Depression In General Hospital Research Articles

Anxiety and Depression in Patients With Physical Diseases and Associated Factors: A Large-Scale Field Survey in General Hospitals in China.

Introduction: To investigate the characteristic of anxiety and depression among patients in general hospitals, and explore the degree of the clinical symptoms and correlated social economic factors.Methods: This is a cross-sectional survey of anxiety and depression in patients with physical diseases, who were suspected of depression and anxiety based on their clinical performance by their physicians and PHQ ≧ 8, from various clinical departments of 57 general hospitals in China. Data regarding demographic characteristics and clinical characteristics were collected. Social and psychological factors and the severity of anxiety or depression were collected through self-rating scales. Finally, we used multivariate logistic regression to identify the factors associated with anxiety and depression in patients with physical diseases.Results: A total of 2,105 (84.6%) valid and completed questionnaires were returned. The proportion of anxiety, depression, combined depression and anxiety, either anxiety or depression among the patients with physical diseases from all clinical departments was 63.3, 75.1, 57.1, and 81.2% respectively. Further regression analysis indicated that gender, monthly income, specific physical diseases, personality traits, social supports and life negative events were related factors of both anxiety and depression.Conclusions: Anxiety and depression were common in patients with physical diseases, with a high proportion of co-morbidity of anxiety and depression. Females, patients with cancer, poor social support and negative life events reported more severe anxiety and depression. The results may help to understand the present situation of anxiety and depression in general hospitals in china, and identify the patients with high risk of depression and anxiety.

Factors associated with loss to follow-up of outpatients with depression in general hospitals

ObjectiveWe aimed to understand the reasons behind outpatient loss to follow-up and the views of Chinese patients with depression regarding disease diagnosis and antidepressant therapy.MethodsConsecutive outpatients with newly diagnosed depressive disorder between September 2012 and August 2013 at the Shanghai First People’s Hospital (a tertiary hospital) were categorized into follow-up and lost-to-follow-up groups. We collected information on demographics, the Hamilton depression (HAMD) scale, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale, and Symptom Checklist-90. Patients were routinely followed at 2, 4, 8, and 12 weeks. Any missed appointment was considered lost to follow-up.ResultsAfter 12 weeks of treatment, only 42.2% (70/166) of patients were continuing follow-up. Patients lost to follow-up were significantly younger (median, 42.5 vs. 56.5 years), had different marital status, higher education level, higher SDS score (43.8 ± 10.8 vs. 40.2 ± 10.9), and higher HAMD score (median, 21 vs. 19). Age (odds ratio (OR) = 0.97, 95% confidence interval (CI): 0.95–0.997), and HAMD score (OR = 1.14, 95% CI: 1.01–1.29) were independently associated with loss to follow-up.ConclusionYoung age, higher HAMD score, and poor knowledge of depression and treatment were the main factors associated with loss to follow-up during depression management among our Chinese patients.

A survey on 564 cases of inpatients with anxiety and depression in general hospitals in 2015

Objective: To understand the prevalence of anxiety and depression in medical patients in general hospitals and find out main influencing factors. Methods: According to the inclusion criteria, a total of 564 inpatients from the Third Affiliated Hospital of Inner Mongolia Medical University were selected during January to June of 2015. Patients were assessed for anxiety and/or depression by use of Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Scale (HAMAS) and Hamilton Depression Scale (HAMDS). Meanwhile, final diagnosis was made on the basis of diagnostic criteria listed in Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). Results: In different departments, the positive rate (HADS ≥ 8) was the highest in Department of Oncology (45.42%), and the lowest in Department of Gastroenterology (16.05%). After assessment with the help of HAMD and HAMA, the prevalence of anxiety/depression was the highest in Department of Oncology (46.43%), and the lowest in Department of Gastroenterology (16.05%). There was no statistical significance in diagnostic results acquired from HAMD and HAMA ( p = .071). Two types of diagnostic methods were highly consistent (κ = 0.852, p = .000). Inpatients aged from 40 to 59 years, with junior high school education or below, very tiring work, poor marital status (separated, divorced, widowed), unharmonious family, low personal income, completely self-paying and family history of anxiety and depression, currently unable to take care of themselves were more prone to anxiety and depression ( p < .05). Conclusions: The prevalence of anxiety and depression in medical patients in general hospitals is high due to many influencing factors. It is necessary to establish an effective diagnosis and treatment system for anxiety and depression, in order to make patients easy to receive an early and comprehensive treatment and improve their life quality.

