Probable Anxiety Disorder Research Articles

Perceived Stigma and Mental Health Care Seeking

There is limited empirical evidence on the extent to which perceived public stigma prevents individuals from using mental health services, despite substantial recent policy interest in this issue. This study investigated associations between perceived public stigma and mental health care seeking.This study used cross-sectional survey data from a representative sample of undergraduate and graduate students (N=2,782) at one university. A five-item scale was used to assess perceived public stigma toward mental health service use. Perceived need for help in the past 12 months and current presence of depressive and anxiety disorders were also assessed.Perceived stigma was higher among males, older students, Asian and Pacific Islanders, international students, students with lower socioeconomic status backgrounds, and students with current mental health problems. Perceived stigma was also higher among those without any family members or friends who had used mental health services and among those who believed that therapy or medication is not very helpful. Perceived stigma was negatively associated with the likelihood of perceiving a need for mental health services, but only among younger students. Among those with probable depressive or anxiety disorders, there was no evidence that perceived stigma was associated with service use.These results suggest that, at least in this population, perceived stigma may not be as important a barrier to mental health care as the mental health policy discourse currently assumes.

Using the Edinburgh Postnatal Depression Scale to screen for anxiety disorders

Screening for postnatal mood disorders in English-speaking women often uses the validated cut-off score of 13 or more on the Edinburgh Postnatal Depression Scale (EPDS) to detect probable major depression. Increasingly there is evidence that for many women, and men, anxiety disorders can occur postnatally in the absence of depression. This study therefore examined data on the three EPDS items frequently found to cluster together on an anxiety factor for women (items 3, 4, and 5: EPDS-3A), to determine the optimum cut-off score to screen for specified anxiety disorders. A sample of 238 women and 218 men were administered a diagnostic interview for anxiety and depressive disorders, and completed the EPDS, at 6 weeks postpartum. The receiver operating characteristics show that the optimum cut-off score on the EPDS-3A for women is 6 or more (possible range: 0-9), and for men it is 4 or more, though it appears that the factor structure for men is different than for women. The conclusion is that the EPDS can be used to screen for probable depression in women (using the validated total cut-off score of 13 or more) and also probable anxiety (using the EPDS-3A cut-off score of 6 or more). For men there is already a validated total cut-off score for both depression and anxiety (6 or more)--however, if services are not using this, they can use the EPDS-3A score of 4 or more to screen for probable anxiety disorders in fathers, though further work needs to be undertaken to clarify whether the anxiety factor structure for men is different to that found for women.

Psychiatric morbidity among patients with cancer of the esophagus or the gastro-esophageal junction: a prospective, longitudinal evaluation

Cancer of the esophagus is often diagnosed at a late stage and is related to severe morbidity and a low 5-year survival rate. Previous studies have reported low health-related quality of life and high suicide rates for these patients. The occurrence of psychiatric morbidity and thus the potential need for psychological support may vary over time after diagnosis. This has not been adequately studied in patients with newly diagnosed cancer of the esophagus or gastro-esophageal junction. The present study therefore aimed to prospectively evaluate the prevalence of psychiatric morbidity in 94 consecutive patients (median age 66, range 45-88 years) with all stages of disease. Psychiatric morbidity was evaluated with the Hospital Anxiety and Depression Scale (HADS) questionnaire at inclusion and 1, 2, 3, 6 and 12 months later. At inclusion, 42% of the patients had HADS scores indicating possible or probable anxiety disorder and/or depression. At all follow-ups except at 3 months, proportions of patients with possible/probable anxiety disorder were significantly lower than at inclusion. Among patients with a duration of tumor-specific symptoms exceeding 6 months pre-diagnosis, larger proportions of patients with a possible/probable anxiety disorder were found at the 1- and 6-month follow ups. The prevalence of possible/probable depression was greater among patients treated with a palliative intent than among those with a curative intent at inclusion. Patients who died during the study period scored worse for depression compared to the survivors. Apart from this, the proportion of patients with possible/probable psychiatric morbidity (anxiety and/or depression) was relatively stable over time and was unrelated to patient characteristics or clinical background, including the treatment regime. In conclusion, psychiatric morbidity is common among esophageal cancer patients, both at inclusion and over time, regardless of the cancer therapy given. The findings stress the importance of monitoring the patients' mental health and of offering adequate psychological care when needed.

