Huaxi Emotional-distress Index Research Articles

Influencing factors of self-management ability among dry eye patients in west China.

To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China. A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University. All participants completed the rating scale of health self-management skill for adults (AHSMSRS), Huaxi Emotional-Distress Index (HEI), e-health literacy scale (e-HEALS) and Brief Illness Perception Questionnaire (Brief-IPQ). A generalized linear model was employed to establish a multivariate linear model with demographic data, psychological state, e-HEALS, and illness perception as independent variables and health self-management skill score as the dependent variable. The mean score for health self-management skill was 165.58±15.79. Multivariate analysis revealed that advanced age, better illness perception and improved psychological state were associated with better health self-management ability among dry eye patients. Furthermore, the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y. The health self-management ability of dry eye patients in west China is relatively high. Age, duration of disease, illness perception and psychological state are the influencing factors on the health self-management ability of dry eye patients.

The effect of somatic pain and comorbid mental distress on oral health-related quality of life in orthodontic patients.

The purpose of the present study was to evaluate the prevalence of somatic pain in orthodontic patients and determine whether somatic pain contributes to worsening oral health-related quality of life (OHRQoL) through the mediating effect of psychological discomfort. Scale measurements and analyses were conducted on a cohort of 769 orthodontic outpatients, encompassing Patient Health Questionnaire-15-pain (PHQ-15-P), Hua-Xi Emotional-Distress Index (HEI), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Oral Health Impact Profile-14 (OHIP-14). Among the respondents, 56.3% (N = 433) reported somatic pain and 20.0% (N = 154) had mental discomfort based on PHQ-15-P and HEI scores. Patients with somatic pain symptoms had significantly higher scores of HEI and OHIP-14 (P < 0.001), and higher PHQ-15-P and HEI scores emerged as statistically significant predictors of lower OHIP-14 scores (P < 0.001). HEI scores which assessed anxiety and depression partially mediated the correlation between PHQ-15-P and OHIP-14 scores, of which anxiety accounted for 52.9% of the overall mediation effect, dominating the indirect effect. Orthodontic patients reporting somatic pains were at a significantly higher risk of worsening OHRQoL during treatment, and this adverse effect is partially mediated by anxiety and depression. Our findings highlight the necessity for the assessment of general health and mental well-being during orthodontic interventions. To prevent delays in treating general disorders and the potential failure of orthodontic treatments, we encourage increased attentiveness towards patients with somatic symptoms and consideration of the adverse effects of comorbid mental distress.

Effects of nurses-led multidisciplinary-based psychological management in spinal surgery: a retrospective, propensity-score-matching comparative study

BackgroundPatients in spine surgery often have emotional disorders which is caused by multi-factors. Therefore, a multidisciplinary and multimodal intervention program is required to improve emotional disorders during the perioperative period. However, related studies were rare. This study aimed to confirm that the multidisciplinary-based psychological management leading by nurses was effective in treating emotional disorders and show the assignments of the members of the multidisciplinary team with the orientations of nurses.DesignA retrospective, comparative study.MethodThis study was a retrospective cohort research and compared the results between the intervention group and control group using the Huaxi Emotional Distress Index (HEI) which was used to evaluate emotional disorders. The intervention group consisted of patients who underwent surgery between January 2018 and December 2020 after psychological management was implemented. The control group consisted of patients with regular care who underwent surgery between January 2015 and December 2017. To improve comparability between the two groups, baseline data from the recruited patients were analyzed using propensity-score-matching (PSM) based on age, sex, marital status, education, and disease region.ResultsA total of 539 (11.5%) people developed emotional disorders, of which 319 (6.8%), 151 (3.2%) and 69 (1.5%) had mild, moderate mood and severe emotional disorders, respectively. 2107 pairs of patients were matched after PSM. Scores of HEI in the intervention group were heightened compared with those in the control group (P<0.001) after matching. Moreover, the incidence of emotional disorders in patients decreased after implementing psychological management (P = 0.001). The severity of emotional disorders was alleviated with statistical significance as well (P = 0.010).ConclusionsNurses-led Multidisciplinary-Based psychological management was able to reduce the incidence of emotional disorders and improve the severity of these in spine surgery patients.

