Disease-specific Anxiety Research Articles

Reliability, Validity, Modification and Expansion of the Chinese Version of the Disease-Specific Anxiety Questionnaire for Chronic Obstructive Pulmonary Disease.

To translate a disease-specific anxiety questionnaire on chronic obstructive pulmonary disease (COPD) and test its reliability and validity in China. The German version of the revised COPD Anxiety Questionnaire (CAF-R) was initially validated using step-by-step translation, back-translation, and cross-cultural adaptation. The reliability and validity of the Chinese version of the CAF-R (CAF-R-CN) were tested among 448 patients with COPD (mean age =71.42±9.33 years, 17.2% female) from four medical institutions in Suzhou, Jiangsu Province, using convenience sampling, from April 2022 to June 2023. The CAF-R-CN included six dimensions with a total of 25 items. The item-level content validity index was 0.860-1.000; the scale-level content validity index was 0.920. The structural validity χ2/df was 2.326, the root mean square error of approximation was 0.077, the comparative fit index was 0.924, and the Tucker-Lewis index was 0.912. The six-dimensional internal consistency index Cronbach's α coefficient was 0.696-0.910, and the test-retest reliability was 0.949. An optimal cut-off score of 50.5 was selected with a sensitivity of 0.786 and specificity of 0.870. The CAF-R-CN had satisfactory reliability and validity and can be used to identify and assess anxiety in COPD patients with a Chinese cultural background.

The emotional well-being of parents with children at genetic risk for type 1 diabetes before and during participation in the POInT-study.

This study examined the emotional impact that parents experience when confronted with an increased genetic risk of type 1 diabetes (T1D) in their child. Population-based screening of neonates for genetic risk of chronic disease carries the risk of increased emotional burden for parents. Information was collected using a well-being questionnaire for parents of infants identified as having an increased risk for T1D in a multinational research study. Parents were asked to complete this questionnaire after they were told their child had an increased risk for T1D (Freder1k-study) and at several time points during an intervention study (POInT-study), where oral insulin was administered daily. Data were collected from 2595 parents of 1371 children across five countries. Panic-related anxiety symptoms were reported by only 4.9% after hearing about their child having an increased risk. Symptoms of depression were limited to 19.4% of the parents at the result-communication visit and declined over time during the intervention study. When thinking about their child's risk for developing T1D (disease-specific anxiety), 47.2% worried, felt nervous and tense. Mothers and parents with a first-degree relative (FDR) with T1D reported more symptoms of depression and disease-specific anxiety (p < 0.001) than fathers and parents without a FDR. Overall, symptoms of depression and panic-related anxiety are comparable with the German population. When asked about their child's risk for T1D during the intervention study, some parents reported disease-specific anxiety, which should be kept in mind when considering population-based screening. As certain subgroups are more prone, it will be important to continue psychological screening and, when necessary, to provide support by an experienced, multidisciplinary team.

Disease-Specific Anxiety in Chronic Obstructive Pulmonary Disease: Translation and Initial Validation of a Questionnaire.

BackgroundCommonly applied measures of symptoms of anxiety are not sensitive to disease-specific anxiety in patients with chronic obstructive pulmonary disease (COPD). There is a need for validated instruments measuring COPD-specific anxiety. Therefore, we translated the COPD-Anxiety Questionnaire (CAF) into Danish (CAF-R-DK) and performed an initial validation of the psychometric properties in a sample of patients with COPD.Materials and MethodsTranslation procedures followed the World Health Organization guidelines. Participants with COPD completed questionnaires measuring COPD-specific anxiety (CAF-R-DK), general psychological distress (Hospital Anxiety and Depression Scale) as well as variables related to COPD (COPD Assessment Test; modified Medical Research Council dyspnea scale), quality of life (the 12-item Short Form survey, SF12), and socio-demography.ResultsA total of 260 patients with COPD (mean age: 65.0, 69% female) completed questionnaires. The Danish version of CAF-R-DK demonstrated acceptable Cronbach’s α values that were comparable with those of the original CAF. As expected, the CAF-R-DK showed positive correlations with convergent constructs (CAT; HADS) and negative correlations with discriminant constructs (SF-12). However, the results for specific subdomains of the CAF-R-DK indicated inconsistency in the underlying concept of disease-specific anxiety, which was also suggested based on the subsequent confirmatory and exploratory factor analyzes.ConclusionThe CAF could serve as an important supplement to generic psychological distress screening of patients with COPD in somatic health care settings, and the questionnaire is now available in Danish. Translation into other languages is needed with the purpose of obtaining data for further testing the psychometric properties of the questionnaire.