Impact of Comorbid Anxiety in an Effectiveness Study of Interpersonal Psychotherapy for Depressed Adolescents

To assess the impact of comorbid anxiety on treatment for adolescent depression in an effectiveness study of interpersonal psychotherapy for depressed adolescents (IPT-A). A randomized clinical trial was conducted from April 1, 1999, through July 31, 2002. Sixty-three depressed adolescents, ages 12 to 18, received either IPT-A or treatment as usual delivered by school-based mental health clinicians. Adolescents with and without probable comorbid anxiety disorders were compared on depression and overall functioning. All analyses used an intent-to-treat design. Comorbid anxiety was associated with higher depression scores at baseline (p <.01) and poorer depression outcome posttreatment (p <.05). IPT-A was nonsignificantly more effective in treating the depression of adolescents with comorbid anxiety (p =.07). Adolescents whose depression and functioning improved during the course of treatment also showed an improvement in anxiety (p <.01), largely irrespective of treatment condition. Adolescents with comorbid depression and anxiety present with more severe depression and may be more difficult to treat. Structured treatments like IPT-A may be particularly helpful for comorbidly depressed adolescents as compared to supportive therapy.

Prevalence of DSM-IV-Defined Mood, Anxiety, and Substance Use Disorders in an HIV Clinic in the Southeastern United States

Mood and anxiety disorders, particularly depression, and substance abuse (SA) commonly co-occur with HIV infection. Appropriate policy and program planning require accurate prevalence estimates. Yet most estimates are based on screening instruments, which are likely to overstate true prevalence. Large academic medical center in Southeast. A total of 1,125 patients, representing 80% of HIV-positive patients seen over a 2.5-year period, completed the Substance Abuse-Mental Illness Symptoms Screener, a brief screening instrument for probable mood, anxiety, and SA disorders. Separately, 148 participants in a validation study completed the Substance Abuse-Mental Illness Symptoms Screener and a reference standard diagnostic tool, the Structured Clinical Interview for DSM-IV. Using the validation study sample, we developed logistic regression models to predict any Structured Clinical Interview for DSM-IV mood/anxiety disorder, any SA, and certain specific diagnoses. Explanatory variables included sociodemographic and clinical information and responses to Substance Abuse-Mental Illness Symptoms Screener questions. We applied coefficients from these models to the full clinic sample to obtain 12-month clinic-wide diagnosis prevalence estimates. We estimate that in the preceding year, 39% of clinic patients had a mood/anxiety diagnosis and 21% had an SA diagnosis, including 8% with both. Of patients with a mood/anxiety diagnosis, 76% had clinically relevant depression and 11% had posttraumatic stress disorder. The burden of psychiatric disorders in this mixed urban and rural clinic population in the southeastern United States is comparable to that reported from other HIV-positive populations and significantly exceeds general population estimates. Because psychiatric disorders have important implications for clinical management of HIV/AIDS, these results suggest the potential benefit of routine integration of mental health identification and treatment into HIV service sites.

Changes in quality of life during palliative chemotherapy for solid cancer

We conducted this prospective study to assess the changes in quality of life (QOL), anxiety and depression in patients receiving palliative chemotherapy for solid cancers. Patients were eligible if they had histologically confirmed metastatic or recurrent cancer and a life expectancy of more than 6 months, and were able to complete the self-administered questionnaires. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale (HADS) were used to measure the effects of chemotherapy on the patients' QOL, anxiety and depression at baseline and three times after every three cycles of chemotherapy. From July 2001 to October 2003, 146 patients were recruited, and of these 98 completed the questionnaires and 48 were withdrawn from the trial (27 lost to follow-up, 11 withdrew consent, 5 for toxicity, 5 for progression of the cancer). Their median age was 58 years (range 28-78 years) and the male to female ratio was 1.6. Of the 146 patients, 52 had gastric cancer, 39 non-small-cell cancer, 29 colorectal cancer, 11 breast cancer, and 15 had other cancers. Initial QOL scores were closely related to performance status. Compared with baseline, clinically meaningful relief (score decreased by more than 10) of symptoms such as pain and sleep disturbance was observed. There was significant improvement (score increased by more than 10) in the functional scales after the first cycle of chemotherapy, but these effects did not persist throughout the whole course of therapy. The incidences of probable anxiety and depression disorder before chemotherapy were 20% and 29%, respectively. The anxiety scores decreased throughout the period of intervention. Pretreatment anxiety and depression were negatively correlated with baseline QOL scores. Palliative chemotherapy treatment in patients with solid cancer improved cancer-related symptoms, lessened anxiety and did not disturb the QOL of cancer patients.

