Mean Hospital Anxiety And Depression Scale Research Articles

Anxiety and Depression in the Relatives of COVID-19 and Non-COVID-19 Intensive Care Patients During the Pandemic.

Background and aimIn the literature, there is no study on the anxiety and depression status of the relatives of intensive care COVID-19 and non-COVID-19 patients during the pandemic period. In this study, we aimed to compare the risk of developing anxiety and depression in the relatives of COVID-19 and non-COVID-19 intensive care patients during the pandemic, and also to determine the factors that may cause anxiety and depression.Materials and methodsRelatives of patients admitted to Ankara City Hospital COVID-19 (n=45) and non-COVID-19 (n=45) intensive care units between 15 May and 31 July 2021 were included in this prospective study. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to the relatives of the patients within the first 48 hours of their admission to the intensive care unit. The answers were recorded and HADS, HADS-A (anxiety) and HADS-D (depression) scores were calculated accordingly. Demographics, education and marital statuses of both the patients and their relatives were recorded. Logistic regression analysis was performed to determine the factors associated with depression and anxiety. Receiver operator characteristics (ROC) curves were drawn for the factors affecting depression and anxiety, and the area under the curve values were calculated.ResultsDemographics, APACHE II score, and patient affiliation were similar in both groups. The mean HADS scores of the relatives of COVID-19 and non-COVID-19 patients were 24.76 and 16.04 (p<0.001). The mean HADS-A scores were 12.89 and 7.78 (p<0.001), and the mean of HADS-D scores were 11.87 and 8.27 (p=0.001). Moderate and high-risk anxiety and depression were significantly higher in relatives of COVID-19 patients (p=0.018, p=0.001, respectively). The area under curve (AUC) values were 0.727 in the ROC curve plotted for the independent risk factor Q3 responses that reduced anxiety, and 0.791 and 0.785 in the ROC curve drawn for the independent risk factor Q1 and Q3 responses that reduced the development of depression.ConclusionWe found that the anxiety and depression risk of the relatives of COVID-19 patients in the intensive care unit during the pandemic period is significantly higher than the relatives of non-COVID-19 patients in the intensive care unit. In addition, regardless of the diagnosis, younger intensive care patients may increase the anxiety and depression of the relatives of the patients during the pandemic. The higher-education level of the relatives of patients was determined as a factor reducing anxiety and depression.

Dedicated Psychiatry Clinic for Inflammatory Bowel Disease Patients Has a Positive Impact on Depression Scores

Background: Psychiatric disorders, including anxiety and depression, are significantly more common in patients with inflammatory bowel disease (IBD). We established an integrated psychiatry clinic for IBD patients at our tertiary center IBD clinic to provide patients with critical, but frequently unavailable, coordinated mental health services. We undertook this study to evaluate the impact of this service on psychiatric outcomes, quality of life, and symptom experience. Methods: We performed a longitudinal prospective study comparing patients who had been cared for at our integrated IBD-psychiatry clinic to those who had not. We abstracted demographic and clinical information as well as contemporaneous responses to validated surveys. Results: Thirty-six patients cared for in the IBD psychiatry clinic were compared to a control cohort of 35 IBD patients. There was a significant reduction in the Hospital Anxiety and Depression Scale (HADS) depression score over time in the study cohort (p = 0.001), though not in the HADS anxiety score. When compared to the control group, the study cohort showed a significant reduction in the HADS depression score. No significant differences were observed in the Harvey-Bradshaw Index, Simple Clinical Colitis Activity Index, or Short IBD Questionnaire. Conclusions: This is the first study to evaluate the impact of an integrated psychiatry clinic for IBD patients. Unlike their control counterparts, individuals treated in this clinic had a significant reduction in the mean HADS depression score. Larger scale studies are necessary to verify these findings. However, this study suggests that use of an integrated psychiatry IBD clinic model can result in improvement in mental health outcomes, even in the absence of significant changes in IBD activity.

Prevalence of anxiety and depressive disorders in facial trauma patients: A cross-sectional study

