Hospital Anxiety And Depression Scale Results Research Articles

Anxiety and depression in patients with giant cell arteritis.

To compare the prevalence of anxiety and depression in patients with GCA with that in the general population, using the Hospital Anxiety and Depression Scale (HADS), and to identify independent predictors of these psychiatric manifestations in patients with GCA. We conducted a cross-sectional study including all patients diagnosed with GCA followed during 1 year in a vasculitis outpatient clinic. The HADS and 36-item Short Form (SF-36) questionnaires were prospectively collected. Patients' HADS results were compared with an age- and gender-matched control group. HADS anxiety (HADS-A) and HADS depression (HADS-D) scores between 8 and 10 defined possible anxiety and depression and ≥11 defined probable anxiety and depression, respectively. We included 72 patients and 288 controls. Compared with controls, patients with GCA had a statistically significant higher prevalence of HADS-A ≥8 (48.6% vs 26.4%), HADS-A ≥11 (30.6% vs 12.2%) and HADS-D ≥11 (33.3% vs 18.1%). GCA was an independent predictor of HADS-A ≥8 [odds ratio (OR) 3.3 (95% CI 1.9, 5.9)], HADS-A ≥11 [OR 3.8 (95% CI 2.0, 7.4)] and HADS-D ≥11 [OR 2.6 (95% CI 1.4, 4.7)]. Among patients with GCA, a negative correlation was observed between HADS-A/D and SF-36 mental health scores (r = -0.780 and r = -0.742, respectively). Glucocorticoid therapy was a predictor of HADS-A ≥8 [OR 10.4 (95% CI 1.2, 94.2)] and older age of HADS-D ≥8 [OR 1.2 (95% CI 1.1, 1.3)] and HADS-D ≥11 [OR 1.1 (95% CI 1.0, 1.2)]. Compared with the general population, patients with GCA have a higher prevalence of anxiety and depression and GCA is an independent predictor of these symptoms. Glucocorticoid treatment and older age are predictors of anxiety and depression, respectively, in patients with GCA.

Anxiety and Depression in Adults With Congenital Heart Disease.

IntroductionAnxiety and depression can worsen outcome in patients with heart disease. We elucidate the prevalence of anxiety and depression in a cohort of adults with congenital heart disease (ACHD).Materials and MethodsProspective screening for anxiety or depression was performed in 204 consecutive patients of the outpatient clinic of our tertiary care center using the Hospital Anxiety and Depression Scale (HADS) questionnaire and the distress thermometer (DT) as a potential ultra-short screening test. Functional data were assessed at liberty of the responsible physician. HADS scores ≥ 8 were considered doubtful and scores ≥ 11 as confirmed cases of anxiety or depression, respectively. HADS results were compared with a historical group of 100 patients with non-Hodgkin Lymphoma (NHL) as well as German reference values from the literature.ResultsPatients from the ACHD cohort were 28 ± 10 years old (mean ± SD, 54% male), 34% had a simple, 51% a moderate, including 52 patients with transposition of the great arteries after arterial switch operation, and 15% a heart defect of severe complexity. Prevalence of depression in ACHD was comparable to the German normal population (5.9% ACHD vs. 5.4% control). In contrast, prevalence of anxiety was higher than expected from reference values (12.7% ACHD vs. 5.6% control). There was a positive association between psychological distress and NYHA class [anxiety: OR 2.67 (95% CI, 1.50–4.76) p = 0.001; depression: OR 2.93 (95% CI, 1.60–5.35) p = 0.0005], but not with age, gender, or heart defect severity. Percentages of patients with ACHD with anxiety were significantly higher than in a cohort of patients with indolent non-Hodgkin lymphoma (NHL) but comparable to those with aggressive NHL (HADS-A ≥ 11: ACHD 12.7%, indolent NHL 2.2%, aggressive NHL 13.2%; p = 0.037 ACHD vs. indolent NHL; p = 0.929 ACHD vs. aggressive NHL). The distress thermometer screening test had only a fair discriminatory ability (AUC 0.708; p = 0.002) and is therefore of limited usability.ConclusionAdults with congenital heart disease exhibit an increased risk for anxiety disorders independently of the severity of the underlying heart defect. Anxiety prevalence was comparable to a historical cohort of patients with aggressive NHL underlining the importance of a routine screening for psychosocial distress in adults with congenital heart disease.