The \u201ccan do, do do\u201d concept in individuals with chronic obstructive pulmonary disease: an exploration of psychological mechanisms

BackgroundThe “can do, do do” concept aims at identifying subgroups among persons with chronic obstructive pulmonary disease (COPD). Following a two-dimensional categorization, individuals are binarily classified with respect to their levels of physical capacity (“can’t do” or “can do”) and physical activity (“don’t do” or “do do”), resulting in four disjunct quadrants. The approach has been debated recently and the latest articles have concluded that the quadrants should be specifically examined in terms of psychological aspects of physical activity. Therefore, the goal of the present study was to explore the role of psychological variables in physical activity in the context of the “can do, do do” quadrant concept.MethodsWithin the scope of secondary data analyses of the “Stay Active After Rehabilitation” (STAR) randomized controlled trial, a total of 298 COPD rehabilitants of an inpatient pulmonary rehabilitation program were grouped into the suggested quadrants. We set fixed cut-offs at 70% of relative 6-min walking test performances for healthy individuals (physical capacity dimension) and 5.000 steps per day (physical activity dimension). Univariate and multivariate logistic regression analyses served to analyze whether depression scores, fear avoidance behaviors, disease-specific anxiety, self-concordance for physical activity, and five indicators of physical activity-related health competence (PAHCO) effectively discriminated between the “don’t do” and “do do” groups.ResultsAmong persons with lower relative physical capacity, depression scores, fear avoidance behaviors, and disease-specific anxiety (univariate case) significantly differentiated between the more and the less active. Among persons with higher relative physical capacity, fear avoidance behaviors, disease-specific anxiety, as well as three PAHCO indicators (physical activity-specific self-efficacy, self-control, and affect regulation) significantly separated the more and the less active. In multivariate analyses, only fear avoidance behaviors and affect regulation discriminated among individuals with better relative physical capacity.ConclusionThe findings identified important psychological and competence-oriented variables that explain discrepancies in the quadrant concept. Based on this, we discuss implications for physical activity promotion in individuals with COPD. Respiratory research can benefit from future studies complementing the quadrant concept through further behavioral analyses.Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered 17 November, 2016, https://clinicaltrials.gov/ct2/show/NCT02966561.

The Need for Patient-centered Education Among Patients Newly Diagnosed With a Pituitary Tumor.

ObjectivesBrain tumors, including pituitary adenomas (PA), cause anxiety and distress, with a high unmet need for information correlating with increased anxiety. Condition-specific education may alleviate anxiety. We explored patients’ experience around the diagnosis of a PA and piloted a patient education intervention to address peridiagnostic anxiety in adults diagnosed with PA.MethodsAnxiety, patient satisfaction, patient knowledge, and need for information were measured prior to, immediately after, and 1 month following the appointment in this multimethods study. A phone interview to explore patient diagnostic and intervention experiences was analyzed using qualitative methods.ResultsA total of 17 patients participated in the study; 15 completed the interview. The baseline need for information was high. Disease-specific anxiety decreased, and patient knowledge and satisfaction increased significantly after the initial visit. Interview analysis identified 3 main themes: (1) the importance of communication; (2) the need for information; and (3) the impact of the diagnosis on patient experience.ConclusionsFor patients with newly diagnosed PA, the diagnostic experience was associated with high levels of anxiety. Patients expressed a need for information. Information delivery reduced anxiety and had a positive impact on patient satisfaction.Practice ImplicationsThe study findings suggest a need for a streamlined diagnostic process with readily accessible information.

