Hospital Anxiety Depression Scale Scores Research Articles

In Systemic Sclerosis, Anxiety and Depression Assessed by Hospital Anxiety Depression Scale Are Independently Associated with Disability and Psychological Factors

Background. Anxious and depressive symptoms are frequent in Systemic Sclerosis (SSc). Our objective is to assess their prevalence and association with district and global disability and psychological variables. Methods. 119 SSc patients were assessed by Hospital Anxiety Depression Scale (HADS). Clinical depression and anxiety were defined for HADS score cutoff ≥8. Patients were assessed for psychological symptoms (RSES, COPE-NIV), hand (HAMIS, CHFDS, fist closure, and hand opening) and face disability (MHISS, mouth opening), global disability, and fatigue (HAQ, FACIT). Results. Both depression and anxiety in SSc are 36%. Depressive patients with comorbid anxiety have higher HADS-D score than patients with depression only (P = 0.001). HADS-A and -D are positively correlated with global disability, hands and mouth disability, fatigue, self-esteem and avoidance coping strategy, and, only HADS-A, also with social support (P < 0.05). By multiple regression, HADS-D is independently associated with FACIT-F (P < 0.001), RSES (P < 0.001), and MHISS total score (P = 0.016), together explaining 50% of variance. HADS-A is independently associated with RSES (P = 0.006), COPE-NIV SA (P = 0.003), COPE-NIV SS (P = 0.008), FACIT-F (P = 0.022), and MHISS mouth opening (P = 0.029), explaining 41% of variance. Conclusions. In SSc depression and anxiety correlate to local and global disabilities and psychological characteristics. Depressive patients with comorbid anxiety have higher level of depressive symptoms.

Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression?

The impact of metabolic and reproductive features of polycystic ovary syndrome (PCOS) compromises psychological functioning. We investigated factors associated with negative psychological functioning to determine whether they were predictive of anxiety and depression in PCOS. A cross-sectional study was performed by questionnaire in 177 women with PCOS (mean ± SD age 32.8 ± 7.8 years) and 109 healthy controls (mean age 41.9 ± 15.4 years). Main outcome measures were anxiety and depression, measured using the Hospital Anxiety Depression Scale (HADS) and Multidimensional Body-Self Relations Questionnaire (MBSRQ), respectively. Women with PCOS, compared with control women, had a higher mean anxiety HADS score (9.5 ± 3.9 versus 6.5 ± 3.6; P < 0.001), a higher mean depression score (5.7 ± 3.7 versus 3.3 ± 3.1; P < 0.001) and more negative body image in 7 out of 10 subscales of the MBSRQ. Multivariate regression analysis in PCOS showed that anxiety was predicted by self-worth (P < 0.0001), health evaluation (P = 0.005), time taken to diagnose PCOS (P = 0.003) and age (P = 0.02), while in control women, anxiety was predicted by self-worth (P = 0.009), health evaluation (P = 0.001) and rural living (P = 0.03). Depression in PCOS was predicted by self-worth (P = 0.0004), quality of life (QOL) (P = 0.004), fitness orientation (P = 0.002), appearance evaluation (P = 0.001) and time to diagnosis (P = 0.03) and in women without PCOS, by self-worth (P < 0.0001), QOL (P < 0.0001), illness orientation (P = 0.001) and appearance orientation (P = 0.02). Women with PCOS have increased anxiety, depression and negative body image compared with women without PCOS. In women with or without PCOS, body image and self-worth are predictors of both anxiety and depression, while QOL also predicts only depression. Time taken to diagnose PCOS is associated with poor psychological functioning.

W09-03 - Associations of affective disorder in patients with inflammatory bowel disease