Intensity and Prevalence of Psychological Distress in Cancer Inpatients: Cross-Sectional Study Using New Case-Finding Criteria for the Hospital Anxiety and Depression Scale.

Psychological distress includes all negative subjective experiences elicited by a disease and its treatments. Since psychological distress in oncology is associated with negative outcomes, its detection and description are helpful for designing tailored supportive interventions. This study used the Hospital Anxiety and Depression Scale (HADS) to assess the intensity and prevalence of psychological distress (i.e., anxiety and depression) in cancer inpatients and examined the relationships between these variables and sociodemographic and clinical factors. An existing dataset of HADS results, from 2021 consecutive adult cancer inpatients at a single hospital, was analyzed. Only those questionnaires with complete responses were used. The intensity of anxiety and depression was determined from HADS sub-scores. The prevalence of anxiety and depression was calculated using, as case-finding criteria, cut-offs of ≥ 10 and ≥ 8, respectively. The mean HADS scores describing intensity were 7.3 for anxiety (n = 1,990) and 5.8 (n = 1,970) for depression. The prevalence rates for anxiety and depression were 26.6 and 28.6%, respectively. Among the 1,916 patients who completed both subscales, 17.2% had both anxiety and depression, 21.0% had either anxiety or depression, and 61.7% had neither. Gender, age, occupational status, and cancer diagnosis were associated with anxiety intensity or prevalence, while age, occupational status, and cancer diagnosis were associated with depression intensity or prevalence. Anxiety intensity was affected by the interaction effect between gender and diagnosis. Our study showed anxiety and depression being distinct entities, with more intense anxiety overall. From a research perspective, it reaffirms the usefulness for assessing both intensity and prevalence concurrently to gain a more detailed description of anxiety and depression.

Distress Tolerance Levels in Alopecia Areata Patients

Aim: Alopecia areata (AA) is a clinical manifestation that is characterized with hair loss with hairs in sharp borders, and in a round or oval shape on the scalp or in any part of the body. It is considered that genetic factors, infections, autoimmune factors, neuropeptides and psychological factors play roles in its etiopathogenesis. As psychological traumas have an important role in the onset and exacerbation period of the disease, it is also considered as a psychosomatic one. Distress Tolerance (DT) is defined as the capacity to experience and survive negative psychological situations. DT is considered important in etiopathogenesis of diseases, and it is also considered as one of the factors that determine the response to treatment and is targeted to increase in psychotherapy. In the present study, the purpose was to determine the Distress Tolerance levels of AA patients, and compare them with healthy controls.Material and Methods: A total of 36 patients, who applied to the dermatology clinic, and who did not have any other diseases except AA, were included in the study. In the Control Group, 36 healthy volunteers, who were matched in terms of age and gender with the Patient Group, and who did not have any physical or mental illness, were included. The Sociodemographic and Clinical Data Form (SCDF), Distress Tolerance Scale (DTS), and Hospital Anxiety and Depression Scale (HADS) were given to the Patient and Control Group.Results: No significant differences were detected between the groups in terms of age and gender. A significant difference was detected in the Patient Group in terms of both the total score of DTS (p0.001) and the DTS tolerance, DTS regulation and DTS self-efficacy subscales (p=0.004, p=0.008, p=0.006, respectively). When the groups were analyzed in terms of HADS results, the anxiety levels were higher at a significant level in the Patient Group (p0.001), and no significant differences were detected in terms of depression scores (p=0.57).Conclusions: In this study, the DT levels were determined as low in AA patients. The DT levels in AA, which is also considered as a psychosomatic disease, might be important for the onset, course and treatment of the disease. Meanwhile, it may also be aimed to increase the DT levels during the psychotherapy process.