Association between disease-specific anxiety at discharge and functional outcome in patients after total knee arthroplasty

BackgroundPatients who undergo total knee arthroplasty (TKA) may experience disease-specific problems, including decline in motor function and intense pain, which may result in disease-specific anxiety. This study aimed to investigate disease-specific anxiety at discharge, and any association between anxiety and functional outcomes following TKA. MethodsThe study prospectively included 129 patients who had undergone TKA. Each patient's disease-specific anxiety about wounds, pain, gait, and falling was assessed at discharge using a numerical rating scale, in which 0 represented no anxiety and 10 represented the highest level of anxiety. In addition, patient-reported outcomes (PROs) were evaluated using the Knee Society Score (KSS) at six-months postoperatively. The effects of disease-specific anxiety at discharge were evaluated with the KSS at six-months postoperatively and analyzed separately using multiple regression analysis. ResultsThe median score for anxiety about wounds, pain, and gait was 4.0 (IQR 2.0–5.0) at discharge five days after surgery. The median score for anxiety about falling was also 4.0 (IQR 2.0–6.0). The level of anxiety regarding wounds, pain, gait, and falling was negatively associated with the KSS six-months postoperatively after adjusting for all confounding factors (wounds: β = −2.8, 95% CI −4.3 to −1.3; pain: β = −3.4, 95% CI −4.9 to −1.9; gait: β = −4.3, 95% CI −5.8 to −2.9; falling: β = −2.5, 95% CI −3.9 to −1.1). ConclusionPatients reported similar levels of anxiety regarding wounds, pain, gait, and falling at discharge after TKA. The severity of anxiety symptoms at discharge was negatively associated with PROs six-months postoperatively.

„Dr. Google“ – Informationssuche und Krankheitsangst bei Männern mit lokal begrenztem Prostatakarzinom

After the diagnosis of localized prostate cancer (LPCa), many men seek additional information about their disease. However, it is not yet proven how different sources of information influence uncertainty and disease-specific anxiety. The aim of this study is to investigate to what extent different types of information sources, the number of used sources and the perceived level of information are predictive of disease-specific anxiety. Men with LPCa (N = 292; n = 150 radical prostatectomy, n = 142 active surveillance) completed questionnaires assessing sociodemographic variables, number and type of sources of information used, perceived level of information, and disease-specific anxiety. The association of information-seeking behavior with anxiety was tested using moderated sequential multiple regression. Men were 70 ± 7.2years old and the survey was taken 47.9 ± 15.4months after decision for therapy. The multiple regression analysis showed that, after controlling for potential covariates, internet usage (β = 3.28; p > 0.001), number of sources (β = 1.09; p > 0.01) and alower level of informedness (β = 4.49; p > 0.001) independently predicted variability of anxiety. In addition, the 3‑way interaction (β = 2.03; p > 0.05) accounted for asignificant proportion of variance. Overall, the model explained 30% of the criterion variance. Our results show that many men with LPCa already use the internet as asource of information and that this online search is associated with increased disease-specific anxiety. It may be possible to reduce disease-specific anxiety and uncertainty if physicians advise their patients on the selection of reliable online sources.

Killer Insects: Who Is at Risk for Anaphylaxis From Insect Stings?

Patients who have had an anaphylactic reaction to stinging insect should be educated on the potential of fatality from venom allergy. These patients should be referred to an allergist/immunologist, a specialist with training in the diagnosis and management of stinging insect allergy. The three tenets of treatment for stinging insect allergy are insect avoidance measures, proper use of epinephrine, and insect immunotherapy. Avoidance is ideal but not always practical. Intramuscular epinephrine is the only effective therapy for anaphylaxis. Insect immunotherapy is proven to reduce the probability of anaphylaxis with repeat stings from approximately 60 % to less than 5 %. This reduction is not only potentially life-saving but also improves quality of life and reduces anxiety. Before starting immunotherapy, clinicians should have a discussion with patients regarding their goals of care, disease-specific anxiety level, comorbid conditions, and possible compliance issues.

Disease-specific anxiety symptomatology in Parkinson's disease.

