These findings strengthen the argument that emotional distress influences survival. Larger prospective studies are needed to confirm this conclusion, explore possible mediators, and investigate the effects of treatment for depression. No significant financial relationships to disclose.

Effects of psychotherapy in moderately severe COPD: a pilot study.

Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".

How distressing is attendance for routine breast screening?

AbstractA prospective cohort study of 2357 women eligible for participation in the UK National Breast Screening Programme was carried out to evaluate the immediate emotional and behavioural effects of attending for routine mammography. Women completed the Hospital Anxiety and Depression Scale (HADS) in the context of a survey by their General Practitioner before they knew they were to receive an invitation to attend screening and again at screening some 6 weeks later. In addition, an ad hoc Health Questionnaire was administered when the women attended for screening to assess possible self‐perceived stress‐related behaviour changes in the previous week.2110 (89.5% response rate) women returned the initial postal baseline HADS and 1635 completed the HADS again at screening. Anxiety and depression scales were significantly lower at screening than at baseline (t = 3.16, p &lt; 0.002, 95% CI = 0.07 to 0.31) and (t = 8.46, p &lt; 0.0001, 95% CI = 0.32 to 0.52) respectively. Women scoring in the borderline range at baseline were more likely to move into the normal than the clinically significant range for anxiety (χ2 = 40.36, p &lt; 0.001) and also for depression (χ2 = 56.04, p &lt; 0.001), and women scoring in the clinically significant range for anxiety were more likely to become normal than vice versa (χ2 = 5.95, p &lt; 0.02). The Health Questionnaire indicated that some women reported stress‐related behaviour changes in the week prior to screening, especially those who were most anxious or depressed.