Hospital Anxiety And Depression Scale Depression Subscale Research Articles

SCREENING OF ANXIETY AND DEPRESSIVE DISORDERS IN MEDICAL STUDENTS

The aim of the research was to study the frequency of occurrence of anxiety and depression in first-year medical university students in the post-holiday period.Materials and methods. The study involved 70 first-year medical university students (average age 17,9 ± 1,31 years). The study was conducted as part of a periodic medical examination of participants during the first semester (in the early post-holiday period). The Hospital Anxiety and Depression Scale (HADS) was used.Results. The analysis of the answers to the questions of the HADS anxiety subscale showed that more than a third of the survey participants (38,6%) had anxiety disorders, of which more than half of the participants (51,9%) needed the advice of a clinical psychologist or psychotherapist. 21,4% of participants had a feeling of tension, 27,2% - fear, 24,3% - restless thoughts, 17,1% - inability to relax, 22,8% - internal tension or trembling, 40% - restlessness, 31,4% - panic. Analysis of answers to questions on the HADS depression subscale indicated that 22,9% of students had depressive disorders, of which more than a third (37,5%) needed the advice of a clinical psychologist or psychotherapist. 27,1% of participants had a decrease/lack of pleasure from something that used to bring positive emotions, 10% - inability to laugh, 15,7% - lack of a sense of cheerfulness, 20% - slowness, 15,7% - unwillingness to monitor their appearance, 18,6% - decreased sense of satisfaction from hobbies, 20% - decreased feelings of pleasure from a good book, radio or TV program.Conclusion. The expansion of the standard scope of periodic medical examination made it possible to screen the psycho-emotional state of students in the post-holiday period of the autumn semester and identify a risk group for the development and increase of existing anxiety-depressive disorders during the educational process, which can have an adverse effect on both the quality of life of students and the effectiveness and success of training.

The Interplay of Anxiety, Depression, Sleep Quality, and Socioeconomic Factors in Somali Hemodialysis Patients.

This study aimed to assess anxiety, depression, and sleep quality in kidney failure patients receiving hemodialysis (HD) in Somalia and examine the relationship between anxiety, depression, and sleep quality. We conducted a study with 200 kidney failure patients on HD treatment for over 3 months. Participants completed sociodemographic questionnaires, the Patient Health Questionnaire-9 (PHQ-9), the Hospital Anxiety and Depression Scale (HADS), the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI). Among the 200 participants (mean age = 52.3; SD = 14.13), 58.5% were men, 64% had CKD for 1-5 years, and 52.6% received HD for 1-5 years. Depressive symptoms were found in 61.5% (PHQ-9) and 37.5% (HADS depression subscale) of HD patients. Poor sleep quality (PSQI) was observed in 31.5% and significantly correlated with PHQ-9 (rs = 0.633), HADS anxiety (rs = 0.491), and HADS depression (rs = 0.529). The ISI score correlated significantly with PHQ-9 (rs = 0.611), HADS anxiety (rs = 0.494), and HADS depression (rs = 0.586). All PSQI components correlated with depression and anxiety, except sleep medication use. Hierarchical regression analysis revealed that HADS anxiety (β = 0.342) and HADS depression (β = 0.372) predicted ISI scores. HADS anxiety (β = 0.307) and HADS depression (β = 0.419) predicted PSQI scores. Higher anxiety and depression levels negatively correlated with various dimensions of sleep quality in kidney failure patients. Early identification and appropriate management of these psychological disturbances are crucial for enhancing patients' overall quality of life.

Unsupervised item response theory models for assessing sample heterogeneity in patient-reported outcomes measures

PurposeUnsupervised item-response theory (IRT) models such as polytomous IRT based on recursive partitioning (IRTrees) and mixture IRT (MixIRT) models can be used to assess differential item functioning (DIF) in patient-reported outcome measures (PROMs) when the covariates associated with DIF are unknown a priori. This study examines the consistency of results for IRTrees and MixIRT models.MethodsData were from 4478 individuals in the Alberta Provincial Project on Outcome Assessment in Coronary Heart Disease registry who received cardiac angiography in Alberta, Canada, and completed the Hospital Anxiety and Depression Scale (HADS) depression subscale items. The partial credit model (PCM) based on recursive partitioning (PCTree) and mixture PCM (MixPCM) were used to identify covariates associated with differential response patterns to HADS depression subscale items. Model covariates included demographic and clinical characteristics.ResultsThe median (interquartile range) age was 64.5(15.7) years, and 3522(78.5%) patients were male. The PCTree identified 4 terminal nodes (subgroups) defined by smoking status, age, and body mass index. A 3-class PCM fits the data well. The MixPCM latent classes were defined by age, disease indication, smoking status, comorbid diabetes, congestive heart failure, and chronic obstructive pulmonary disease.ConclusionPCTree and MixPCM were not consistent in detecting covariates associated with differential interpretations of PROM items. Future research will use computer simulations to assess these models’ Type I error and statistical power for identifying covariates associated with DIF.