A survey on 564 cases of inpatients with anxiety and depression in general hospitals in 2015

Objective: To understand the prevalence of anxiety and depression in medical patients in general hospitals and find out main influencing factors. Methods: According to the inclusion criteria, a total of 564 inpatients from the Third Affiliated Hospital of Inner Mongolia Medical University were selected during January to June of 2015. Patients were assessed for anxiety and/or depression by use of Hospital Anxiety and Depression Scale (HADS), Hamilton Anxiety Scale (HAMAS) and Hamilton Depression Scale (HAMDS). Meanwhile, final diagnosis was made on the basis of diagnostic criteria listed in Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV). Results: In different departments, the positive rate (HADS ≥ 8) was the highest in Department of Oncology (45.42%), and the lowest in Department of Gastroenterology (16.05%). After assessment with the help of HAMD and HAMA, the prevalence of anxiety/depression was the highest in Department of Oncology (46.43%), and the lowest in Department of Gastroenterology (16.05%). There was no statistical significance in diagnostic results acquired from HAMD and HAMA ( p = .071). Two types of diagnostic methods were highly consistent (κ = 0.852, p = .000). Inpatients aged from 40 to 59 years, with junior high school education or below, very tiring work, poor marital status (separated, divorced, widowed), unharmonious family, low personal income, completely self-paying and family history of anxiety and depression, currently unable to take care of themselves were more prone to anxiety and depression ( p < .05). Conclusions: The prevalence of anxiety and depression in medical patients in general hospitals is high due to many influencing factors. It is necessary to establish an effective diagnosis and treatment system for anxiety and depression, in order to make patients easy to receive an early and comprehensive treatment and improve their life quality.

A Randomized Controlled Trial of Right Low Frequency rTMS Combined with Escitalopram in Treatment of Patients with First-episode Depression in General Hospitals

Objective: To explore the clinical efficacy of right low frequency repetitive transcranial magnetic stimulation (rTMS) therapy combined with escitalopram in treating outpatients with first-episode depression. Methods: Seventy-eight patients with depressive disorder of ICD-10 criteria were recruited for the trial. All subjects were randomly divided into the active rTMS group (receive active rTMS) and sham group (receive sham rTMS). Each group received low frequency active or sham rTMS combined with 10 mg escitalopram per day. Patients in the active rTMS group were treated with active rTMS for continuous two weeks, while the sham patients were treated with pseudo stimulation. HAMD, HAMA and TESS were used to assess the efficacy and side effects before the treatment and at the ends of the second week and the fourth week of treatment, respectively. Results: 1) At the end of 4 weeks’ treatment, patients in the active rTMS group had a response rate of 87.8 % while the patients in the sham group had 41.5 %; 2) patients in the active rTMS group showed a significant efficacy at the end of 2 weeks, which was significantly different from the patients in the sham group; 3) Patients in the active rTMS group got a significantly lower score in HAMA at the end of 2 weeks, and there was a significant difference from the sham group; 4) There was only a local pain response. Conclusion: The right low-frequency rTMS technique combined with escitalopram in treatment of depressive patients in general hospitals has a significant better effect than mono-pharmacotherapy and can shorten the time of treatment.

Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity, age and personality

Objective: Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement.Methods: Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation–liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory.Results: Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder.Conclusion: These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.

The clinical diagnosis and treatment of depression in general hospital

The clinical diagnosis and treatment of depression in general hospital

Knowledge and Attitude of 851 Nursing Personnel toward Depression in General Hospitals of Korea.

Our study aimed to examine the knowledge and attitude of nursing personnel toward depression in general hospitals of Korea. A total of 851 nursing personnel enrolled at four university-affiliated general hospitals completed self-report questionnaires. Chi-square tests were used to compare the knowledge and attitude of registered or assistant nurses toward depression. In addition, binary logistic regression analysis was used to adjust for the following confounders: age-group and workplace. Registered and assistant nurses differed in their knowledge and attitude toward depression. The proportion of rational and/or correct responses were higher in registered nurses than assistant nurses for the following: constellation of depressive symptoms defined by DSM-IV (adjusted odds ratio [aOR], 3.876; P<0.001); suicide risk in depression recovery (aOR, 3.223; P=0.001) and psychological stress as a cause of depression (aOR, 4.370; P<0.001); the relationship between chronic physical disease and depression (aOR, 8.984; P<0.001); and other items. Our results suggest that in terms of the biological model of depression, the understanding of registered nurses is greater than that of assistant nurses. Moreover, specific psychiatric education programs for nursing personnel need to be developed in Korea. Our findings can contribute to the development of a general hospital-based model for early detection of depression in patients with chronic medical diseases.