Differential approach to the diagnosis of sleep disorders at Prakinson’s disease

To study the differential approach to the diagnosis of sleep disorders in at Prakinson’s disease 30 patients with Parkinson's disease (PD) at the 1st and 2nd stage were studied. The average age of patients were 57 ± 3.5 years, from them 12 women and 18 men. All patients were divided into two comparison groups according to psycho-emotional disorders. For the analysis of sleep disorders conducted polysomnography. The hospital anxiety and depression scale (HADS) was used to identify psycho-emotional disorders. According to the results of HADS, the patients were divided into two comparison groups: the first group included 17 patients with clinically severe depression (average score 15 ± 6.5); the second - 13 patients with clinically severe anxiety (average score 14 ± 4.5) [ρ ≥ 0.05]. The results of polysomnography in both groups showed that in the first group there was a high incidence of increased motor activity during the fast sleep phase (67%), in 5% of cases, sleep apnea was observed. In the second group, a high level of sleep fragmentation was noted (74%), the parasomnia was significantly lower (15%) [ρ ≥ 0.05]. According to the results of the study, it is clear that parasomnia is often accompanied by clinically severe depression, in turn, sleep fragmentation with prolonged daytime sleepiness is observed in severe anxiety, which may be one of the diagnostic criteria for choosing a method for correcting of sleep disorders in Parkinson's disease.

Symptoms of anxiety and depression are frequent in patients with acute hepatitis C and are not associated with disease severity

Neuropsychiatric symptoms of hepatitis C virus (HCV) infection and during peginterferon α therapy have been investigated in the chronic stage of the infection, but have not been described during the acute phase of the disease so far. We therefore evaluated anxiety and depression in patients with acute hepatitis C by the Hospital Anxiety and Depression Scale (HADS) within a clinical trial. Data were analysed from the German Hep-Net Acute HCV-III study. Anxiety and depression were characterized by an anxiety (HADS-A) and a depression subscale (HADS-D). More than eight points in each subscale were considered clinically relevant. Data were prospectively collected at baseline, end of treatment and at the end of the study. At baseline, a HADS-A above eight points was observed significantly more frequently than a HADS-D above eight points [n=23/103 (22%) vs. n=12/103 (12%); P=0.041].A pathological HADS-A or HADS-D score did not correlate with age, sex, IL28B genotype, the probable mode of infection, HCV genotype or severity of disease as investigated by alanine aminotransferase and bilirubin levels.Antiviral therapy did not influence anxiety as 12/50 (24%) of patients had HADS-A above 8 at the end of therapy. The proportion of patients with HADS-D above eight points increased from 12% at baseline to 24% (n=12/50) at the end of therapy (P=0.06). HADS results were not associated with lost to follow-up or sustained virological response rates. HADS data in acute HCV infection indicate that anxiety and depression do not correlate with severity of the disease, mode of acquisition, lost to follow-up and sustained virological response rates.

Long-term fatigue state in postoperative patients with breast cancer.

To investigate the prevalence of long-term fatigue, anxiety, depression and social support, and the relationships among these symptoms in postoperative patients with breast cancer. A total of 180 postoperative patients with breast cancer meeting criterion were recruited in this cross-sectional study. The Brief Fatigue Inventory (BFI), Hospital Anxiety and Depression Scale (HADS) and The Social Support Survey-Chinese version were used to assessing the fatigue, anxiety and depression, Social support of participants. The magnitude of the relationship among the symptoms of fatigue and other variables was measured by Spearman Rho correlation. The prevalence of long-term fatigue was 52.7%, and 18.3% occurred moderate/severe fatigue. Two-thirds of patients had a basal social support, only 12.8% of patients had better-perceived social support. Results of HADS showed that 16.7% and 21.1% of the participants have anxiety or depression disorder. Moderate/severe fatigue was negatively correlated with social support (r=-0.158, P=0.038) and positively correlated with age (r=0.132, P=0.042), chemotherapy (r=0.297, P=0.027), anxiety (r=0.324, P=0.018) and depression (r=0.211, P=0.034). Long-term fatigue was highly prevalent among over half of postoperative patients with breast cancer, and moderate/severe fatigue was associated with social and psychological factors such as social support, anxiety and depression. Our results suggest that overall nursing care may be a more effective manner in improving fatigue and quality of life.