Symptoms of anxiety relating to Parkinson's disease (PD) occur commonly and include symptomatology associated with motor disability and complications arising from PD medication. However, there have been relatively few attempts to profile such disease-specific anxiety symptoms in PD. Consequently, anxiety in PD is underdiagnosed and undertreated. The present study characterizes PD-related anxiety symptoms to assist with the more accurate assessment and treatment of anxiety in PD. Ninety non-demented PD patients underwent a semi-structured diagnostic assessment targeting anxiety symptoms using relevant sections of the Mini International Neuropsychiatric Interview (MINI-plus). In addition, they were assessed for the presence of 30 PD-related anxiety symptoms derived from the literature, the clinical experience of an expert panel and the PD Anxiety-Motor Complications Questionnaire (PDAMCQ). The onset of anxiety in relation to the diagnosis of PD was determined. Frequent (>25%) PD-specific anxiety symptoms included distress, worry, fear, agitation, embarrassment, and social withdrawal due to motor symptoms and PD medication complications, and were experienced more commonly in patients meeting DSM-IV criteria for an anxiety disorder. The onset of common anxiety disorders was observed equally before and after a diagnosis of PD. Patients in a residual group of Anxiety Not Otherwise Specified had an onset of anxiety after a diagnosis of PD. Careful characterization of PD-specific anxiety symptomatology provides a basis for conceptualizing anxiety and assists with the development of a new PD-specific measure to accurately assess anxiety in PD.

The Relationship Between Coping Styles and Clinical Outcomes in Patients with COPD Entering Pulmonary Rehabilitation

Background: Symptoms of anxiety, depression and exercise intolerance contribute to an impaired health status in patients with Chronic Obstructive Pulmonary Disease (COPD). Coping styles may also be related to symptoms and health status. Objectives of this study were to assess the distribution of coping styles in patients entering pulmonary rehabilitation (PR) with and without anxiety and/or depression; and to assess whether coping styles contribute to exercise intolerance and reduced health status. Methods: Coping styles were studied in 698 patients using the Utrecht Coping List (UCL). Disease-specific health status (St. George's Respiratory Questionnaire, SGRQ), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), exercise tolerance (6-minute walking distance, 6MWD) and clinical characteristics were assessed. Results: High levels (16.5%) of active confronting coping style were rarely reported. A minority of patients used low levels (17.5%) of passive reaction pattern coping style. Differences in coping profiles were present between patients with and without anxiety and/or depression. A higher level of active confronting coping style was associated with a higher 6MWD (Beta 0.092, p < 0.01), while a higher level of avoidance coping style was associated with a lower 6MWD (Beta -0.074, p = 0.017). The UCL subscales were not related to SGRQ total score (p > 0.05). Conclusions: In COPD patients entering PR, coping styles were associated with symptoms of anxiety, depression and exercise intolerance, but not associated with disease-specific health status. Future studies should examine whether interventions aiming at optimizing coping styles during PR can improve outcomes for patients with COPD.

Exploration of patient anxiety 1 year after surgery for breast cancer.

e19590 Background: Women treated surgically for breast cancer (BrCa) can experience anxiety that affects their quality of life (QoL), sexual function, mood and even tumor-specific immune response. What remains unclear however is whether or not this anxiety correlates with known predictors of BrCa patient outcome. To address this, we completed a pilot study to explore associations of anxiety and clinicopathologic features in women one year after BrCa surgery. Methods: We prospectively identified 72 women with Tis-T3 BrCa who had surgery between 12/2008 and 12/2009. All patients completed the FACT-B questionnaire at one year. We determined anxiety based on response to the question “I worry my condition will worsen” and categorized anxiety as ‘none’ or ‘some’(a little bit to very much). We abstracted information on demographic and clinical covariates from our BrCa Registry and made comparisons using Kruskal-Wallis test or Kendall’s tau correlation. Results: At one year, 24 (33%) women reported no anxiety and 48 (67%) reported some anxiety. With issues of sample size in mind, women who reported anxiety were more likely to have DCIS compared to women who reported no anxiety (55% vs. 4%; p=0.04). Further, we noted little evidence that anxiety was associated with tumor size (p=0.23), positive nodes (p=0.97), lymphovascular invasion (p=0.23), type of surgery (BCT or mastectomy) (p=0.86), receipt of chemotherapy (p=0.55), or marital status (p=0.59). Interestingly, many women reporting anxiety had favorable pathologic features as 47% had tumors <2cm, 61% had negative nodes, and 71% had ER+/Her2 negative tumors. Conversely, of women reporting no anxiety, 30% had grade 3 tumors, 23% had >4 positive nodes, and 8% had tumors >5cm. Conclusions: In our pilot study, 67% of women having surgery for BrCa report some disease-specific anxiety at one year; however, anxiety does not correlate with clinicopathologic factors associated with prognosis. Given the documented adverse affects of anxiety, further investigation is warranted. Ideally, improving our understanding of BrCa-specific anxiety would allow for targeted interventions to allay fears in women with a favorable prognosis and provide coping strategies for women with more aggressive disease.