QOL-08. LONGITUDINAL EFFECTS OF A PSYCHOLOGICAL INTERVENTION FOR CAREGIVERS OF PATIENTS WITH PRIMARY MALIGNANT BRAIN TUMORS: SECONDARY ANALYSIS OF A RANDOMIZED CONTROLLED TRIAL

Abstract BACKGROUND Caregivers of patients with primary malignant brain tumors (PMBT) experience high rates of anxiety. In our randomized controlled trial assessing the effects of a caregiver-directed, telehealth-based psychological intervention (“NeuroCARE”), NeuroCARE participants had significantly lower anxiety symptoms (primary outcome) and depression symptoms, and better self-efficacy and coping immediately post-intervention compared to usual care (UC). We subsequently examined the longitudinal effects of NeuroCARE on caregiver-reported outcomes across all study timepoints. METHODS We enrolled and randomized 120 caregivers of patients with PMBT to NeuroCARE (N = 60) versus usual supportive care (N = 60). Eligible participants had significant baseline anxiety symptoms (Generalized Anxiety Disorder-7 score ≥ 5). We collected caregiver-reported anxiety symptoms (Hospital Anxiety and Depression Scale (HADS)–Anxiety Subscale), depression symptoms (HADS–Depression Subscale), self-efficacy (Lewis Cancer Self-Efficacy scale), coping (Measure of Current Status), quality of life (QOL; CareGiver Oncology Quality of Life survey), caregiver burden (Caregiver Reaction Assessment) and post-traumatic stress disorder (PTSD) symptoms (PTSD Checklist for DSM-5) at baseline, 11 weeks (immediately post-intervention) and 16 weeks (one-month post-intervention). We used mixed effects linear regression models to assess longitudinal intervention effects on study outcomes. RESULTS Enrolled caregivers had a mean age of 53 years; the majority were female (99/120; 82.5%) and were the patient’s spouse/partner (84/120; 70%). NeuroCARE participants experienced greater improvement than UC in depression symptoms (change/week [slope]: -0.09 vs. -0.01, p = 0.041), self-efficacy (slope: 0.64 vs. -0.17, p = 0.006) and coping (slope: 0.31 vs. -0.01, p < 0.001). We observed non-statistically significant differences between NeuroCARE and UC for change in anxiety symptoms (slope: -0.13 vs. -0.05, p = 0.059) and QOL (slope: 0.26 vs. 0.04, p = 0.050). Study arms did not differ in longitudinal trajectories for caregiver burden or PTSD symptoms. CONCLUSIONS NeuroCARE participants experienced greater improvements over time in depression symptoms, self-efficacy, and coping than UC participants, highlighting the sustained benefits of this caregiver-directed supportive intervention.

Anxiety and Depressive Symptoms Correlated to Patient-Reported Outcome Measures after Rotator Cuff Repair: A Prospective Study in the Perioperative Period.

Anxiety and depressive symptoms adversely affect surgical outcomes in patients with rotator cuff tear (RCT) undergoing surgical repair. Patients without a diagnosis of mood disorders, such as anxiety and depression, before rotator cuff repair (RCR) can be considered an optimal candidate for surgery. The objective of this prospective observational study was to evaluate the relationship between anxiety and depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS) as an assessment tool, and patient-reported outcome measures in RCT after repair surgery. This study included patients with RCT undergoing arthroscopic rotator cuff repair (RCR). Forty-three patients were included who had completed the HADS, Constant Murley Score (CMS), and Short Form Health Survey 36 (SF-36) questionnaires before surgery and in the postoperative follow-up, at 1 month, 3 months, and 6 months. The Friedman test showed that there were statistically significant changes in the different times point for HADS (p < 0.001), anxiety subscale of HADS, i.e., HADS-A (p < 0.001), depression subscale of HADS, i.e., HADS-D (p < 0.001), CMS (p < 0.001), and SF-36 (p < 0.001). The average scores of HADS, HADS-A, and HADS-D improved at each follow-up, showing improvement in discomfort. From the third month after surgery, there was an improvement in anxiety and depression disorders related to improved quality of life, functionality, and pain perception. The trend remained stable until the sixth month of follow up. This study shows that anxiety and depressive symptoms in RCT patients are significantly reduced after RCR with subsequent important improvements in terms of functionality, ability to carry out activities of daily living, perceived pain, and quality of life.