IntroductionInflammatory Bowel Disease (IBD) is associated with co morbid depression and anxiety of up to 42%. Corticosteroids, used commonly in IBD, are known to cause psychiatric side-effects and could be an independent risk factor for affective illness. Recent studies show that depression is also associated with raised CRP and IL6.AimsThis study aims to show which demographic, clinical, medication and immunological factors are predictors of anxiety and depression in IBD.MethodsThe IBD, Steroids and Affective Disorder (ISA) study is a cross-sectional study of IBD patients in Edinburgh, UK. Out patients underwent assessment including Hospital Anxiety Depression Scale (HADS) past psychiatric history, steroid medication history, inflammatory markers, the Medication Adherence Rating Scale (MARS) and Altman Self Rated Mania Scale (ARSM).Results326 patients with Crohns and 256 with Colitis (72% of clinic attendees) were recruited. 251 (43%) patients scored 12 or above on the HADS questionnaire. 45% of patients had previously suffered from affective illness. Patients on Prednisolone and Budesonide scored significantly higher on HADS Depression (p = 0.03 and p = 0.002) as did those who had been on Prednisolone for more than 8 weeks (p = 0.041). Being on prednisolone was not associated with increased Colitis and Crohns activity indices (p = 0.2). HADS scores were measured against other disease and demographic variables.ConclusionAffective illness is common in the IBD population and the prescription and duration of systemic corticosteroids are associated with depression. Biological and disease variables may play an important role in co morbid affective illness in IBD

Host- rather than virus-related factors reduce health-related quality of life in hepatitis C virus infection

Background:Hepatitis C virus (HCV) infection is associated with decreased health-related quality of life (HRQOL). Although HCV has been suggested to directly impair neuropsychiatric functions, other factors may also play a...

Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine

This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms. Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit. There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients. Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.

Quality of life and psychological problems in patients undergoing neurological rehabilitation

Aim:To assess the quality of life (QoL) and prevalence of psychological problems (PP) in patients with neurological illness, and their correlation with functional abilities.Materials and Methods:Prospective cross-sectional study conducted in the neurological rehabilitation unit of tertiary research hospital in 30 consecutive hospitalized patients (21 men), age 16-55 years (34.63±11.87).Outcome Measure:WHOQoL-BREF was used to assess QoL. The prevalence of PP was recorded using Hospital Anxiety Depression Scale (HADS) and General Health Questionnaire (GHQ-12). QoL and HADS scores were correlated with functional abilities using mean Barthel Index (BI) Score.Results:The duration of illness was three to 30 months (10.63±7.83) and their primary diagnoses were stroke 12, traumatic spinal cord injury seven and non-traumatic spinal cord lesion 11. Twenty-two patients qualified for GHQ-12 caseness, with 15 patients having distress (score ≥15) and seven having severe problem and psychological distress (score≥20). Twenty five patients had abnormal anxiety and 17 had abnormal depression on HADS (abnormal = 8-21), with moderate to severe anxiety and depression (scores≥11) in nine and three patients respectively. The mean WHOQoL-BREF transformed scores (on WHOQoL 0-100 scale) were (38.83±8.02), (50.76±9.79), (48.53±18.46) and (49.13±10.63) in physical, psychological, social, and environmental domains respectively. The social domain of QoL had significant correlation (P<.05) with functional abilities.Conclusion:Patients with neurological disorders requiring inpatient rehabilitation have impaired QoL that affects all domains of life. There is high prevalence of psychological problems, including anxiety and depression. The social domain of QoL adversely affected functional abilities, but the correlation between PP and functional abilities was insignificant.

Predictors of drop-out from an outpatient cardiac rehabilitation programme

Objective: To investigate the prevalence and predictors of early drop-out from a cardiac rehabilitation programme and also whether completers and drop-out patients differed in relation to their illness cognitions, gender and psychological distress and quality of life. Design: A six-week outpatient cardiac rehabilitation programme. Setting: A university teaching hospital. Subjects: One hundred and eighty-nine patients were recruited from a consecutive series of outpatient referrals prior to a six-week comprehensive cardiac rehabilitation programme. Outcome measures: The revised Illness Perception Questionnaire, Quality of Life after Myocardial Infarction Questionnaire and the Hospital Anxiety and Depression Scale. Results: One hundred and forty-seven cardiac patients completed the cardiac rehabilitation programme. Forty-two (22%) patients dropped out in the first two weeks. Factors predicting early drop-out were female gender, younger age, higher Hospital Anxiety Depression Scale score, lower illness perception consequences and higher illness perception personal control and lower illness perception treatment control (all P < 0.05). Conclusion: Over a fifth of the patients did not complete this typical cardiac rehabilitation programme. Female patients are more likely to drop out from cardiac rehabilitation than men. Psychological distress, younger age and lower perceptions of consequences, higher perception personal control and lower illness perception of treatment control were predictors of early drop-out from a cardiac rehabilitation programme.