Abstract Background To evaluate the prevalence of anxiety and depressive disorders in facial trauma patients admitted to the Ibn ROCHD University Hospital of Casablanca, we initiated this study. Indeed, facial trauma is damage that can have serious repercussions on the mental health of patients. However, there is little data in Morocco. Methods This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January to April 2019 among facial trauma patients without a history of anxiety and depressive disorders, admitted to the Maxillofacial Surgery Department within 72 hours of the trauma. The patients' socio-demographic and clinical data were collected through a questionnaire, and then the Hospital Anxiety and Depression Scale (HADS) was applied to assess depression and anxiety. In addition to a descriptive analysis of the results, a multinomial regression analysis was performed to assess factors that might be associated with depression and anxiety. Results Among 50 facial trauma patients admitted to the Ibn Rochd University Hospital in Casablanca and included in our study, 11 had symptoms of anxiety (22%) and 12 had symptoms of depression (24%) according to the HADS classification. The mean HADS anxiety and depression subscale scores of the patients were 7.32±4.17 and 6.32±5.10, respectively. Although gender (OR = 2.28 [0.35; 5.70] females), marital status (OR = 3.30 [0.70; 12.70] singles), occupation (OR = 2.66 [0.58; 12.18] not employed), and circumstances of occurrence (OR = 3.66 [0.35; 15.70] public roads) increased the risk of anxiety in patients without anxiety (HADS score≤7); none of these factors was statistically associated with either anxiety or depression. Conclusions This cross-sectional study showed that the prevalence of anxiety and depression in victims of facial trauma is very high in Casablanca. Key messages The prevalence of anxiety and depression among facial trauma victims is very high. Gender, marital status, occupation, and circumstances of occurrence non-significantly increase the risk of anxiety and depression.

Anxiety and related factors among parents of patients with breast cancer after surgery in Japan: A multi-informant and multilevel study.

Anxiety and its correlates in parents of patients with breast cancer have rarely been studied. We explored anxiety among parents of postoperative patients with breast cancer and its relationship with parents' social support and care needs and patients' anxiety. A cross-sectional survey using self-report questionnaires and medical records was conducted among patients with breast cancer after surgery and their parents at four designated cancer care hospitals between September 2015 and June 2016. Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS). Parents provided information about social support and care needs. Multilevel analysis was performed on patient-parent paired data controlling for patient-level variation. Participants included 107 patients, 83 mothers, and 51 fathers. The mean HADS anxiety scores reported by mothers and fathers were 7.2 and 6.5, respectively, which were higher than patients' HADS anxiety scores. Fulfillment of important care needs was related to lower anxiety among mothers and fathers (estimate=-1.38, p=.01). Lower family support and higher patient anxiety were associated with higher anxiety in mothers, but not fathers. Parents of patients with breast cancer had high anxiety. Communication, providing cancer-related information, and fulfilling care needs can alleviate anxiety in parents of patients with breast cancer after surgery. Furthermore, increasing family support and decreasing patients' anxiety are essential to alleviating mothers' anxiety.

Resilience among caregivers of patients with heart failure: a convergent mixed methods study

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): HFA Nurse training Fellowship Award Center for Excellence for Culture and Nursing Research (CECRI)Nursing Scholarship OPI Rome Italy Introduction Resilience is a dynamic process of utilising abilities to harness personal, social, and spiritual resources and coping characteristics and developing regulatory flexibility to manage challenges and bounce back from emotional and physical distress. Caregivers of patients with heart failure are prone to increased stress and reduced resilience while assisting their family members in meeting self-care needs, activities of daily living, and complex medical and dietary regimens. To date, limited research exists on resilience and its predictors among caregivers of people with heart failure. Purpose To develop a comprehensive understanding of resilience and its predictors among caregivers of patients with heart failure. Methods A convergent mixed methods design was used. In total, 50 caregivers completed the Connor-Davidson Resilience Scale (CDRS) (score range: 0–100, with higher scores indicating higher resilience), the Caregiver Burden Inventory (CBI) (higher scores indicate greater caregiver burden; there are no cut-off points for classifying burden), and the Hospital Anxiety and Depression Scale (HADS) (two subscales, range score 0 and 21 per each subscale; higher scores mean worse anxiety and depression) and participated in semi-structured face-to-face interviews. Data were analysed using multiple regression, qualitative content analysis, and joint displays. Results The caregivers’ mean age was 62.8 ± 12.83 years. The CDRS mean score was 62.37 ± 24.2, and the mean HADS scores for anxiety and depression were 12.38 ± 2.74 and 8.54 ± 2.49, respectively. The mean CBI score was 16.82 ± 17.12. Regression analysis showed that the resilience score was only predicted by depression (B = -1.491, p = 0.031). Qualitative analysis generated three resilience-inhibiting factors (psychological outlook, physical weariness, and affective state) and two promoting factors (community interconnectedness and self-comforting activities). Mixed analysis confirmed that depression decreased caregivers’ resilience. Conclusions Caregivers of people with heart failure are likely to experience extreme stress and anxiety that affect their resilience to provide better care for their family members. This study identified that depression, hopelessness, pessimism, powerlessness, physical fatigue, and fluctuating emotional states affected negatively caregivers’ resilience. However, self-comforting activities and community interconnectedness improved caregivers’ resilience. Community care organizations and hospitals could establish alliances to develop programs for enhancing caregivers’ resilience.