Incidence Rate of Nicotine Addiction in University Students of Tomsk

Background: tobacco use is one of the leading risk factors for early death and disability worldwide. Comorbidity of anxiety disorders and nicotine dependence reduces the efficiency of the specialist complex therapy of tobacco dependence. Of significance is a problem of timely detection of such concurrent disorders.Objective: to study nicotine addiction and severity of anxiety in students of the Tomsk State University (TSU) and Siberian State Medical University (SSMU) of Tomsk City.Surveyed students and methods: the Fagerström Test for Nicotine Dependence (FTND) and the Hospital Anxiety and Depression Scale (HADS) were usedto recognize nicotine addiction in 323 students (78 males; 24.1% and 245 women; 75.9%).Results: the findings on nicotine addiction in students were as follows: 59.0% never smoked, 12.4% smoked previously, 21.9% are currently cigarette smokers, 6.7% use tobacco heating systems (THS). The median total score according to the HADS anxiety subscale in current smokers made 7 (6; 9) points, in current THS smokers — 7 (5; 10), in previously smokers — 7 (5; 9), in never smoking —7 (4; 9). The median total score according to the HADS depression subscale in currently cigarette smokers made 6 (4; 8) points, currently THS smokers — 4.5 (2; 5), previously smokers — 4 (3; 7), in never smoking — 5 (3; 7). The study revealed formation of nicotine addiction in 26% of surveyed individuals; age of the regular smoking onset was 16.1 (14.2; 17.5) years, nicotine dependence formed at the age of 17.0 (16; 18) years (p = 0.001).Conclusions: the availability of direct dependency between indicators of total score of anxiety according to the HADS and the FTND (rs = 0.51; p &lt; 0.05) is an evidence of predictive value of anxiety for nicotine addiction and need of timely preventive intervention.

Retention, efficacy, tolerability, and quality of life during long-term adjunctive brivaracetam treatment by number of lifetime antiseizure medications: A post hoc analysis of phase 3 trials in adults with focal seizures

ObjectiveTo evaluate long-term retention, reasons for discontinuation, efficacy, tolerability, and health-related quality of life (HRQOL) during adjunctive brivaracetam (BRV) treatment in adults with focal seizures by number of lifetime antiseizure medications (ASMs). MethodsPost hoc analyses of a randomized, double-blind, placebo-controlled trial (N01358; NCT01261325) and corresponding open-label extension (OLE) (N01379; NCT01339559) of adjunctive BRV in adults (16–80 years of age) with focal seizures. Outcomes were assessed from the first day of BRV treatment in the double-blind (patients randomized to BRV) or open-label trial (patients randomized to placebo) by number of lifetime ASMs (1–2, 3–4, 5–6, or ≥ 7). Lifetime ASMs were defined as previous (stopped before BRV initiation) and concomitant ASMs at BRV initiation. ResultsSeven hundred and forty patients received adjunctive BRV (safety set [SS]; median modal dose: 200 mg/day [N = 737]; median treatment duration: 2.67 years), of whom 13.8 % had 1–2, 20.8 % had 3–4, 21.1 % had 5–6 and 44.3 % had ≥7 lifetime ASMs. Patients with a higher number of lifetime ASMs had a younger age at epilepsy onset, longer epilepsy duration, and higher baseline seizure frequency. Kaplan-Meier estimated retention on BRV at 12 (83.2–65.9 %) and 36 months (63.0–44.1 %) was highest in patients with 1–2 lifetime ASMs and decreased with the number of lifetime ASMs. The estimated proportions of patients who discontinued BRV due to lack of efficacy or treatment-emergent adverse events (TEAEs) increased with the number of lifetime ASMs. Efficacy analyses included seven hundred and thirty eight patients (intention-to-treat set [ITT]). Median percentage reductions from baseline in focal seizure frequency/28 days (76.3–39.6 %), 50 % responder rates (66.7–39.8 %), 75 % responder rates (51.0–19.6 %), and continuous seizure freedom for ≥12 months at any time during BRV treatment (35.3–6.1 %) were highest in patients with 1–2 lifetime ASMs and decreased by the number of lifetime ASMs. The overall incidence of TEAEs (SS) was generally similar in each lifetime ASM subgroup (84.4–90.5 %). Discontinuations due to TEAEs increased with the number of lifetime ASMs (7.8–20.1 %). The greatest improvements in QOLIE-31-P scores occurred in the Seizure Worry and Daily Activities/Social Function subscales, with no clear pattern by the number of lifetime ASMs at 12 months and with the highest improvement in patients with 1–2 lifetime ASMs at 24 months. At 24 months, the Hospital Anxiety and Depression Scale (HADS) Anxiety subscale scores improved in patients (SS) with 1–2 and 3–4 lifetime ASMs. HADS Depression subscale scores were generally stable independent of the number of lifetime ASMs. ConclusionsThe balance between efficacy, tolerability, and HRQOL was most favorable in patients with focal seizures who had been exposed to one or two ASMs before BRV initiation. However, patients exposed to ≥7 ASMs before BRV initiation also benefitted from long-term adjunctive BRV treatment.