Screening for negative emotions and analysis of related factors among general surgery inpatients: a retrospective cross-sectional study.

Adverse psychological states in surgical patients can impact outcomes. This study aimed to evaluate mood disorders and associated factors in general surgery inpatients using the Huaxi Emotional Distress Index (HEI). This retrospective cross-sectional study analyzed HEI scores of 20,398 adult patients hospitalized for elective surgery at a tertiary hospital in China (2018-2021). Univariable and multivariable logistic regression identified factors linked to moderate/severe mood disturbances. Factors linked to moderate/severe mood disturbances were identified through univariable and multivariable logistic regression. The results showed that 3.7% of the patients had HEI ≥ 13, indicating significant emotional issues. The mean age was 52.67 (16.14) years in the group with no/mild distress and 59.65 (16.34) years in the group with moderate/severe distress. Among all the cases included, there were 2,689 cases (13.18%) of gastric and esophageal diseases, 1,437 cases (7.04%) of hepatic diseases, 913 cases (4.47%) of periampullary and pancreatic tumors, 9,150 cases (44.85%) of gallbladder diseases, 2,777 cases (13.61%) of colorectal diseases, and 3,432 cases (16.83%) of other diseases. The male percentage was 45.5 and 54.9% in the two groups, respectively. Older age, male gender, unstable occupations, lower education, and unmarried status were associated with higher risks of mood disturbances (all p < 0.05). A significant downward trend in adverse emotions was observed with increasing education levels (p < 0.001). Furthermore, the study found that the inpatients had higher HEI scores prior to the COVID-19 pandemic compared to during the pandemic (p < 0.001). However, the occurrence of adverse mood states in these patients was not exacerbated by the COVID-19 pandemic. The trend test remained highly significant in the none-adjusted, age-sex adjusted, and fully adjusted models (all p for trend <0.001). The implementation of routine screening in higher education institutions (HEIs) allows for the early identification of surgical inpatients who require psychological intervention. It is recommended that counseling services focus on individuals with lower levels of education and income instability in order to address negative mood states. Furthermore, the potential application of this screening system in other clinical settings could enable earlier psychological interventions for a larger number of patients.

CHOROIDAL AND RETINAL ABNORMALITIES IN CUSHING SYNDROME: Correlation with the Cortisol Level.

To investigate the structure and blood flow of the retina and choroid in Cushing syndrome and their relationship with cortisol levels. A consecutive series of patients with Cushing syndrome with adrenocortical carcinoma were included in this study. Cortisol levels gradually returned to normal after adrenalectomy. Optical coherence tomography and optical coherence tomography angiography were used to assess patients with Cushing syndrome before and after the surgery for retina and choroid. Correlation analysis was performed between cortisol level and fundus changes. Compared with normal cortisol levels, patients with Cushing syndrome had significantly lower central macular thickness with increased cortisol level (220.82 ± 16.59 µ m and 223.68 ± 15.78 µ m, P = 0.019). However, the central choroidal thickness was higher with increased cortisol level (255.18 ± 105.89 µ m and 205.94 ± 87.04 µ m, P < 0.001). The choriocapillaris flow area was higher with increased cortisol level (2.05 ± 0.14 mm 2 and 2.00 ± 0.13 mm 2 , P = 0.02). The change of choriocapillaris flow area was correlated with the score of Huaxi Emotional-distress Index and 24-hour urine-free cortisol (24h-UFC). The increased cortisol level was correlated with lesser central macular thickness and thicker central choroidal thickness. The decrease of choriocapillaris flow area was correlated with 24h-UFC, indicating the effect of increased cortisol level on choroidal vessels.

Orthodontic Patients with Poor Oral Health-Related Quality of Life are More Likely to Have Emotional Distress: A Cross-Sectional Study.