EPA-1388 – Mental health service needs of patients with depression in general hospital - a qualitative interview

Object To know the treatment experiences of patients with depression in general hospital, and their suggestion on the present mental health services. To provides theoretical support for optimizing the mental health services model in general hospital. Methods Qualitative interviews were given to 10 patients diagnosed as depressive disorder from department of psychiatry, Renmin Hospital of Wuhan University. Questions were asked from following aspects: the process of seeking medical help before hospitalization in psychiatry department(when, where, who, referral), evaluation of drug treatment (efficacy, side effects, doctors) and psychotherapy, satisfaction and suggestions on medical services(including hospital environment, medical staff and etc.), social rehabilitation (stigma, social functional recovery, survival / quality of life etc.), socioeconomic factors (health insurance coverage, financial resources, social support resources). Answers referred to above factors were conducted to statistical analysis. Results showed departments of neurology, gastroenterology, endocrinology, Chinese traditional medicine, obstetrics and gynecology are the first medical choice of depressive patients; the average number of departments before they get psychiatric treatment is five, the average number of referral is 2. Medication side effects are the most concerned problems. Enough and reasonable information given from doctor about drug's name, efficacy, side effects, and length of treatment can improve patient's compliance, even can predict recurrence rate. Discrimination medical personnel can reduce compliance of patients: contempt, pessimism, avoidance, activity limitations, and impolite language and behavior. Psychotherapy can shorten the hospital stay. Health insurance coverage, job, social support can predict social functional recovery. Conclusions Doctors in general hospital should improve their ability in recognizing depression to ensure referral patients timely; Education of depression, medication-related knowledge should offered by psychiatrists to improve patients’ treatment compliance, and reduce relapse rate; psychological therapy should be incorporated into psychiatric conventional treatment; Medical personnel should be conscious of using positive affirmation, respectful words and actions; effective communication with families is necessary for promoting patients’ social rehabilitation.

Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China

Objective To determine the prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China. Method A total of 513 patients were randomly selected from 1923 inpatients from three general hospitals and evaluated with a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I disorders by eight psychiatrists. Logistic regression was used to identify factors that were associated with depression. Results The prevalence (95% confidence interval) of all current depressive disorders and major depressive disorder (MDD) was found to be 16.2% (13.0–19.4%) and 9.4% (6.8–11.9%), respectively. The correlates for depression include higher hospital class, divorce/being widowed/separation, low family income, chronic diseases, lack of medical insurance, dwelling in rural area, suffering from severe illness and multiple hospitalization history. None of the patients with current MDD were detected, treated or referred to psychiatric consultation. Conclusions The prevalence of depression among inpatients of general hospitals in Wuhan, China, was high. None of the depressive patients were recognized or treated for depression, indicating a serious neglect of depression in general hospitals. Our studies suggest an urgent need to improve clinicians' ability to detect and treat depression.

The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression

Depression is the most common mental disease in patients hospitalized with physical illness. Disorders of anxiety and depression in general hospitals are frequently underdiagnosed and inappropriately treated. To assess the prevalence of undiagnosed anxiety and depression in surgical inpatients and assess the referral rate and utilization of liaison psychiatry services. A prospective study of surgical admissions (n = 96) to two surgical services at two separate institutions between 01/01/05 and 31/12/05. The Hospital Anxiety and Depression (HADS) scale was used to evaluate all patients. About 12.5% of patients had significant depression, 18.75% had significant anxiety, and 8.3% had significant mixed anxiety and depression. About 22.9% of patients warranted referral to liaison psychiatry services for further assessment and management. Anxiety and depression are highly prevalent in surgical inpatients. An increased awareness of the possibility of undiagnosed psychiatric disorders is required, along with prompt and appropriate use of liaison psychiatry services.

The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression

Depression is the most common mental disease in patients hospitalized with physical illness. Disorders of anxiety and depression in general hospitals are frequently underdiagnosed and inappropriately treated. To assess the prevalence of undiagnosed anxiety and depression in surgical inpatients and assess the referral rate and utilization of liaison psychiatry services. A prospective study of surgical admissions (n = 96) to two surgical services at two separate institutions between 01/01/05 and 31/12/05. The Hospital Anxiety and Depression (HADS) scale was used to evaluate all patients. About 12.5% of patients had significant depression, 18.75% had significant anxiety, and 8.3% had significant mixed anxiety and depression. About 22.9% of patients warranted referral to liaison psychiatry services for further assessment and management. Anxiety and depression are highly prevalent in surgical inpatients. An increased awareness of the possibility of undiagnosed psychiatric disorders is required, along with prompt and appropriate use of liaison psychiatry services.

Diagnosing and treating depression in general hospitals

Depressive conditions are common in general hospital patients but if recognized can be treated by both pharmacotherapeutic and psychotherapeutic means. Although hospital doctors cannot be expected to be masters of the intricacies of treating depression, they can make the diagnosis and prescribe first-line antidepressants to the benefit of most cases.