Measuring True Change in Individual Patients: Reliable Change Indices of Cardiac Rehabilitation Outcomes, and Implications for Quality Indicators

BackgroundMediated by outcomes such as improved exercise capacity, cardiac rehabilitation (CR) reduces morbidity and mortality. For accuracy, an individual CR patient's change must be measured reliably, an issue not typically considered in practice. Drawing from psychometric theory, we calculated reliable change indices (RCIs), to measure individual CR patients’ true clinical change, apart from that from error and test practice/exposure, in exercise capacity, anxiety, and depression. MethodsIndirectly calculated exercise capacity (peak metabolic equivalents [METs]) and psychological symptoms were each measured twice, 1 week apart, by administering treadmill tests or the Hospital Anxiety and Depression Scale (HADS) to separate samples of 35 (mean age: 59.0 years; 6 women) and 96 (mean age: 64.4 years; 32 women) CR patients, respectively. Using test-retest reliability and mean difference scores from these samples to estimate error and practice/exposure effects, we calculated RCIs for a separate cohort (n = 2066; mean age: 62.0 years; 533 women) who completed 6-month CR, and compared change distributions (worsened/unchanged/improved) based on critical RCIs, mean and percent changes, cut-off scores, and standard deviations. ResultsPractice/exposure effects were nonsignificant, except the mean HADS anxiety score decreased significantly (P ≤ 0.013; d = 0.17, small effect). Test-retest reliabilities were high (METs r = 0.934; HADS anxiety score r = 0.912; HADS depression score r = 0.90; P < 0.001). Among 2066 CR patients, RCI distributions differed (P < 0.001) from those of most other change criteria. ConclusionsChange ascertainment depends on criterion choice. A Canadian Cardiovascular Society CR quality indicator of increase by 0.5 MET may be too small to assess individuals’ functional capacity change. RCIs offer a pragmatic approach to benchmarking reliable change frequency, and pending further validation, could be used for feedback to individual patients.

Psychosocial response of infertile patients to COVID-19-related delays in care at the epicenter of the global pandemic.

The aim of this study was to describe the psychosocial response of the infertile population whose care was curtailed due to the COVID-19 pandemic. A web-based cross-sectional survey was administered to 117 infertile patients at our Center who had their infertility treatment delayed due to suspension of care at our hospital during the COVID-19 pandemic. The survey consisted of 52-question multiple-choice questions including the Life Orientation Test-Revised (LOT-R) and the Hospital Anxiety and Depression Scale (HADS) instruments. Characteristics of respondents who "agreed" (strongly agree and agree) that "delaying treatment has permanently impacted my chances at future conception" were compared with participants who "disagreed" (neutral, disagree, and strongly disagree) using Fischer's Exact Test. In total, 79.5% agreed that delaying treatment has permanently impacted their chances at future conception. There were no discernible demographic differences between patients who "agreed" versus "disagreed" with the above statement. The mean LOT-R score was 14.1 (5.1) with an optimism score of 6.8 (2.6) and a pessimism score of 7.3 (2.9). The mean HADS depression score was 5.4 (3.4) with 28.2% reporting scores in the borderline-abnormal to abnormal range. The mean HADS anxiety score was 9.0 (3.9) with 64.6% reporting scores in the borderline-abnormal to abnormal range. Nearly one third of respondents (36.8%) reported wanting to "expedite/be more aggressive with treatment," whereas only 5.1% wanted to postpone treatment. Women undergoing ART during the COVID-19 pandemic express significant concern and signs of distress about how delays in care affect their future reproductive potential.

Pediatric and Maternal Anxiety at First Visit to a Turkish Gastroenterology Clinic Compared to Anxiety Prior to Pediatric Endoscopy Procedure.

The aim of this study was the prospective comparison of pediatric and maternal anxiety at the first visit to a gastroenterology clinic with anxiety prior to a pediatric endoscopy procedure. A total of 101 children aged 4-18 years plus their mothers who were referred to an outpatient pediatric gastroenterology clinic were included in the first group. The second group consisted of 101 different children aged 4-18 years undergoing pediatric endoscopy. The Hospital Anxiety and Depression Scale (HADS) was administered to mothers. Visual analog scale scores were obtained from the children to measure anxiety. The demographic characteristics of the groups were similar. The mean HADS anxiety score was 3.83 in mothers of the first group. The same score was significantly higher as (6.96) in the mothers whose children underwent an endoscopy (p < .001). The comparison of the depression scores revealed significantly higher scores in the endoscopy group. Visual analog scale values of the children revealed remarkably higher anxiety scores in the endoscopy group. About 5% of mothers in the first group and almost half of the mothers in the endoscopy group developed remarkable anxiety (>8 HADS anxiety). The rate of significant depression (>8 HADS depression) was 2% and 17.82% in the first and second groups, respectively. The current prospective trial concluded that particularly anxiety is a major concern for mothers and children when endoscopy is required.