Prevalence and Risk Factors for Anxiety and Depression in Thai People with Parkinson’s Disease: A Cross-Sectional Study in Buriram Hospital

Background: Anxiety and depression are non-motor symptoms commonly found in patients with Parkinson’s disease (PD). Objective: To investigate the prevalence of anxiety and depression in patients with PD, including factors related to their anxiety and depression. Materials and Methods: Forty-four PD patients of the present cross-sectional study were observed between August 1, 2021 and September 30, 2021. Anxiety and depression were assessed using the hospital anxiety and depression scale (HADS). A score of 8 or more on both HADS anxiety subscale (HADS-A) and HADS depression subscale (HADS-D) denoted significant symptoms of anxiety and depression among the PD patients. Descriptive statistics were used to analyze the prevalence and demographic data. The authors used binary logistic regression, linear regression, and Spearman’s rank correlation coefficient to analyze the factors associated with anxiety and depression. Results: From the 44 Thai PD patients, the prevalence of anxiety and depression were 27.3% and 31.8%, respectively. The anxiety related factors were PD duration of 10 years or more (OR 7.50, 95% CI 1.16 to 48.56), levodopa equivalent dose (LED) of 600 mg/day or more (OR 7.00, 95% CI 1.50 to 32.72), total Unified Parkinson’s Disease Rating Scale (UPDRS) (β=0.46, 95% CI 0.18 to 0.74), UPDRS part II (β=0.32, 95% CI 0.02 to 0.61), and UPDRS III (β=0.37, 95% CI 0.08 to 0.66). The depression related factors were total UPDRS (β=0.39, 95% CI 0.11 to 0.68), and UPDRS part II (β=0.33, 95% CI 0.03 to 0.62). Conclusion: Results indicate that anxiety and depression are associated with disease severity among individuals with PD. Therefore, physicians who treat PD patients with high disease severity should be aware of and screen for these emotional problems to facilitate appropriate management. Keywords: Anxiety; Depression; Disease severity; Functional performance test; Hospital anxiety and depression scale; Parkinson’s disease

Depressive symptoms in the general population: The 7th Tromsø Study

• In an adult population (≥40 years), participants in the age groups 40–49 and 80+ reported the highest prevalence of depressive symptoms. • Measured by the Hospital Anxiety and Depression Scale (HADS), men reported higher prevalence of depressive symptoms than women, but the difference disappeared after controlling for other factors. • Low social support, low education and living without a spouse increased the risk for depressive symptoms. The prevalence of depressive symptoms may differ in various age groups. The aim of the study was to investigate the point-prevalence of depressive symptoms in the adult general population and in various age groups. The impact of sex, marital status, education, and social support on depressive symptoms was also explored. The population ≥40 years in the city of Tromsø, Norway, were invited to participate in the survey, of whom 64.7% (n=21,083) participated. All participants with a completed Hospital Anxiety and Depression Scale (HADS) were included in the study. A score ≥8 in the HADS depression subscale (HADS-D) was used to indicate caseness for depression. The caseness for depression was 7.5% for men and 6.3% for women, overall 6.9%. The age groups 40-49 years and 80+ years had highest caseness. The overall HADS-D score for the total population was 2.8 (SD 2.7). The mean HADS-D for men (3.1; SD 2.8) was higher than for women (2.6; SD 2,6) (p<0.001). Low social support, low education and not living with a spouse was associated with higher risk for depressive symptoms. The prevalence of depressive symptoms was based on a questionnaire, and represents only an estimate of depression in the population. Participants over 80 years were underrepresented, as fragile elderly and elderly living in nursing homes did not participate. Depressive symptoms were more prevalent in the youngest and oldest age groups. Participants reporting low social support, low education and not living with a spouse had higher risk for depressive symptoms.

Factors Associated with Kinesiophobia in Patients with Knee Osteoarthritis

Abstract Purpose This study aims to determine factors affecting kinesiophobia in patients with knee osteoarthritis (OA). Materials and Methods The fear of movement was measured using the Tampa Scale of Kinesiophobia in 60 patients with knee OA. Pain intensity was assessed with the Visual Analog Scale, quality of life with the Nottingham Health Profile (NHP), disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), anxiety and depression with the Hospital Anxiety and Depression Scale (HADS), balance with the Berg Balance Scale, mobility with the Timed Up and Go Test, and the physical activity status was measured with the International Physical Activity Questionnaire. Results Physical mobility and emotional reactions subscales of NHP, all WOMAC subscales and the HADS depression subscale were significantly related to kinesiophobia. Muscle strength, ROM, level of physical activity, balance, mobility and anxiety were not significantly related to kinesiophobia. Quality of life and disability explained 34.4% of the variation in the Tampa Scale of Kinesiophobia. Conclusions Kinesiophobia was associated with quality of life, disability and depression. It may be useful for clinicians to pay attention to the evaluation of psychosocial characteristics instead of physical performance parameters in order to increase treatment success in OA patients.