The Symptom of Night Pain in a Back Pain Triage Clinic

Prospective longitudinal study of patients attending a back pain triage clinic with night pain. To assess the importance of the symptom of night pain in patients attending a back pain triage clinic. The 1994 US Agency for Health Care Policy and Research guidelines suggest nighttime pain should be used as a "red flag." Night pain is known to occur in many conditions, and although common in patients with known serious pathology, the prevalence of night pain in a back pain triage clinic is not known. A total of 482 consecutive patients attending a back pain triage clinic were assessed, including history of frequency and duration of night pain. Clinical examination was performed, and demographic data obtained. Magnetic resonance imaging was performed if indicated according to local guidelines. Oswestry, visual analog scales (for pain), and hospital anxiety depression scale, patient-based outcome scores were obtained. There were 213 patients who had night pain, with 90 having pain every night. No serious pathology was identified. Patients with night pain had 4.95 hours continuous sleep (range 2-7) and were woken 2.5 times/night (range 0-6). Patients with pain every night had higher Oswestry, visual analog scale, and hospital anxiety depression scale scores than those who did not. Although it is a significant and disruptive symptom for patients, these results challenge the specificity of the presence of night pain per se as a useful diagnostic indicator for serious spinal pathology in a back pain triage clinic.

Impact on quality of life (QL) during chemotherapy (CT) of FEC-T compared to FEC or E-CMF: Results from the UK NCRI Taxotere as Adjuvant Chemotherapy Trial (TACT)

661 Background: TACT (ISRCTN79718493) randomised 4162 pts to FECx4 followed by taxotere x4 (FEC-T) v standard anthracycline regimens of similar duration (FECx8 or epirubicin x4 followed by CMFx4 (E-CMF)) in patients with operable early stage breast cancer. The primary endpoint is disease-free survival. Overall survival, acute toxicities and QL are secondary endpoints. Methods: Pts completed EORTC QLQ-C30, BR23 and Hospital Anxiety & Depression Scale (HADS) questionnaires before randomisation, before 5th & after 8th cycles of CT, and at 9, 12, 18 & 24 mths. In this report, impact of CT was compared via mean QL change scores from baseline to cycle 8. Differences in domain scores of ≥10 points are considered clinically relevant. Clinical threshold scores for HADS were applied. A significance level of α=0.01 allowed for multiple testing. Results: In a 1 yr period, 829 pts from selected centres (71% pts randomised from those centres) entered the QL study: median age 49yrs (range 27–70); 270 FEC-T v 264 FEC, 147 FEC-T v 148 E-CMF. Compliance with QL was 99% at baseline and 79% at cycle 8. FEC-T was associated with worse global QL (p=0.002 v FEC; p=0.18 v E-CMF) & decreased physical function (p=0.007 v FEC; p=0.003 v E-CMF) after cycle 8, but magnitude of differences did not appear clinically relevant. No other significant differences between regimens were found but there was a trend for FEC-T to have greater impact on QLQC30 & BR23 domains. Anxiety was high at all time points (>20% pts with HADS scores >11) and depression rates increased 3-fold from baseline to end of CT with no differences between regimens. There was a significant and clinically relevant increase in BR23 body image concerns in all regimens during CT. Conclusions: Within the context of a general negative impact of CT on QL, FEC-T had a greater impact than standard anthracycline containing CT but magnitude of differences was below that considered clinically relevant. Relationships between QL and clinician assessed toxicity will be explored. Analysis of post-treatment QL will establish if effects are observed longer term. Any QL impairment will need to be balanced against therapeutic efficacy when these data are available. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Aventis Funding from Aventis, Cancer Research UK, Pharmacia, and Roche supports The Institute of Cancer Research

Normative data for the HADS from a large non-clinical sample.

To provide normative data for the Hospital Anxiety Depression Scale (HADS). Repeated measures and correlational. The HADS was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1792) in terms of the distributions of age, gender and occupational status. Correlational analysis was used to determine the influence of demographic variables on HADS scores. Demographic variables had only very modest influences on HADS scores. The reliability of the HADS is acceptable; the Anxiety and Depression scales are moderately correlated (.53). Tables to convert raw scores to percentiles are presented for females and males. The present normative data allow clinicians to assess the rarity of a given HADS score, and thus provide a useful supplement to existing cut-off scores.