Sexual Functions and Quality of Life in Patients Developing Lymphedema After Total Mastectomy: A Pilot Study.

Background: Sexual functions in women with lymphedema secondary to breast cancer surgery have not been investigated sufficiently. This study aimed to compare patients with and without lymphedema after total mastectomy in terms of emotional state, sexual functions, and quality of life. We also investigated the factors affecting sexual functions in these patients. Methods: Married women 20-55 years of age, who presented to lymphedema polyclinic of Health Sciences University Ankara Training and Research Hospital after having undergone total mastectomy at least 1 year earlier owing to breast cancer were included. Twenty-five patients with lymphedema were assigned to the lymphedema group, and 20 without lymphedema to the control group. Hospital Anxiety and Depression Scale (HADS) was used to assess emotional state. We evaluated sexual functions of the participants by Female Sexual Function Index (FSFI) and quality of life with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QOL-C30). Results: There was no statistically significant difference in age and body mass index between the groups (p > 0.05). The mean HADS score was 13.4 ± 6.5 in lymphedema group and 13.4 ± 6.0 in control group. The groups were also similar in aspect of the HADS score (p > 0.05). FSFI and global health and physical function scores of EORTC QOL-C30 were statistically significantly lower in the lymphedema group (p < 0.05). A statistically significant correlation was found between FSFI and age and time elapsed postmenopause (p < 0.05, for both). Conclusion: We evaluated sexual functions of the patients who underwent mastectomy in this study. Although the HADS score is similar in patients with and without lymphedema, both sexual functions and quality of life are adversely affected in patients who undergo mastectomy and develop lymphedema. This study is important for investigating whether lymphedema developing after total mastectomy affects sexual functions of the patients.

Long-term health-related quality of life in patients treated with subcutaneous C1-inhibitor replacement therapy for the prevention of hereditary angioedema attacks: findings from the COMPACT open-label extension study

BackgroundLong-term prophylaxis with subcutaneous C1-inhibitor (C1-INH[SC]; HAEGARDA, CSL Behring) in patients with hereditary angioedema (HAE) due to C1-INH deficiency (C1-INH-HAE) was evaluated in an open-label extension follow-up study to the international, double-blind, placebo-controlled COMPACT study. The current analysis evaluated patient-reported health-related quality of life (HRQoL) data from 126 patients in the open-label extension study randomized to treatment with C1-INH(SC) 40 IU/kg (n = 63) or 60 IU/kg (n = 63) twice weekly for 52 weeks. HRQoL was evaluated at the beginning of the open-label study and at various time points using the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the Hospital Anxiety and Depression Scale (HADS), the Work Productivity and Activity Impairment Questionnaire (WPAI), and the Treatment Satisfaction Questionnaire for Medication. The disease-specific Angioedema Quality of Life Questionnaire (AE-QoL) and HAE quality of life questionnaire (HAE-QoL) instruments were administered in a subset of patients. Statistical significance was determined by change-from-baseline 95% confidence intervals (CIs) excluding zero. No adjustment for multiplicity was done.ResultsMean baseline EQ-5D scores (Health State Value, 0.90; Visual Analog Scale, 81.32) were slightly higher (better) than United States population norms (0.825, 80.0, respectively) and mean HADS anxiety (5.48) and depression (2.88) scores were within “normal” range (0–7). Yet, patients using C1-INH(SC) 60 IU/kg demonstrated significant improvement from baseline to end-of-study on the EQ-5D Health State Value (mean change [95% CI], 0.07 [0.01, 0.12] and Visual Analog Scale (7.45 [3.29, 11.62]). In the C1-INH(SC) 60 IU/kg group, there were significant improvements in the HADS anxiety scale (mean change [95% CI], − 1.23 [− 2.08, − 0.38]), HADS depression scale (− 0.95 [− 1.57, − 0.34]), and WPAI-assessed presenteeism (mean change [95% CI], − 23.33% [− 34.86, − 11.81]), work productivity loss (− 26.68% [− 39.92, − 13.44]), and activity impairment (− 16.14% [− 26.36, − 5.91]). Clinically important improvements were achieved in ≥ 25% of patients for all domains except WPAI-assessed absenteeism (which was very low at baseline). Mean AE-QoL total score by visit ranged from 13.39 to 17.89 (scale 0–100; lower scores = less impairment). Mean HAE-QoL global scores at each visit (115.7–122.3) were close to the maximum (best) possible score of 135.ConclusionsLong-term C1-INH(SC) replacement therapy in patients with C1-INH-HAE leads to significant and sustained improvements in multiple measures of HRQoL.Trial registration A Study to Evaluate the Long-term Clinical Safety and Efficacy of Subcutaneously Administered C1-esterase Inhibitor in the Prevention of Hereditary Angioedema, NCT02316353. Registered December 12, 2014, https://clinicaltrials.gov/ct2/show/NCT02316353.