Prevalence of Probable Mental Disorders Among Pediatric Asthma Patients in an Inner-City Clinic

Objective. To determine the screen-positive prevalence of anxiety disorders and depression among pediatric asthma patients in an inner-city asthma clinic and to investigate the association between probable diagnoses of anxiety disorders and depression and medical service use among inner-city pediatric asthma patients. Method. In this pilot study, a consecutive sample of pediatric asthma patients aged 5–11 in the waiting room of an inner-city asthma clinic was screened for mental disorders using the DISC Predictive Scales (DPS), which produces probable DSM-IV diagnoses. In addition, data on health service use for asthma were collected. Statistical analyses were performed to examine the relationship between probable anxiety disorders and depression and health service use for asthma among pediatric asthma patients. Results. Approximately one in four (25.7%) pediatric asthma patients in an inner-city asthma clinic met criteria for a probable diagnosis of current anxiety disorders or depression (past 4-week prevalence). Specifically, childhood separation anxiety disorder was common among 8.1%, panic among 14.9%, generalized anxiety disorder among 4.1%, agoraphobia among 5.4%, and 2.7% had depression. Having more than one anxiety disorder or depression diagnosis was associated with higher levels of inpatient and outpatient medical services, compared with patients who were negative on screening for anxiety or depressive disorders, although differences failed to reach statistical significance. Conclusions. These findings are the first to provide preliminary evidence suggesting that mental health problems are common among pediatric asthma patients in an inner-city clinic. The results also suggest that mental health problems in pediatric asthma patients may be associated with elevated levels of medical service use for asthma. Replication of this pilot study is needed with a larger sample, more precise diagnostic methodology, and a comparison group with chronic medical illness.

The changes in quality of life during the palliative chemotherapy for solid cancer

8237 Background: We conducted this prospective study to assess the changes of quality of life, anxiety and depression in patients receiving palliative chemotherapy for solid cancers. Methods: Patients with histologically confirmed metastatic or relapsed cancer, life expectancy of more than 6 months and the ability to fill-up questionnaires by oneself were eligible. The effect of chemotherapy on quality of life and the levels of their anxiety and depression were assessed at baseline and after every 3 cycles of chemotherapy, by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale (HADS). Results: Between July 2001 and October 2003, 146 patients were entered onto the protocol. Ninety-eight patients completed the questionnaire and 46 patients withdrew from trial (27 for lost follow-up, 11 for withdrawal of consents, 5 for toxicity, 5 for progression). Their median age was 58 years old (range 28–78) and male to female ratio was 1.6. Chemotherapy was administered as the first, second, and third or more line in 107, 29, and 10 patients respectively (including 52 cases of gastric cancer, 39 of non-small cell lung cancer, 29 of colorectal cancer, 11 of breast cancer, and 15 of others). Compared with baseline, clinically meaningful relief (score decreased more than 10) of symptoms such as pain, dyspnea, and sleep disturbance was observed. There was significant improvement (score increased more than 10) of the functioning scales after the first cycle of chemotherapy, but these effects didn't persist through the whole course of therapy. The incidence of probable anxiety and depression disorder before the chemotherapy were 20% and 29% each. The anxiety scores decreased throughout the whole period of intervention (p<0.01). Pre-treatment anxiety and depression were negatively correlated with baseline QOL scores. Conclusions: The palliative chemotherapy in patients with solid cancer improved the cancer-related symptoms and lessened the anxiety. Also it did not disturb the function and overall quality of life. No significant financial relationships to disclose.

The changes in quality of life during the palliative chemotherapy for solid cancer

8237 Background: We conducted this prospective study to assess the changes of quality of life, anxiety and depression in patients receiving palliative chemotherapy for solid cancers. Methods: Patients with histologically confirmed metastatic or relapsed cancer, life expectancy of more than 6 months and the ability to fill-up questionnaires by oneself were eligible. The effect of chemotherapy on quality of life and the levels of their anxiety and depression were assessed at baseline and after every 3 cycles of chemotherapy, by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and Hospital Anxiety and Depression Scale (HADS). Results: Between July 2001 and October 2003, 146 patients were entered onto the protocol. Ninety-eight patients completed the questionnaire and 46 patients withdrew from trial (27 for lost follow-up, 11 for withdrawal of consents, 5 for toxicity, 5 for progression). Their median age was 58 years old (range 28–78) and male to female ratio was 1.6. Chemotherapy was administered as the first, second, and third or more line in 107, 29, and 10 patients respectively (including 52 cases of gastric cancer, 39 of non-small cell lung cancer, 29 of colorectal cancer, 11 of breast cancer, and 15 of others). Compared with baseline, clinically meaningful relief (score decreased more than 10) of symptoms such as pain, dyspnea, and sleep disturbance was observed. There was significant improvement (score increased more than 10) of the functioning scales after the first cycle of chemotherapy, but these effects didn't persist through the whole course of therapy. The incidence of probable anxiety and depression disorder before the chemotherapy were 20% and 29% each. The anxiety scores decreased throughout the whole period of intervention (p<0.01). Pre-treatment anxiety and depression were negatively correlated with baseline QOL scores. Conclusions: The palliative chemotherapy in patients with solid cancer improved the cancer-related symptoms and lessened the anxiety. Also it did not disturb the function and overall quality of life. No significant financial relationships to disclose.