Efficacy of early interdisciplinary palliative care based on WARM model in non-small-cell lung cancer

Objective: To assess the therapeutic effect of the early interdisciplinary palliative care based on WARM model (whole, assessment, revaluation, management) on the quality of life, psychological state, pain and nutritional status in patients with non-small-cell lung cancer (NSCLC). Methods: A total of 60 patients from Chongqing University Cancer Hospital with newly diagnosed advanced NSCLC from Oct 15, 2019 to Jun 12, 2020 were enrolled. According to the method of random number table, the patients were divided into two groups: standard oncologic care group (SC, n=30) and early palliative care group (EPC, n=30). SC group only received standard oncological care, while EPC group received standard oncological care and additional comprehensive treatment from a MDT consisted of medical oncologists, palliative care nurses, dietitians and psychologists. The quality of life [functional assessment of cancer therapy-lung (FACT-L) scale], psychological state [hospital anxiety and depression scale (HADS) and patient health questionnaire-9 (PHQ-9)], nutritional status [patient-generated subjective global assessment (PG-SGA)], and cancer pain status [numerical rating scale (NRS)] were observed and compared between the two groups before and after the 6 months treatment, respectively. Results: A total of 45 patients completed 6 months treatment, including 24 males and 21 females, aged 38-82 (60.5±1.7), with 23 patients in the EPC group and 22 patients in the SC group. Patients assigned to EPC group had a better quality of life than those assigned to SC group [FACT-L scale: (122.3±1.6) vs (111.8±2.1), P<0.001]. Fewer patients had anxiety and depressive symptoms in the EPC group than those in the SC group [HADS anxiety subscale: (1.1±0.3) vs (2.9±0.4), P<0.001; HADS depression subscale: (0.7±0.3) vs (3.6±0.4), P<0.001]. The PHQ-9 results showed that 100.0% (23/23) patients were free of depression in the EPC group, while 45.5% (10/22) patients were free of depression in SC group (P<0.001). Furthermore, patients in the EPC group had a better nutritional status [moderate malnutrition: 60.9% (14/23); no malnutrition: 39.1% (9/23)] than those in the SC group [severe malnutrition: 40.9% (9/22); moderate malnutrition: 50.0% (11/22); no malnutrition: 9.1% (2/22)] (P<0.001). There was no significant difference in NRS score between EPC group and SC group (P=0.140). Conclusion: Early interdisciplinary palliative care based on WARM model can improve the quality of life, psychological state and nutritional status in NSCLC patients.

Translation, reliability, and structural validity of the Hospital Anxiety and Depression Scale (HADS) in the general population of Mongolia

Various psychological, biological, and social factors make people vulnerable to mental health problems. These precursory factors as mental distress, are not sufficient alone for diagnosing a mental disorder but are recognised as risks to mental health. There has been no screening tool available in Mongolia that is adequately validated for mental health screening and neuropsychiatric functions of the brain. Therefore, we aimed to translate and validate the hospital anxiety and depression scale (HADS) to identify potential mental distress in healthy people. The HADS is reliable, valid, and practical for identifying the most common psychological disturbances. This nationwide comparative observational study for the validity of a self-reported measure was conducted between June and December 2020. One thousand ninety-four participants were randomly selected, aged 13-75, mean age was 37.7±13.7 years old, 60.9% were females, 63.9% were married. HADS total score was 13.0±5.7, HADS anxiety (HADS-A) score was 6.8±3.6, and HADS depression (HADS-D) score was 6.0±3.1 for the original two-factor model. The external reliability was good in the whole scale, and both subscales using the Intraclass Correlation Coefficient (0.872, 0.837, and 0.801 for the HADS-T, HADS-A, and HADS-D, respectively). Cronbach's alpha value was 0.776, 0.756, and 0.582, respectively, for the HADS-T, HADS-A, and HADS-D, indicating an acceptable internal consistency for the entire scale but marginal reliability for the HADS-D subscale. The reliability of both the two-factor and three-factor structures of the HADS was confirmed using confirmatory factor analysis with a satisfactory model fit on a separate sample. In conclusion, the Mongolian version of the HADS can be considered a valid and reliable measurement tool for various scientific and clinical practices in the general population.