The Effects of Peat-Pack Poultice and Salt Groundwater Foot Bath in Taean-gun on Depression and Pain in Single Parent Family

Purpose: Studies have reported on treating various diseases with marine healing, but not the effects of marine healing on depression, anxiety, and pain in single-parent families. This study aimed to evaluate the scientific efficacy of treatment using peat-pack poultice and salt groundwater and evaluate its effects on depression, anxiety, and pain in single-parent families.Methods: For 26 women of single-parent families, peat-pack thermal therapy and salt-water foot baths were performed daily for 4 days. Of the 26 subjects, three dropped out and 23 were enrolled in the study. The depression and pain results were compared before versus after the peat-pack poultice and salt groundwater treatments. The Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale (HADS), and visual analog scale (VAS) pain score were evaluated.Results: In Taean-gun, a peat-pack poultice and salt groundwater foot bath program were administered along with a questionnaire for depression, anxiety, and pain. Mean Edinburgh score was significantly improved after the program (11.78±7.6 vs. 9.7±7.6, p=0.005), mean HADS anxiety score (7±9.7 vs. 5.3± 2.7, p=0.002) and mean VAS pain score also improved (5.39±2.8 vs. 3.96±2.7, p=0.003).Conclusion: Peat-pack thermal therapy and salt groundwater foot bath improved chronic pain, depression, and anxiety in single-parent families.

Evaluation of Salivary C-Reactive Protein and Psychological Factors in Patients with Oral Lichen Planus: A Cross-sectional Study

Introduction: Aetiology and pathogenesis of Oral Lichen Planus (OLP) has been focus of research since a long time and various aetiological factors like autoimmunity, heredity, drugs, dental materials, psychological factors, especially stress and anxiety have been reported to be associated with this disease. Few studies in past have found significant elevations in C-Reactive Protein (CRP) levels in individuals who reported to be having chronic stress. Both altered salivary CRP levels and psychological stress have been reported in OLP patients. To the best of our knowledge no such studies have been conducted in past, so a need was felt to conduct a study to evaluate and also correlate salivary CRP and psychological factors in OLP patients. Aim: To evaluate salivary CRP and psychological factors and assess only possible correlation between them in patients with OLP. Materials and Methods: This cross-sectional study included of two groups: Group A- consisting of 33 individuals clinically diagnosed with OLP and Group B- consisting of 33, age and gender matched healthy individuals. Hospital Anxiety and Depression Scale (HADS) was used for all the participants to evaluate the psychological factors. Salivary CRP levels were evaluated using Mispa i2 Nephelometry. Statistical analysis was done using SPSS software. Results: Mean salivary CRP value among cases was 3.42±2.786 and among controls was 2.84±.848. Mean HADS score among cases was 6.60±2.796 and among controls was 2.70±.948. Mean Salivary CRP and HADS values were higher in OLP patients compared to controls. However, no statistical significant association could be established between CRP and HADS in patients with OLP (p=0.200). Conclusion: No correlation between psychological status and CRP levels could be established in patients with OLP. CRP couldbe used as a diagnostic marker in oral premalignantlesions.

AB0757 ASSOCIATION BETWEEN DEPRESSIVE SYMPTOMS AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH PSORIATIC ARTHRITIS