This study aims to investigate the relationship between oral health-related quality of life (OHRQoL) and emotional distress (ED), including anxiety and depression, in orthodontic patients. A cross-sectional study was conducted involving 603 orthodontic patients, consisting of 401 females (66.5%) with a mean age of 24.15 ± 7.72 and 202 males (33.5%) with a mean age of 24.16 ± 7.72. A questionnaire containing questions of demographic information, the Oral Health Impact Profile (OHIP-14) and the Huaxi emotional-distress index (HEI) was employed to assess OHRQoL and ED. According to the HEI score, the respondents were divided into ED group (HEI > 8) and non-ED group (HEI ≤ 8). Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney test and logistic regression analysis with the significance level set at p < 0.05. The prevalence of poor OHRQoL and ED of the study sample was 28.4% and 19.57%, respectively. There was a significantly higher prevalence of ED among poor OHRQoL patients (35.67%) compared to those with good OHRQoL (13.19%) (p < 0.001). Poor OHRQoL and risky drinking behavior addressed higher significant correlation with ED patients than non-ED patients (p < 0.05). There were no statistical differences in other factors such as gender, age, and appliance type (p > 0.05). Poor OHRQoL orthodontic patients were at a higher risk of suffering from anxiety and depression compared to those with good OHRQoL (age-risky drinking behavior-sex-adjusted: OR = 4.00; all p < 0.001). Oral health-related quality of life (OHRQoL) is related to emotional stress. Namely, patients with poor OHRQoL are more likely to experience anxiety and depression. As a result, orthodontists should consistently assess the emotional well-being and OHROoL of patients over the treatment course for better treatment outcomes.

Assessment of psychometric properties of the Huaxi Emotional-distress Index questionnaire (HEI)in a large sample of general hospital inpatients

ObjectivesHuaxi Emotional-distress Index questionnaire (HEI) is a 9-item questionnaire designed to measure psychological distress. The present study aimed to validate the factor structure of the HEI and its reliability and validity using a large sample from inpatients of West China Hospital. MethodsHEI data were collected from inpatients of various departments at West China Hospital in 2019 through the hospital's data management platform (total sample, N = 55,396). The internal consistency reliability of the HEI was examined. Exploratory factor analysis (N = 27,696) and confirmatory factor analysis(N = 27,700) were conducted to validate the construct validity. ResultsThree factors, namely depression (DEP), anxiety (ANX), and suicidal risk (SR), were extracted through exploratory factor analysis, which accounted for 79.55% of the total variance.The results of confirmatory factor analysis supported the fit for the three-component model oblique model as the best-fitting model compared with one-component model and two-component model. The internal consistency of the HEI was α =0.918. The internal consistencyα of ANX, DEP and SR is 0.87,0.814,0.843 respectively. ConclusionsHEI is a validated and concise tool that serves a dual purpose of screening for mood disorders and assessing depressive and anxiety symptoms as well as suicidal risk among inpatients in Chinese general hospitals.

Effect of Psychosocial Interventions for Individuals Who Underwent Arthroscopy in Femoroacetabular Impingement: A Randomized Controlled Trial.

The purpose of this protocol was to discover the connection between patients with non-surgical pain or other discomfort and their psychosocial status. Cognitive behavior therapy will be used, which we verified will determine the effect and feasibility of postoperative rehabilitation processes. This study will include 200 patients ranging from 18 to 60 years old who have underwent or will undergo FAI arthroscopy in the West China Hospital Sports Medicine Center from 2023 to 2026. A standardized prospective single-center parallel-group randomized controlled trial will be used for these participants. The participants will be divided into intervention (telephone versus face-to-face versus music versus floatation) and control groups. The follow-up periods will be measured pre-operatively, as well as postoperatively at 1, 3, and 6 months. The primary outcomes will include the modified Harris Hip Score (mHHS) and the Visual Analogic Score (VAS), and the secondary outcomes will include the range of motion (ROM), the Huaxi Emotional-distress Index (HEI), and the depression, anxiety, and stress scale (DASS-21 scale). Furthermore, the Patient Health Questionnaire-9 (PHQ-9) and a Short-Form 12 (SF-12) questionnaire will also be evaluated. This study will evaluate the clinical and cost-effectiveness of different types of psychosocial-therapy-based rehabilitation methods designed to improve the quality of life of FAI patients with persistent symptoms.

Prevalence of depression and anxiety and associated factors among geriatric orthopedic trauma inpatients: A cross-sectional study.