Screening for Psychosocial Distress in Patients with Hematological Malignancies and Identifying Specific Factors That Cause Distress throughout Stage of Disease

Abstract 2086 Background:Studies incorporating measurement tools for emotional distress into clinical care for hematology patients are rare. We previously reported that distress levels of >5 on the National Comprehensive Cancer Network (NCCN) distress thermometer (DT) were significantly more likely to occur in patients who were seen within the first 30 day of presentation, women, younger patients, those with previous depression/anxiety, and those who are unmarried. However, the diagnosis of malignant or non-malignant hematologic disorder was not associated with DT levels >5. Since this report, the DT indicator of distress was adjusted to ≥4. AIM:To assess and measure psychosocial distress in adult patients with hematological malignancies pertaining to Hodgkin's Lymphoma (HL), Non-Hodgkin's Lymphoma (NHL), Multiple Myeloma (MM), and Chronic Lymphocytic Leukemia (CLL) at a multidisciplinary community-based hematology/oncology clinic, and identify the specific factors of these subjects associated with the most distress. Methods:Consecutive adult subjects with HL, NHL, MM, and CLL (n=302) seen at the Gundersen Lutheran Center for Cancer and Blood Disorders were approached over a period from September 2010 to March 2011. Study subjects consented to a one-time assessment of two prospective surveys that included the DT (scale of 0–10) and the Hospital Anxiety and Depression Scale (HADS), which indicates the specific factors that cause distress in daily life. Subjects were excluded for incomplete surveys. The Charlson Comorbidity Index (CCI) was utilized to assess comorbid conditions at the time of consent and is predictive of mortality within one year. Additional medical information including history of anxiety/depression, as well as disease related information and disease state (diagnosed, observation, remission, treatment) were collected by chart review. A score ≥4 was used an indicator of distress for the DT, and a score of ≥8 was used as a positive indicator of anxiety/depression for the HADS. All prospective surveys were completed prior to the subject’s clinic appointment. Results:A total of 190 subjects (63%) consented and completed both the DT and HADS (mean age 65.8±13.4 yrs; 62% men). Subjects were grouped into hematological malignancy cohorts, with 31% having NHL, 25% CLL, 11% HL and MM 20%. The mean DT score was 2.8±2.5 and the mean CCI was 4.5±1.4, with 34% of subjects rating distress ≥4 and 31% of subjects having a positive HADS result. No differences between hematological malignancy cohorts were found for subjects with a history of anxiety/depression (p=0.079), DT ≥4 (p=0.468) or positive HADS results (p=0.079); however, the percentage of subjects with a positive HADS result trended higher in HL subjects (52%). When stratified by DT score (≥4 vs. 0–3), no differences were found for hematological malignancy cohorts, disease state, sex, age, marital status or CCI. However, a positive HADS result was associated with a DT score ≥4 (p=0.001), thereby validating DT as a screening tool for anxiety/depression. Women were more likely to have a history of depression (p=0.008), but a history of anxiety/depression or medication usage was strongly associated with a DT score ≥4 (p=0.001) for the entire population. Conclusion:In subjects with common hematologic malignancies, a history of anxiety/depression was a very strong indicator of distress. Degree of comorbid illness, disease status and type of hematologic malignancy were not associated with distress. Based on these results, patients with hematologic malignancies who have a DT score ≥4 and/or a positive HADS result should be considered for aggressive management of prior anxiety and depression to ensure treatment that encompasses patient-centered care. Disclosures:No relevant conflicts of interest to declare.

Cognitive Effects of Once Weekly (QW) Epoetin Alfa in Anemic Patients (pts) with Hematologic Malignancies Receiving Chemotherapy (CT): Interim Results of the EPOLYM Trial.