Background:Cardiovascular complications are the leading cause of death in patients with psoriatic arthritis (PsA), but current strategies for reducing cardiovascular risk are still inadequate. Depression is a common comorbidity in PsA patients and it is recognized as an independent cardiovascular risk factor in the general population. Endothelial dysfunction, assessed as a reduction in brachial artery Flow Mediated Dilation (FMD), is a predictor of major cardiovascular events in high and low risk populations.Objectives:To investigate the relationship between endothelial function and depressive symptoms in a cohort of patients with PsA.Methods:Sixty consecutive patients with PsA, aged between 30 and 79 years, with no history of major cardiovascular events, were characterized for traditional cardiovascular risk factors and features of psoriatic disease. The risk of cardiovascular events according to traditional risk factors was calculated using the Framingham Risk Score (FRS) and the presence of depressive symptoms was defined through the Hospital Anxiety and Depression Scale (HDS) using the validated cut-off of 8. Endothelial function was assessed by FMD. Serum IL-6 was quantified by ELISA, IL-17 and TNF-α levels by Luminex method.Results:Patients had an average age of 52.1±11.0 years, 43.3% of them were male, 23.3% obese and 25.0% active smokers; 38.3%, 25.0% and 11.7% were treated for high blood pressure, dyslipidemia and diabetes mellitus, respectively. The 10-year risk of major cardiovascular events estimated by FRS was 10.4%. The mean duration of PsA was 9.4 years, 30.0% of patients were in minimal disease activity (MDA) and 61.7% and 46.7% were treated with conventional and biotechnological DMARDs, respectively. The mean HDS value was 6.9±3.2 and 43.4% of patients had significant depressive symptoms. The severity of depressive symptoms according to HDS correlated with disease activity according to DAPSA (r=0.449, p=0.001). The mean FMD was 7.8±3.8%, this value correlated inversely with age (r=-0.408,p&lt;0.001), risk of major cardiovascular events according to FRS (r=-0.327, p=0.011) and severity of depressive symptoms according to HDS (r=-0.285, p=0.027). The correlation between FMD and serum IL-6, IL-17 and TNF-alpha levels was not statistically significant. In multivariate linear regression models, the relationship between FMD and HDS was significant also when corrected for age (β=-0.26, p=0.03, R2=0.23) and FRS normalized through logarithmic transformation (β=-0.32, p=0.009, R2=0.22).Conclusion:The degree of endothelial dysfunction quantified by FRS correlates with the severity of the depressive symptoms in patients with PsA, independently of the cardiovascular risk attributable to classical risk factors. The weak relationship between FRS and serum levels of IL-6, IL-17 and TNF-alpha suggests a role of factors independent of inflammation in the regulation of endothelial function in patients with PsA. Systematic research and treatment of depressive symptoms could contribute to a more complete stratification and a better management of cardiovascular risk in patients with PsA.Disclosure of Interests:Enrico De Lorenzis: None declared, Angela Di Giorgio: None declared, Gerlando Natalello: None declared, Antonio Nesci: None declared, Dario Bruno: None declared, Donatella Lucchetti: None declared, Giacomo Tanti: None declared, Clara Di Mario: None declared, Pietro Rubortone: None declared, Maria Rosaria Magurano: None declared, Barbara Tolusso: None declared, Angelo Santoliquido: None declared, Giusy Peluso: None declared, Elisa Gremese Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp &amp; Dohme, Novartis, Sanofi, UCB, Roche, Pfizer, Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp &amp; Dohme, Novartis, Sanofi, UCB, Roche, Pfizer

Length Polymorphisms in the Angiotensin I-Converting Enzyme Gene and the Serotonin-Transporter-Linked Polymorphic Region Constitute a Risk Haplotype for Depression in Patients with Coronary Artery Disease

Genetic variations affecting the course of depressive symptoms in patients with coronary artery disease (CAD) have not yet been well studied. Therefore, we set out to investigate whether distinct haplotypes of the two insertion/deletion polymorphisms in the serotonin-transporter-linked polymorphic region (5-HTTLPR) and the angiotensin I-converting enzyme (ACE) gene located on chromosome 17 can be identified as risk factors for trajectories of depression. Clinical and genotyping data were derived from 507 depressed CAD patients participating in the randomized, controlled, multicenter Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) trial, of whom the majority had an acute cardiac event before study inclusion. Depression scores on the Hospital Anxiety and Depression Scale (HADS) were assessed at baseline and at five follow-up time points up to 2 years after study entrance. At baseline, depression scores did not significantly differ between patients carrying the risk haplotype ACE D/D, 5-HTTLPR I/I (n = 46) and the non-risk haplotypes (n = 461, 10.9 ± 2.7 versus 10.4 ± 2.5, p = 0.254). HADS-depression scores declined from study inclusion during the first year irrespective of the genotype. At each follow-up time point, HADS-depression scores were significantly higher in ACE D/D, 5-HTTLPR I/I carriers than in their counterparts. Two years after study inclusion, the mean HADS depression score remained 1.8 points higher in patients with the risk haplotype as compared to subjects not carrying this haplotype (9.9 ± 4.2 versus 8.1 ± 4.0, p = 0.009). In summary, the presence of the ACE D/D, 5-HTTLPR I/I haplotype may be a vulnerability factor for comorbid depressive symptoms in CAD patients.