BACKGROUNDCommon mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research. AIMTo investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic, social and clinical risk factors.METHODSThis cross-sectional study was performed in geriatric patients (aged ≥ 60 years, both sexes) with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017. Demographic, social, and clinical characteristics were described. Huaxi Emotional-Distress Index (HEI) was used to evaluate the severity of anxiety and depression status. Differences in continuous variables were tested using the t-test, and differences in categorical variables were assessed using the Pearson χ2 test. Binary logistic regression analyses were used to identify the factors associated with a HEI score > 8.RESULTSAmong the 966 patients, 487 were male and 479 were female, with a mean age of 70.2 ± 7.1 years. The age ranged from 60 to 90 years. Seventy-five patients had an HEI score > 8, accounting for about 7.8% of all patients. A higher Injury Severity Score (4.17 ± 3.10 vs 7.96 ± 6.68, P < 0.001), higher Visual Analog Score (5.05 ± 1.09 vs 6.89 ±1.23, P < 0.001), number of chronic diseases (P < 0.001), injury type (P = 0.038), and education level (P = 0.001) were significantly associated with HEI score > 8. On logistic regression, a higher education level was a protective factor for emotional disorders (P = 0.047), whereas Injury Severity Score (P = 0.024), Visual Analog Score (P < 0.001), two or more chronic diseases (P < 0.001) were the related independent risk factors. CONCLUSIONEmotional disorders are common in geriatric patients with orthopedic trauma. Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.

A brief web-based screening plus emotional-disorder health education was associated with improvement of mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China.

Low recognition and intervention rates of emotional disorders among nonpsychiatric clinical patients are primarily attributable to poor mental health awareness of patients and a paucity of mental health care resources. This study aims to investigate the association of a resource-saving brief web-based emotional-disorder self-screening plus a health self-education program (BWBED-SS + HSE) with improved mental health awareness and service-seeking attitudes among nonpsychiatric clinical patients. A sample of 2065 patients seeking health services in nonpsychiatric clinical settings underwent BWBED-SS + HSE using mobile terminals. Participants were defined as being at high risk of anxiety and/or depression according to the optimal cut-off point of ≥11 on the Huaxi emotional-distress index (HEI). The rate of participants at high risk of anxiety and/or depression was 6.63%. Following participation in the BWBED-SS + HSE, after controlling for demographics, type of hospital, and test time, the rates of participants considering themselves as having an emotional disorder and willing to seek mental health services among those at high risk of anxiety and/or depression increased from 29.93% to 47.45% (adjusted odds ratio [aOR] = 2.28, p = .002) and from 11.68% to 29.93% (aOR = 3.65, p < .001), respectively. The BWBED-SS + HSE were associated with improved mental health awareness and service-seeking attitudes among patients seeking nonpsychiatric clinical services in China.

The social psychological impact of the COVID-19 pandemic on medical staff in China: A cross-sectional study.

The COVID-19 outbreak required the significantly increased working time and intensity for health professionals in China, which may cause stress signs. From March 2-13 of 2020, 4,618 health professionals in China were included in an anonymous, self-rated online survey regarding their concerns on exposure to the COVID-19 outbreak. The questionnaires consisted of five parts: basic demographic information and epidemiological exposure; occupational and psychological impact; concerns during the episode; coping strategies; and the Huaxi Emotional-Distress Index (HEI). About 24.2% of respondents experienced high levels of anxiety or/and depressive symptoms since the COVID-19 outbreak. Respondents who worried about their physical health and those who had COVID-19 infected friends or close relatives were more likely to have high HEI levels, than those without these characteristics. Further, family relationship was found to have an independent protective effect against high HEI levels. Their main concerns were that their families would not be cared for and that they would not be able to work properly. Compared to respondents with clear emotional problems, those with somewhat hidden emotional issues adopted more positive coping measures. About a quarter of medical staff experienced psychological problems during the pandemic of COVID-19. The psychological impact of stressful events was related to worrying about their physical health, having close COVID-19 infected acquaintances and family relationship issues. Therefore, the psychological supprot for medical staff fighting in the COVID-19 pandemic may be needed.