Cardiovascular Abnormalities and Mental Health Difficulties Result in a Reduced Quality of Life in the Post-Acute COVID-19 Syndrome.

(1) Background: Post-acute COVID-19 syndrome, characterized by persisting symptoms up to 12 weeks after the acute illness, impairs numerous people’s physical and mental health. (2) Methods: 64 inpatients and 79 outpatients, aged under 55 years, with post-acute COVID-19, were evaluated by a transthoracic echocardiography (TTE), mental health examination, Quality of Life (QoL) questionnaire, post-COVID-19 functional status scale (PCFS) and Hospital Anxiety and Depression Scale (HADS). (3) Results: all inpatients had mild/moderate pulmonary injury during acute COVID-19, in contrast to 37.97% of outpatients. Inpatients who reported an average of 5 persisting symptoms, had, predominantly, level 3 PCFS and a median QoL of 62, compared to outpatients, who reported an average of 3 symptoms, level 1 PCFS and a median QoL score of 70. Increased pulmonary artery pressure was detected in 28.11% of inpatients, compared to 17.72% of outpatients, while diastolic dysfunction was diagnosed in 28.12% of inpatients, in comparison with 20.25% of outpatients (p = 0.02). Abnormal systolic function was assessed in 9.37% of inpatients, and 7.58% of outpatients. According to the HADS depression subscale, 46.87% of inpatients and 27.84% of outpatients had clinical depression. Concomitantly, anxiety was detected in 34.37% of inpatients and 40.5% of outpatients (4) Conclusions: cardiovascular and mental health difficulties were frequently detected in patients with post-acute symptoms of COVID-19, which correlated with the number and intensity of persisting symptoms and reduced QoL scores.

Depression and cognitive distortions in hemodialysis patients with end stage renal disease: A case-control study

Background and objectivesIdentifying cognitive distortions is essential for Cognitive Behavioral Therapy (CBT) that plays a key role in the treatment of depression. Depression seen in patients with End-Stage Renal Disease (ESRD) has not been sufficiently diagnosed and treated. This study aimed to examine the cognitive distortions and schemas of patients diagnosed with ESRD. MethodsFifty-six patients undergoing hemodialysis and forty-seven controls were enrolled in the study. A sociodemographic and clinic data form, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety and Depression Scale (HADS), Dysfunctional Attitudes Scale (DAS), Automatic Thoughts Questionnaire (ATQ) were applied to all participants. ResultsThe prevalence of the psychiatric disorder in the case group was significantly higher than the prevalence of the psychiatric disorder in the control group. Compared with the control group, the HADS depression subscale was significantly high in the patient group. There was a positive correlation between the duration of hemodialysis and total scores of DAS as well as the “dependency attitudes” factor among the case group. The “helplessness” subscale scores of the ATQ were significantly higher in the case group compared to the control group. ConclusionsThe duration of hemodialysis was related to dependency attitudes of cognitive distortions among patients with ESRD. Studies investigating cognitive modalities are needed to treat depression more successfully in this population. It will contribute to the Cognitive Behaviour Therapy of ESRD patients when these factors are taken into consideration.

A mindfulness group intervention in newly diagnosed persons with multiple sclerosis: A pilot study

BackgroundRelapsing MS (RMS) is a lifelong disease without a cure, usually diagnosed between 20-40 years of age. Being newly diagnosed with RMS is a highly stressful event due to the unpredictable disease course after diagnosis. Thus, it is imperative that persons with MS have the skills and support to cope with the negative physical and emotional effects of the disease. The objective of this study was to assess whether a mindfulness-based intervention (MBI) would improve coping skills and thus lessen the negative consequences of stress due to being newly diagnosed with RMS. MethodsThis was a single-blind (assessor), randomized, prospective study of a 10-week MBI vs. usual standard of care in persons newly diagnosed (within 1 year) with RMS, recruited from one tertiary care MS clinic in London (ON), Canada. The MBI was administered in group format with a trained MBI facilitator. Primary outcomes included the Brief COPE measure and the Hospital Anxiety and Depression Scale (HADS) subscales. Secondary outcomes included measures of perceived stress, cognitive function, fatigue, and quality of life. Exploratory (tertiary) outcomes included serum markers of inflammation and stress. Subjects were assessed at baseline, post intervention (or equivalent) and 6 months later. A repeated measures multivariate analysis of covariance (MANCOVA) was used, with baseline scores employed as covariates and the test scores, to compare longitudinal changes, immediately after the MBI sessions and 6 months later. ResultsTwenty-five subjects were recruited (16 MBI, 9 controls) for two (Fall and Spring) MBI interventions over 1.5 years. All controls completed the study, while 4 MBI participants did not, leaving 21 subjects in the analysis. Most were women (17, 81%), with a mean age of 37.1 ± 9.4 years. Two thirds had already started a DMT at the time of consent; the median EDSS was 2.0 (0.0-4.0). The groups were well matched on baseline characteristics, with the exception of months since diagnosis (MBI 6.4 ± 6.5 vs. control 3.6 ± 2.8, p=0.023). All controls completed the study, while 4 MBI participants did not. The MBI group improved significantly on the COPE measure when compared to the control group (p=0.024) pre and post intervention; the MBI group also improved significantly on the HADS depression subscale (p=0.007). There was no significant difference over time on the HADS anxiety subscale (p=0.179). The effect size on COPE was 0.56 and 0.40 on HADS-D. On the secondary outcomes, there was a significant improvement on the Perceived Stress Scale (p=0.015). The exploratory outcomes were not significantly different. None of the outcomes were significant at the six-month follow-up. ConclusionThis pilot study demonstrates that an MBI may improve coping, depression and perceived stress in newly diagnosed (within one year) persons with RMS in the short term. Future research to confirm these results, as well as further investigate measures to extend the benefit beyond the immediate intervention.