Analysis of anxiety, depression and related factors in patients with chronic lumbocrural pain before minimally invasive surgery

To investigate anxiety and/or depression status of patients with chronic lumbocrural pain, and to further analyze related risk factors of anxiety and/or depression . Retrospective analysis of the medical data of patients who suffered from chronic lumbocrural pain caused by lumbar disc herniation and/or lumbar spinal stenosis and received minimally invasive surgery from March 2018 to April 2018. General data (including age, gender, education levels, past history, sleep order and medical insurance), numeric rating scale(NRS), Japanese Orthopedic Association(JOA) back pain scale and hospital anxiety and depression scale(HADS) were collected for analysis. The basic demographic data and clinic data were analyzed, possible related risk factors associated were analyzed by univariate analysis, and multivariate Logistic regression analysis was further used to find the relative independent risk factors and included all the predictive variables with P values less than 0.05 as covariates. A total of 91 patients met the inclusion criteria and finished this study, the mean HADS score for anxiety was 8.1±4.2, 48(52.7%) respondents were screened positive for anxiety, while the rest 43(47.3%) patients had negative anxiety state, the mean HDDS score for depression was 6.9±4.9, 38(41.8%) respondents were screened positive for depression, and the rest 53(58.2%) patients were not depressed, and 56(61.5%) patients experienced anxiety or depression. There were significant difference in sleep disorder, JOA score and leg NRS score between the patients with and without anxiety(P<0.05), and the significant differences were also found in age, sleep disorder and JOA score between the patients with and without depression(P<0.05), Logistic regression analysis further showed that the JOA score and sleep disorder were risk factors for anxiety, and the JOA score was risk factor for depression. Patients with chronic lumbocrural pain are often accompanied by anxiety and/or depression before minimally surgery, the low JOA score and sleep disturbance increased the risk of presenting anxiety, and the low JOA score increased the risk of developing depression. It is necessary to evaluate mental status and related risk factors before surgery.

Association between depression, anxiety and quality of life among patients with diabetes mellitus and/or hypertension in a tertiary care railway hospital in India: A cross-sectional study.

Introduction:Comorbid depression and anxiety have been found to be highly present in patients suffering from chronic physical illnesses such as diabetes mellitus (DM) and hypertension (HTN). These comorbid psychiatric conditions further reduce the quality of life (QOL) in the sufferers. The present study aimed to assess the association between depression, anxiety, and QOL among patients with DM and/or HTN.Materials and Methods:This cross-sectional study was carried out in the outpatient setting of the medicine department of the tertiary care referral hospital of East Central Indian Railways. One hundred and twenty-three individuals of DM and/or HTN of more than 1-month duration were assessed for depression, anxiety, and QOL using the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization QOL Brief (WHOQOL-BREF) version scale.Results:The mean age of the sample (53.7% had HTN, 12.2% had diabetes, and 34.1% had both HTN and diabetes) which comprised 87% males was 50.20 (±6.0) years. The mean HADS (anxiety and depression) scores were 3.6 for both (range 0–14). Nearly 10.6% and 17.1% of the samples had scores above the cutoff for HADS anxiety and depression subscales. The WHOQOL-BREF scores were highest for the environmental domain and were lower for psychological, physical, and social domains. The HADS anxiety and depressive scores correlated significantly negatively with the WHOQOL-BREF physical and psychological domains. Female gender and the presence of an additional medical illness were significantly associated with higher HADS depression scores.Conclusion:Fair proportion of patients with HTN and/or diabetes has been affected with higher anxiety and depressive scores, which predicted a poor QOL. This calls for early identification of these mental health issues in sufferers of depression and HTN, which will facilitate an early holistic management.

Anxiety and depression among patients of non-cardiac chest pain and other medically ill patients

Background: The current study compared severity of anxiety and depression patients of NCCP and other medical conditions in male adults.Methods: Sample consisted of consenting male patients from cardiology OPD with symptom of chest pain, whereas control group consisted of patients without symptoms of chest pain, aged between 18 to 60 years. Exclusion criteria for both groups included unstable or life-threatening medical conditions, psychosis, substance use disorders, or any psychiatric illness. Both experimental and control group were evaluated with history, clinical examinations and indicated investigations. The socio demographic data sheet and Hospital Anxiety and Depression Scale (HADS) was applied, patients were asked to read all 14 question and place a tick against the reply representing their feelings, the answers were rated with Likert pattern of scoring. The collected data statistically analyzed.Results: A total of 51 patients of experimental group with mean age of 44.82±7.63years and 76 control with mean 46.30±8.45 years were participated for this study. The mean HADS anxiety score for NCCP was 13.29±3.42 and for the group of other patients it was 11.06±3.54 (t value=-3.517, df=125 and p value=0.001). Whereas the mean HADS depression score for NCCP was 12.58±2.76 and for the group of other patients it was 10.90±2.26 (t value=-3.743, df=125 and p value=0.000).Conclusions: NCCP is associated with significantly higher anxiety and depression in comparison to other medically ill patients.

Depression Among Patients with Chronic Cluster Headaches.