Anxiety Predicts Poor Perceived Health in Patients With an Implantable Defibrillator

Implantation with an implantable cardioverter defibrillator (ICD) may cause psychological problems, including anxiety. The objective was to determine whether general anxiety and disease-specific anxiety differentially predict poor perceived health in ICD patients. Patient concerns about the ICD and feelings of disability were independently predicted by general as well as disease-specific anxiety. Clinical anxiety was predicted by general anxiety only, whereas cardiopulmonary symptoms were predicted by disease-specific anxiety. Identifying and supporting ICD patients with various anxiety symptoms is important. Future research should examine the differential predictive value of different forms of anxiety toward medical endpoints as well as possible interventions for disease-related anxiety.

Anxiety Predicts Poor Perceived Health in Patients With an Implantable Defibrillator

Implantation with an implantable cardioverter defibrillator (ICD) may cause psychological problems, including anxiety.The objective was to determine whether general anxiety and disease-specific anxiety differentially predict poor perceived health in ICD patients.Patient concerns about the ICD and feelings of disability were independently predicted by general as well as disease-specific anxiety. Clinical anxiety was predicted by general anxiety only, whereas cardiopulmonary symptoms were predicted by disease-specific anxiety.Identifying and supporting ICD patients with various anxiety symptoms is important. Future research should examine the differential predictive value of different forms of anxiety toward medical endpoints as well as possible interventions for disease-related anxiety.

Perception of African American men of their likelihood of a cancer diagnosis at the time of prostate biopsy

6503 Background: Men are supposed to have an “informed discussion” before undergoing PCa screening. African Americans (AA) are diagnosed at later stages of prostate cancer (PCa) than their white counterparts. We studied racial differences in self-prediction compared with actual likelihood of positive biopsy. Method: Face-to-face surveys with patients (n = 172), referred after screening positive for possible PCa, were conducted in urology clinics at the time of biopsy. The surveys include socio-demographics, general anxiety (Hospital Anxiety and Depression Scale), disease-specific anxiety (Memorial Anxiety Scale for Prostate Cancer), and self-estimated likelihood of a positive biopsy. Medical records were reviewed for biopsy results. Results: Average age was 63±7.9, AA comprised 39% of the sample, and 56% had at least a college degree. The overall rate of positive biopsy was 55%, with AA being much more likely to have a positive biopsy (70% vs. 44%; p&lt; 0.05). Despite being referred for biopsy for concern about PCa, 37% of the men indicated that they had a 0% likelihood of having prostate cancer (i.e. that it was impossible), and AA were more likely than whites to say this (58% vs. 24%; p &lt; 0.01). In a logistic regression with important covariates, patients’ ratings of their likelihood of PCa diagnosis were not predictive of a positive biopsy, while older age, higher PSA score, and lower self-rated health were. Generalized anxiety was not correlated with estimated likelihood of having PCa, but cancer-specific anxiety was correlated (p = 0.02). Neither was correlated with likelihood of having PCa. Conclusion: AA are more likely to have PCa at biopsy than whites. Both groups dramatically underestimate their statistical likelihood of having PCa at the time of biopsy. More concerning, AA estimates are lower, yet their likelihood is higher. No significant financial relationships to disclose.