CT-associated cognitive dysfunction, which frequently manifests as subtle changes in memory, concentration, and ability to remain focused or organized, can adversely affect cancer pts' QOL. EPOLYM, a prospective, international, multicenter, open-label, phase IIIb trial has been conducted to investigate the efficacy, safety, and clinical outcomes, including effect on cognitive function, of epoetin alfa 40,000 IU sc QW in anemic (Hb <12 g/dL) pts with hematologic malignancies. Pts enrolled had either non-Hodgkin's lymphoma, multiple myeloma, Hodgkin's disease, or chronic lymphocytic leukemia, for which they were receiving or were expected to receive CT (planned N = 1,000). Dosage increases or decreases were to be made based on clinical response (target Hb, 11.5–13.0 g/dL). Cognitive function was evaluated from baseline to Week 24 (or last evaluation) using the Cognitive Drug Research Computerised Cognitive Assessment System, patient-completed, computer-scored tasks of attention (Simple Reaction Time, Choice Reaction Time, Digit Vigilance), working memory (Numeric Working Memory), and secondary memory (Immediate and Delayed Word Recognition, Picture Recognition). To further characterize the data, task scores were variously summed to provide 4 factor scores (and aspects of cognitive function measured): Power of Attention (concentration intensity), Continuity of Attention (ability to sustain concentration), Quality of Memory (amount of information that can be stored and successfully retrieved in working and long-term memory), and Speed of Memory (speed in ability to recognize information previously presented or held in working memory). Changes from baseline in Hb levels and transfusion requirements were determined and QOL was assessed using the Functional Assessment of Cancer Therapy-Anemia Subscale and the Linear Analog Scale Assessment. Because of the apparent relationship between affect and cognition, anxiety and depression were evaluated at the time of cognitive assessment using the Hospital Anxiety and Depression Scale (HADS). Transfusion, QOL, and HADS results are not considered here. The cognitive data for 568 pts who had completed up to 24 weeks of therapy were examined in an interim analysis. Results showed that Power of Attention was slightly impaired and Continuity of Attention was slightly improved over the course of the study; however, these effects were small and unlikely to have everyday behavioral significance. Greater changes were observed in regard to memory. Mean Speed of Memory was decreased 358.9 msec by Week 24, representing an 8% improvement from baseline. Also, improvement was noted in Quality of Memory, with the score for this factor increased by 0.0899 at Week 24 from a baseline value of 2.895. The improvement in cognitive function was associated with an increase in Hb from 10.5 g/dL at baseline to about 12 g/dL beginning at Weeks 8 to 12 and sustained for up to 24 weeks. Results of this interim analysis suggest improvement in several aspects of cognitive function associated with increased Hb levels in anemic CT pts with hematologic malignancies. These results will have to be confirmed by findings based on the full study cohort.

A pilot study addressing the effect of aromatherapy massage on mood, anxiety and relaxation in adult mental health.

This study was carried out with eight subjects specifically referred for aromatherapy; each received a standardised aromatherapy massage weekly for 6 weeks. The subjects' levels of anxiety and depression were measured using the Hospital Anxiety and Depression (HAD) Scale prior to the first massage and after the final massage. The subjects' levels of mood, anxiety and relaxation were recorded using a visual analogue before and after each massage and then again 6 weeks after the last massage. Comparison was made between the HAD Scale results for each client and also the visual analogue scale results for before and after massage and also first massage and 6 weeks postmassage for the sample group. Improvements were shown in six out of eight subjects' HAD Scale results. Improvements were also shown in all areas when comparing the visual analogue scale results. The study was carried out over an 8-month period. To date there have been few studies addressing the effect of aromatherapy massage on mood, anxiety and relaxation (Therapist 9 (1996) 38). It is acknowledged that there may be a number of reasons for this such as factors related to obtaining a sample group, informed consent, the interaction of current medication regimes and so forth. It is acknowledged that whilst this is a small pilot study a number of methodological issues are raised concerning research into the use of aromatherapy in this clinical field. By reporting on this work, it is hoped that this paper will generate reflection, discussion and debate so forwarding the knowledge base in this discipline.