Validation of the Danish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaires (BRAFs)

Objective: This study aimed to validate the Danish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) and BRAF Numerical Rating Scale version 2 (NRSv2). Method: We tested face and content validity, internal consistency, criterion validity, construct validity, and reproducibility for the BRAF-MDQ, and face and criterion validity and reproducibility for the BRAF-NRS. Results: In all, 224/236 patients (95%) completed the questionnaires [70% female, mean ± sd age 59 ± 13.04 years, disease duration 11.2 ± 9.49 years, Health Assessment Questionnaire (HAQ) 0.724 ± 0.70, and 28-joint Disease Activity Score–C-reactive protein 2.55 ± 1.24]. The unidimensionality for the physical and cognitive fatigue subscales was confirmed, whereas the living with fatigue and emotional fatigue subscales were not unidimensional. Cronbach’s α was 0.94 for the BRAF-MDQ total and 0.78–0.92 for the four subscales. The correlations between BRAF-MDQ and various measures were: 36-item Short Form Health Survey (SF-36) vitality subscale, 0.75; Hospital Anxiety and Depression Scale (HADS) anxiety subscale, 0.65; HADS depression subscale, 0.62; visual analogue scale (VAS) pain, 0.62; VAS global, 0.73; and HAQ, 0.62. The intraclass correlation coefficient for agreement was 0.995. A Bland–Altman plot showed a mean ± sd difference of −1.9 ± 3.62 for BRAF-MDQ. Correlation coefficients between the BRAF-NRSv2 subscales and other subscales were: BRAF-MDQ subscales, 0.57–0.93; SF-36 vitality subscale, 0.54–0.68; and VAS fatigue, 0.66–0.82. Conclusions: The Danish BRAFs are considered valid and reliable for use among Danish patients with rheumatoid arthritis, despite the subscales living with fatigue and emotional fatigue not being unidimensional, as they are in the original version.

Prevalence of anxiety and depression in dizzy patients using Arabic hospital anxiety and depression scale

ObjectivesTo develop an Arabic version of the hospital anxiety and depression scale (HADS) to detect and measure anxiety and depression prevalence in dizzy patients.BackgroundDizziness is a common complaint that has many causes and may be related to psychiatric disorders like anxiety and depression. Early detection of anxiety and depression in dizzy patients helps in proper management and a better outcome. The HADS is a valid screening tool, and having an Arabic version will be of great help.Patients and methodsThe original English HADS was translated following the cross-cultural adaptation guidelines into Arabic. The final Arabic version of HADS was administered to samples of 100 healthy control persons, 30 anxious patients, and 30 depressed patients. Reliability and validity of the translated Arabic HADS were examined. The prevalence of anxiety and depression in dizzy patients were assessed through 100 dizzy patients who were asked to complete the validated Arabic HADS.ResultsThe translated Arabic HADS was found to be reliable with strong internal consistency (Cronbach's alpha was 0.811 for the anxiety group and 0.758 for the depression group). The test–retest reliability was high (Spearman's correlation was 0.980 for the anxiety group and 0.928 for the depression group). There was a good correlation between psychiatric assessment and HADS for anxiety and depression using the Mann–Whitney test, indicating its validity. We performed the receiver operating characteristics curve, and the most sensitive cutoff point for HADS anxiety subscale was 8.5 and for HADS depression subscale was 9.5. In the dizzy group, 32% gave positive HADS scores for anxiety subscale and 22% gave positive HADS scores for depression subscale.ConclusionsThis version of the Arabic HADS is a reliable and valid psychological screening tool for anxiety and depression. The anxiety and depression prevalence in the dizzy patients was 32% and 22%, respectively.