Introduction: Chronic headaches account for a significant proportion of people leading a poor quality of life. Chronic cluster headaches can be defined as episodes of headache usually around the eye in the pattern of a cluster lasting 15-180 minutes each followed by multiple similar episodes occurring at a frequency of 1-8 times per day.Method: This cross-sectional study was conducted in Jinnah Postgraduate Medical Center, Karachi. One hundred patients who were diagnosed cases of chronic cluster headaches were asked to fill the Beck Hopelessness Scale (BHS), Headache Impact Test (HIT), and Hospital Anxiety and Depression Scale (HADS).Results: Of our study subjects, 57 were males and 43 were females. The mean HIT-6 score among these patients was found to be 60.5±7.67 (p-value = 0.04). The mean BHS score among these patients was found to be 13±6.87. The mean HADS reporting anxiety (HADS-A) was found to be 12.54 ± 5.65; whereas, the mean HADS reporting depression (HADS-D) was found to be 7.65 ± 4.65.Conclusion: Patients with chronic cluster headaches have higher scores than the general population. There is an association between headache syndromes and depression which require further investigation.

375P - Illness perceptions, quality of life and mood in metastatic breast cancer patients

BackgroundThe patients’ (pts) illness perception is based on dimensions of cognitive understanding and emotional representations of disease and its symptoms. Previous studies reported that illness perceptions influence quality of life (QoL) and mood. Methods212 pts with metastatic breast cancer, under treatment, were evaluated by Illness Perception Questionnaire Brief version (IPQ-B), EORTC Quality of Life Questionnaire (QLQ-30) and Hospital Anxiety and Depression Scale (HADS). IPQ-B higher scores indicate a negative perception. EORTC QLQ-30 higher scores indicate better functioning/QoL or worse symptom severity. Higher HADS indicate higher anxiety/depression (AD) levels. Variables were studied using Pearls correlation (Sig 0.01) and T test. Primary endpoint was evaluation of illness perception. Secondary endpoints were assessment of pts characteristics, QoL, AD and its associations with illness perception. ResultsMedian age was 64 years (y) and 99.5% (211 pts) were women. Median IPQ-B score was 18/32. All patients reported that their breast cancer is incurable. Perception of disease consequences was more negative in pts younger than 70y versus 70y or older (2.7 vs 2.3, p=0.039). Preoccupation and perception of control with treatment were higher in younger pts (3.4 vs 2.9, p=0.004; 3.6 vs 3.3, p=0.03; respectively). Pts under chemotherapy and/or anti-HER2 therapy shown a greater impact of disease consequences, than pts under endocrine therapy and/or other target therapies (2.6 vs 2.3, p=0.039). The mean overall QoL was 54.6/100 (± 23.0). Physical, cognitive, social and emotional functioning mean scores were respectively 60.3, 69.1, 69.3 and 60.3/100; all lower than EORTC ref. values (p<0.01). Social functioning and IPQ-B shown a moderate negative correlation (r = - 0.507). The mean HADS score was 16.9/42 (± 7.8), reflecting the AD subscales (respectively, 9.1/21; 7.8/21). The overall illness perception and HADS shown a moderate positive association (r=0.62). Anxiety and the emotional dimension of IPQ-B had a moderate positive correlation (r=0.598). ConclusionsIntegrating in clinical practice the relation between illness perceptions, QoL and AD, may improve disease’s coping mechanisms and functional capacity (physical, emotional, social). Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Assessment of patients' psychological state and self-efficacy associated with postoperative constipation after thoracolumbar fracture surgery.

ObjectiveWe aimed to explore the relationship among the duration of constipation at 30 days after thoracolumbar fracture surgery, self-efficacy, and anxiety or depression in patients with constipation after thoracolumbar fracture surgery.MethodsIn this descriptive correlational study, 108 patients with thoracolumbar fracture undergoing pedicle screw fixation surgery were recruited from January 2015 to May 2017 in our hospital. From the day of surgery, we conducted a 1-month follow-up investigation. We evaluated the pattern of defecation, stool consistency, and incidence of defecation-related problems using a structured interview. Clinical data were obtained using a patient intake form, and we applied the Health Behavior Self-Efficacy Scale (HBSES), and Hospital Anxiety and Depression Scale (HADS).ResultsApproximately 83.3% of patients experienced postoperative constipation, and most exhibited normal defecation by postoperative day 13. Self-efficacy and anxiety and depression were graded at a medium level in most patients. The average HBSES score was 74.39 ± 11.08, and the mean HADS score was 7.97 ± 4.08. The duration of postoperative constipation was negatively correlated with self-efficacy and positively associated with anxiety or depression.ConclusionsSelf-efficacy, anxiety, and depression are important sociopsychological factors associated with the duration of postoperative constipation.