Clinical outcomes measurement: Gut feelings: The impact of symptom-specific anxiety in pain

Disease-specific anxiety measures have demonstrated potential utility for clinical assessment, treatment outcome studies, and mechanistic studies of the role of anxiety in disease presentation. Recently a gastrointestinal(GI)-specific measure of anxiety (Visceral Sensitivity Index, VSI) has been developed and validated for the assessment of symptom-specific anxiety in Irritable Bowel Syndrome (IBS), the most common functional abdominal pain syndrome. Replicate the psychometric properties of the VSI in a population based, non-clinic sample of IBS. Examine the relationship between VSI and general anxiety in IBS, controls and subjects with somatic pain. Using a population survey design, the notion of GI-symptom specific anxiety as measured by the VSI was assessed in several known-groups of young adults: non-pain controls, IBS (meeting Rome II diagnostic criteria), and somatic pain (experiencing some non-abdominal pain on a regular basis in the past 6 months) groups. Analyses addressed the relative importance of GI-specific anxiety after controlling for general anxiety, depression, neuroticism, and vitality. The results from a diverse sample of 312 university students (35% male, 65% female) provided further support for the reliability (á=.93) and the discriminant validity of the VSI. Subjects meeting IBS criteria (N=31) had significantly higher mean levels of GI-specific anxiety, p<.001, and neuroticism than controls (N=281), p<.05. Individuals endorsing non-abdominal pain (N=185) had higher levels of anxiety but lower levels of neuroticism than their non-pain counterparts (N=127), p's<001). Logistic regression of group status onto the psychological and vitality variables indicated GI-specific anxiety was the dominant and most relevant predictor for presence of IBS but not somatic pain. Instead general anxiety levels were more relevant for the presence of somatic pain. Results provide further support for the psychometric properties of the VSI and its relevance to assessment of GI-specific anxiety. The findings further support the importance of disease-specific measures of anxiety.

Does Thinking about Personal Health Risk Increase Anxiety?

This study aimed to examine the effect on anxiety about health of a self-referent health questionnaire, in which people were asked to respond to questions about personal risk factors. Participants were randomly allocated into one of two experimental conditions (completing a self-referential assessment of their current health, or personality), with dependent variables measured before and after the experimental manipulation. Dependent variables included general and disease-specific (CHD, Stroke and Diabetes) anxiety and need for reassurance. Analysis of covariance suggested that participants who completed the health-focused questionnaire significantly increased in their anxiety ratings about Heart Disease, Stroke and Diabetes relative to those who completed the personality-focused assessment. There was no effect on general anxiety ratings. The results have important implications for measurement procedures commonly employed in health psychology, as they suggest that asking participants to rate factors related to health risk may lead to other psychological changes. It is important that subsequent research identify the duration of such effects.

The Claudication Scale (CLAU-S)

Until recently, outcomes research in peripheral arterial occlusive disease focused mainly on the measurement of walking distances recorded on a treadmill. There is increasing acceptance that the quality of life of patients should also be considered. It has been shown that generic questionnaires are not sensitive enough to detect the effects of treatment on quality of life; we therefore developed, and validated in Germany, a new disease-specific instrument, the Claudication Scale (CLAU-S). This scale comprises 80 items, which can be assigned to subscales measuring the following dimensions: ‘daily living’, ‘pain’, ‘complaints’, ‘social life’, ‘disease-specific anxiety’, and ‘mood’. It has been translated into 3 different European languages (French, English and Flemish) and then validated in each country. The findings of these validation studies have shown that the instrument is reliable, valid and able to discriminate between patients with different disease severities. In particular, the CLAU-S subscores showed a highly significant correlation with the pain-free walking distances recorded on the treadmill and, in a separate postmarketing surveillance study, with the physician’s assessment of the change in the patient’s condition following oral treatment with naftidrofuryl. We are currently investigating whether CLAU-S can detect treatment effects in a randomised placebo-controlled study.

The Effects of Naftidrofuryl on Quality of Life

The primary aim of treatment in patients with intermittent claudication is symptomatic improvement. This is usually determined by the change in walking distance to onset of pain measured on a treadmill. However, a more appropriate measure of treatment efficacy, especially from the point of view of patients, would be the effect on health-related quality of life. A specific instrument, the Claudication Scale (CLAU-S), has been developed in Germany and validated in Germany, France, the UK and Belgium. The CLAU-S is a multidimensional questionnaire that measures daily living, pain, complaints, social life, disease-specific anxiety, and mood.