Taiwanese Depression Questionnaire Research Articles

The effectiveness of nurse-led case management for patients with rheumatoid arthritis in Taiwan.

Case management is a patient-centred approach which has shown efficacy in managing patients with chronic and life-threatening disease. Presently, the effect of case management delivered by nurses for rheumatoid arthritis (RA) patients remains unclear, especially for those subjects who reside in Asia. This study aimed to examine the effectiveness of nurse-led case management (NLCM) among RA patients in Taiwan. A quasi-experimental research design was utilised to recruit RA patients from a hospital in Taiwan. All patients who were diagnosed as having RA from January 2017 to June 2018 were free to opt to participate in the intervention. The experiment group (n=50) received six sessions of NLCM over six months, while the control group (n=46) received only standard care during the same time period. Effectiveness data were collected through the review of medical records and a structured questionnaire that included the Taiwanese Depression Questionnaire (TDQ), the arthritis self-efficacy scale and a disease activity score by 28 joints (DAS28) at three time points (T1: before NLCM; T2: three days after NLCM completion; and T3: six months after NLCM completion). The effects of NLCM were determined using a generalised estimating equations model. After adjusting for several potential confounders, we found that the NLCM implementation decreased the levels of DAS28 (T1=-0.78; T2=-0.85; all at P=.01) and TDQ (T1=-3.86; T2=-10.57; all at P<.05) and enhanced ASES level for RA patients (T1=132.03; T2=484.69; all at P<.05). This study adopted a non-randomised, unblinded and uncontrolled intervention, and the findings supported the positive effects of NLCM following the use of a robust statistical method. The findings may serve as a reference for instituting more appropriate interventions for RA patients.

Similarities and differences between IBS-C and FC with regards to symptomatology, sleep quality and psychological attributes

Irritable bowel syndrome (IBS) and functional constipation (FC) are highly prevalent in the general population and have significant symptom overlap, while the clinical associations and psychological links between IBS and FC remains poorly understood. We aimed to compare the clinical, metabolic and psychological factors between patients with FC patients and constipation predominated IBS. We consecutively enrolled 360 patients from the outpatient clinics of Hualien Tzu Chi medical center. Constipation-predominant IBS (IBS-C) and FC were diagnosed based on Rome III criteria. All participants completed the Pittsburg Sleep Quality Index (PSQI) score, the State Trait Anxiety Inventory (STAI) score and the Taiwanese Depression Questionnaire (TDQ) score. Fifty-four patients had FC and twenty-three patients had IBS-C. Compared to asymptomatic controls, FC/IBS-C groups had female predominance (p<0.001), FC as well as more GI discomforts and inferior psychosocial characteristics (p<0.05). Compared to FC, IBS-C had higher severity scores of abdominal distention (4.52±1.90 vs. 3.07±1.88) and heartburn (2.17±1.50 vs. 1.46±1.14). However, FC was independently associated with poor sleep quality [adjusted OR: 1.19 (1.08-1.31), p<0.001] and IBS-C with depression [adjusted OR: 1.07 (1.02-1.12), p=0.005]. Patients with FC and IBS-C shared many similar GI complaints and psychosocial characteristics, however IBS-C had more severe bloating, heartburn and depression and FC had worse sleeping quality.

Subjective Cognitive Decline in the Community Is Affected at Multiple Aspects of Mental Health and Life Quality: A Cross-Sectional Study of the Community Medicine of Keelung Chang Gung Memorial Hospital

Background: Subjective cognitive decline (SCD) is one of the early warning signs of objective cognition impairment and dementia. Methods: This cross-sectional study screened SCD and studied multiple domains of mental health, lifestyle, and life quality of the community-dwelling people in the northern coastal region of Taiwan. Results: Among 426 valid AD8 questionnaires, a cutoff of score 2 divided subjects into 115 with SCD (SCD+) and 311 without SCD (SCD–). Analysis of age, sex, body compositions, and blood tests revealed an older age (60.7 ± 10.9 years) of the SCD+ group than the SCD– group (57.6 ± 12.0 years, p < 0.05). Further exclusion of subjects younger than 50 years eliminated age differences and left 100 with SCD (SCD+_50) and 229 without (SCD–_50). Multidomain comparisons of the SCD+_50 group over the SCD–_50 group were made: the Taiwanese Depression Questionnaire found a higher likelihood of depression; the Pittsburgh Sleep Quality Index revealed suboptimal sleep quality; the SF-36 showed inferior function of all 8 aspects of quality of life; the Health-Promoting Lifestyle Profile documented a less health-seeking lifestyle of nutrition, self-actualization, and stress management. Conclusions: Aging increased the SCD risk. People with SCD had suboptimal performance in mental health and life quality in addition to subjective cognition problems.