Significant Association Between Huntingtin Gene Mutation and Prevalence of Hopelessness, Depression and Anxiety Symptoms.

Summary. Background:In Huntington’s disease psychiatric symptoms may manifest prior to motor dysfunction. Such symptoms negatively impact people’s quality of life and can worsen the course of the primary disease. The aim of the present study was to assess and compare depression, anxiety and hopelessness rates in individuals with and without an abnormal expansion of CAG repeats in the huntingtin (HTT) gene and healthy controls.Materials and methods:Study involved 31 individuals referred for genetic testing for Huntington’s disease and a control group of 41. Depressive and anxiety symptoms were assessed using Beck Hopelessness Scale (BHS) and Hospital Anxiety and Depression Scale (HADS). Results between groups were compared using the Mann–Whitney U test. Two-sided Bonferroni corrected p-value was set at ≤0.017.Results:Individuals with HTT gene mutation (“gene mutation positive”, GMP) (N=20) scored higher on the HADS depression subscale (5.90 ± 4.52 vs 1.36 ± 1.91; p ≤ 0.017) than those without HTT gene mutation (“gene mutation negative”, GMN) (N=11). GMP and control groups scored higher than the GMN group on the BHS (5.65 ± 3.91 vs 2.09 ± 1.64 and 5.27 ± 4.11 vs 2.09 ± 1.64, respectively; p ≤ 0.017). No differences in anxiety levels were found.Conclusions:Depressive symptoms and hopelessness were more prevalent in individuals with HTT gene mutation than in individuals who were tested but had no said mutation. Such results emphasise the importance of timely diagnosis and treatment of psychiatric comorbidities in individuals affected by Huntington’s disease.

Anxiety, depression and marital satisfaction in women with hyperemesis gravidarum: A comparative cross-sectional study in Hospital Tengku Ampuan Rahimah, Klang, Malaysia.

Hyperemesis Gravidarum (HG) is a severe form of vomiting that occurs among pregnant mothers. Due to the nature of HG, pregnant mothers may feel fatigued and burdened by it and questions have been raised about the emergence of psychiatric illness during this period of vulnerability. A comparative cross-sectional study using Hospital Anxiety and Depression Scale (HADS), M.I.N.I (MINI International Neuropsychiatric Interview) and ENRICH- EMS (Evaluation and Nurturing Relationship Issues, Communication and Happiness - Marital Satisfaction Scale) were performed in a group of 112 pregnant women. There were no differences in the prevalence rate of any anxiety disorder among the patient with HG vs comparative group (9% vs 3%, P > 0.05) and depressive disorder in women with HG vs comparative group (16% vs 8%, P > 0.05) respectively. There were associations between HG and gravida, past history of miscarriage, and gestational diabetes (P < 0.05). After adjustment, only past history of gestational diabetes was associated with HG as a protective factor (AOR 0.034 95% CI 0.002-0.181; P=0.0014). We found that women in the HG group tended to score statistically significantly higher than the comparison group for depressive symptoms in the HADS Depression subscale (P=0.041). We found no convincing association between HG and anxiety disorder, depressive disorder, and marital satisfaction, but women with HG statistically significantly reported more depressive symptoms than women who were not diagnosed with HG. Psychiatric evaluation should be considered for women with HG.

Insomnia and caregiver burden in chronic pain patients: A cross-sectional clinical study.

Insomnia is a major comorbid symptom of chronic pain and is likely to affect caregiver burden. This cross-sectional study investigated the association between insomnia in chronic pain patients and family caregiver burden. Participants were 60 patients with chronic pain of ≥3 months duration. Demographic and clinical information were collected using the Athens Insomnia Scale (AIS), the Pain Disability Assessment Scale (PDAS), the Hospital Anxiety and Depression Scale (HADS), and a pain intensity numerical rating scale (NRS). Family members who accompanied chronic pain patients to hospital completed the Zarit Burden Interview (ZBI). Univariate regression analysis and multiple regression analysis were conducted to clarify the associations between ZBI scores and total/subscale AIS scores. Covariates were age; sex; pain duration; and scores on the PDAS, HADS anxiety subscale, HADS depression subscale, and NRS. Insomnia was independently associated with ZBI scores [β: 0.27, 95% confidence interval (CI): 0.07–0.52, p = 0.001]. Scores on the AIS subscale of physical and mental functioning during the day were significantly associated with ZBI scores (β: 0.32, 95% CI: 0.05–0.59, p = 0.007). In conclusion, the findings suggest that in chronic pain patients, comorbid insomnia and physical and mental daytime functioning is associated with family caregiver burden independently of pain duration, pain-related disability, and pain intensity.