Does satisfaction reflect the technical quality of mental health care?

To analyze the relationship between satisfaction and technical quality of care for common mental disorders. A nationally representative telephone survey of 9,585 individuals conducted in 1997-1998. Using multinomial logistic regression techniques we investigated the association between a five-level measure of satisfaction with the mental health care available for personal or emotional problems and two quality indicators. The first measure, appropriate technical quality, was defined as use of either appropriate counseling or psychotropic medications during the prior year for a probable depressive or anxiety disorder. The second, active treatment, indicated whether the respondent had received treatment for a psychiatric disorder in the past year. Covariates included measures of physical and mental health and sociodemographic indicators. Appropriate technical quality of care was significantly associated with higher levels of satisfaction. The strength of the association was moderate. Satisfaction is associated with technical quality of care. However, profiling quality of care with satisfaction will likely require large samples and case-mix adjustment, which may be more difficult for plans or provider groups to implement than measuring technical indicators. More importantly, satisfaction is not the same as technical quality, and our results suggest that at this time they cannot be made to approach each other closely enough to eliminate either.

Depression Program Promising In Primary Care Settings

Depression Program Promising In Primary Care Settings

The Quality of Care for Depressive and Anxiety Disorders in the United States

Depressive and anxiety disorders are prevalent and cause substantial morbidity. While effective treatments exist, little is known about the quality of care for these disorders nationally. We estimated the rate of appropriate treatment among the US population with these disorders, and the effect of insurance, provider type, and individual characteristics on receipt of appropriate care. Data are from a cross-sectional telephone survey conducted during 1997 and 1998 with a national sample. Respondents consisted of 1636 adults with a probable 12-month depressive or anxiety disorder as determined by brief diagnostic interview. Appropriate treatment was defined as present if the respondent had used medication or counseling that was consistent with treatment guidelines. During a 1-year period, 83% of adults with a probable depressive or anxiety disorder saw a health care provider (95% confidence interval [CI], 81%-85%) and 30% received some appropriate treatment (95% CI, 28%-33%). Most visited primary care providers only. Appropriate care was received by 19% in this group (95% CI, 16%-23%) and by 90% of individuals visiting mental health specialists (95% CI, 85%-94%). Appropriate treatment was less likely for men and those who were black, less educated, or younger than 30 or older than 59 years (range, 19-97 years). Insurance and income had no effect on receipt of appropriate care. It is possible to evaluate mental health care quality on a national basis. Most adults with a probable depressive or anxiety disorder do not receive appropriate care for their disorder. While this holds across diverse groups, appropriate care is less common in certain demographic subgroups.

Points From Letters: Hospital Advisory Service

<h3>Summary</h3> <h3>Background</h3> The impact of COVID-19 on mental health is unclear. Evidence from longitudinal studies with pre pandemic data are needed to address (1) how mental health has changed from pre-pandemic levels to during the COVID-19 pandemic and (2), whether there are groups at greater risk of poorer mental health during the pandemic? <h3>Methods</h3> We used data from COVID-19 surveys (completed through April/May 2020), nested within two large longitudinal population cohorts with harmonised measures of mental health: two generations of the Avon Longitudinal Study of Parents and Children (ALPSAC): the index generation ALSPAC-G1 (n= 2850, mean age 28) and the parent’s generation ALSPAC-G0 (n= 3720, mean age = 59) and Generation Scotland: Scottish Family Health Study (GS, (n= 4233, mean age = 59), both with validated pre-pandemic measures of mental health and baseline factors. To answer question 1, we used ALSPAC-G1, which has identical mental health measures before and during the pandemic. Question 2 was addressed using both studies, using pre-pandemic and COVID-19 specific factors to explore associations with depression and anxiety in COVID-19. <h3>Findings</h3> In ALSPAC-G1 there was evidence that anxiety and lower wellbeing, but not depression, had increased in COVID-19 from pre-pandemic assessments. The percentage of individuals with probable anxiety disorder was almost double during COVID-19: 24% (95% CI 23%, 26%) compared to pre-pandemic levels (13%, 95% CI 12%, 14%), with clinically relevant effect sizes. In both ALSPAC and GS, depression and anxiety were greater in younger populations, women, those with pre-existing mental and physical health conditions, those living alone and in socio-economic adversity. We did not detect evidence for elevated risk in key workers or health care workers. <h3>Interpretation</h3> These results suggest increases in anxiety and lower wellbeing that may be related to the COVID-19 pandemic and/or its management, particularly in young people. This research highlights that specific groups may be disproportionally at risk of elevated levels of depression and anxiety during COVID-19 and supports recent calls for increasing funds for mental health services. <h3>Funding</h3> The UK Medical Research Council (MRC), the Wellcome Trust and University of Bristol.