Effects of anxiety and depression and early detection and management of emotional distress on length of stay in hospital in non-psychiatric inpatients in China: a hospital-based cohort study

BackgroundEmotional distress, including anxiety and depression, is associated with negative outcomes (such as poorer prognosis of physical diseases, longer hospital stays, and more readmissions) of patients in non-psychiatric settings. We investigated the effects of anxiety and depression, as well as the effects of early detection and management of emotional distress, in non-psychiatric inpatients on length of stay in hospital, with the aim of better informing the provision of medical care to meet the needs of non-psychiatric patients receiving general hospital care. MethodsThis real-world hospital-based cohort study included inpatients (aged ≥15 years) from 20 non-psychiatric departments in West China Hospital. The Huaxi emotional-distress index (HEI), a validated questionnaire for screening depression and anxiety in Chinese non-psychiatric clinical settings, was recommended for use in brief screening of non-psychiatric inpatients on their admission to hospital. Patients with depression or anxiety were provided with a graded psychological service, ranging from brief supportive care (for mild distress [HEI score 9–12]) to treatment by a psychiatrist or psychotherapist (for severe distress [HEI score ≥17]). Patients were grouped on the basis of whether brief screening and graded psychological service was provided (BS-GPS group) or not (non-BS-GPS group). Length of stay was compared between the groups and between patients with and without clinically significant anxiety or depression. FindingsFrom Jan 1, 2015, to Dec 31, 2018, 487 871 patients admitted to 20 non-psychiatric departments were included in the study, of whom 178 883 (36·7%) patients underwent brief screening on admission (BS-GPS group) and 308 988 (63·3%) patients were not screened (non-BS-GPS group). Across all departments, 9590 (5·4%) patients in the BS-GPS group (range 2·6–20·5% across departments) showed clinically significant anxiety or depression (ie, total HEI score ≥11). Mean length of stay differed significantly between patients with (12·7 days [SD 0·12]) and without (9·5 days [0·02], p<0·0001) clinically significant anxiety or depression, and between the BS-GPS group (9·6 days [0·02]) and the non-BS-GPS group (10·8 days [0·02], p<0·0001). These differences remained significant after controlling for sociodemographic factors and categories of physical diseases. InterpretationAnxiety and depression significantly prolonged the length of stay of non-psychiatric inpatients in general hospital. Early detection and management of emotional distress should be promoted and applied to better care for patients with non-psychiatric disorders and to conserve medical resources. Funding1.3.5 Project for Disciplines of Excellence of West China Hospital (Sichuan University), Science and Technology Benefit the People Project of Chengdu Municipal Government (grant numbers 2015-HM01-00011-SF and 2016-HM02-00095-SF), Science and Technology Support Program of Sichuan Provincial Government (grant number 2015SZ0058).

The development and validation of Huaxi emotional-distress index (HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings

BackgroundDepression and anxiety among general hospital patients are common and under-recognized in China. This study aimed toward developing a short questionnaire for screening depression and anxiety in non-psychiatric clinical settings, and to test its reliability and validity. MethodsThe item pool which included 35 questions about emotional distress was drafted through a comprehensive literature review. An expert panel review and the first clinical test with 288 general hospital patients were conducted for the primary item selection. The second clinical test was performed to select the final item in 637 non-psychiatric patients. The reliability and validity of the final questionnaire were tested in 763 non-psychiatric patients, in which 211 subjects were interviewed by psychiatrists using Mini International Neuropsychiatric Interview (MINI). Multiple data analysis methods including principal components analysis (PCA), item response theory (IRT), and receiver operating characteristic (ROC) curve were used to select items and validate the final questionnaire. ResultsThe series selection of items resulted in a 9-item questionnaire, namely Huaxi Emotional-distress Index (HEI). The Cronbach's α coefficient of HEI was 0.90. The PCA results showed a unidimensional construct. The area under the ROC curve (AUC) was 0.88 when compared with MINI interview. Using the optimal cut-off score of HEI (11/12), the sensitivity and specificity were 0.880 and 0.766, respectively. ConclusionsThe HEI is considered as a reliable and valid instrument for screening depression and anxiety, which may have substantial clinical value to detect patients' emotional disturbances especially in the busy non-psychiatric clinical settings in China.

46P The Huaxi Emotional-Distress Index: An instrument for screening distress in Chinese inpatients with lung cancer

46P The Huaxi Emotional-Distress Index: An instrument for screening distress in Chinese inpatients with lung cancer