Differential effects of age on quality of sleep and depression in patients receiving maintenance haemodialysis

Poor quality of sleep and depression are common and highly associated with each other in patients on haemodialysis. We aimed to investigate whether they share common risk factors and how age may influence their development. Cross-sectional observation study on 120 haemodialysis patients with quality of sleep and depression assessed by Pittsburgh Sleep Quality Index (PSQI) and Taiwanese Depression Questionnaire (TDQ), respectively. The prevalence of poor quality of sleep and depression was 92.5% and 43.3%, respectively. PSQI scores were associated with age, gender, education and monthly income while TDQ scores were associated with low serum creatinine and albumin levels. Elderly patients at ages older than 65 had the highest average PSQI score (12.26 ± 4.35) than the young group at age 20-44 (8.25 ± 4.39) (P = 0.028) but the average TDQ scores were similar across three age groups. The proportion of those who had high PSQI scores was significantly higher in the elderly group (54.4%, P = 0.017) and the 44-65-years group (51.9%, P = 0.028) than the young group (16.7%). The proportion of those who reported normal quality of sleep was much lower in the elderly group (0.0%) than the other two groups (25.0%, P < 0.001 and 11.7%, P < 0.01). The proportions of those who had different ranges of TDQ scores did not show such a pattern of strong age dependence. Poor quality of sleep in haemodialysis patients is associated with socio-economic factors while depression is more related to biochemistry indicators. A majority of older patients suffer very poor quality of sleep while depression appears equally severe and common across different age groups.

Taiwanese depression questionnaire revisit: Factor structure and measurement invariance across genders

Taiwanese Depression Questionnaire (TDQ) was widely used in Taiwan to measure individuals' proneness to depression. In light of well-established gender differences in the manifestation of depression, TDQ's structure invariance and measurement invariance across genders were examined in this study. Data from 2604 adults was analyzed. Exploratory factor analysis was first performed to explore the factor structure. Possible factor structures and the original 2-factor structure were then compared by confirmatory factor analysis (CFA). The best fitting model was tested for measurement invariance across genders using multi-group CFA. EFA revealed 2 possible factor structures and suggested cross-loaded items deletion needed. This resulted in 4 models along with the original 2-factor structure to be tested in the follow-up CFA. Among the 5 models tested, the best-fitting model was the 3-factor solution with 3 cross-loaded items removed. The multi-group CFA performed on this 15-item TDQ revealed that the configural invariance, metrix invariance, and scalar invariance were all supported; partial strict invariance was supported when residual variances of items 1, 9, and 18 were set to vary. The 15-item TDQ with a 3-factor structure reflects the manifestations of depression of Taiwanese general population well. Although the results of measurement invariance suggest no gender difference in factor structure, the partial strict invariance suggests that there is gender difference in the amount of variance captured by TDQ. Hence, examining gender differences in the predictive value of different factors regarding health behaviors or medical conditions may bring fruitful results.

Impact of concomitant dyspepsia and irritable bowel syndrome on symptom burden in patients with gastroesophageal reflux disease

Patients with gastroesophageal reflux disease (GERD) frequently report symptoms like dyspepsia or/and irritable bowel syndrome (IBS). The aim of the study was to investigate the impact of symptom overlap on GERD symptom burden. We also investigate whether GERD overlapping dyspepsia or/and IBS would have different clinical and psychological features as compared with GERD alone. A total of 2752 subjects were screened from a health check-up population. We compared the clinical and psychological factors among subjects with GERD alone and with overlap of two or all three diseases. All participants underwent an evaluation with questionnaires including Reflux Disease Questionnaire score, Pittsburgh Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory before receiving endoscopic exam. Among the GERD population, we identified 26 with IBS (GERD-IBS), 60 with dyspepsia (GERD-D), and 25 subjects with overlap of all three conditions (GERD-D-IBS). GERD-D and GERD-D-IBS subjects had more severe GERD symptoms as compared subjects with GERD alone (p<0.001). Subjects with overlapping dyspepsia or/and IBS showed a significant increase in the severity of depression and poorer sleep quality than subjects with GERD alone. Notably, anxiety scores did not differ significantly between subjects with overlapping diseases and GERD alone. Our study demonstrates that disease overlap in GERD population is associated with greater symptom burden, higher depression and poorer sleep quality, but not with anxiety. This study highlights the importance of identifying overlapping conditions as a therapeutic strategy for better management of GERD.

Affective and cognitive rather than somatic symptoms of depression predict 3-year mortality in patients on chronic hemodialysis

Depression is more common in many medical conditions than among the general population and is associated with an increased risk of mortality. We aimed to determine whether somatic symptoms of depression were more predictive of mortality than affective and cognitive symptoms in hemodialysis patients. We conducted a prospective cohort study in which the survival outcomes of 151 subjects were followed for more than 3 years. Depression was assessed with the Taiwanese Depression Questionnaire (TDQ). Subjects with TDQ scores 19–54 (correlated with clinically significant depressive symptoms) and those with scores 15–18 had higher 3-year mortality rates than the two groups with lower scores (40.0%, 46.7%, 16.0% and 19.6%, p = 0.021, ANOVA). Affective and cognitive symptoms, including sadness, tenseness, indecisiveness and low self-confidence, and one somatic item (bodily discomfort) were associated with mortality. Affective and cognitive symptoms affected quality of life more than somatic symptoms. The somatic subscale was associated with female gender, low income and education, dialysis vintage, and low serum creatinine and albumin levels, whereas the affective and cognitive subscale was associated with less education and a low serum albumin level. In conclusion, affective and cognitive symptoms of depression may better predict long-term mortality in patients undergoing chronic hemodialysis than somatic symptoms.

Mental health of caregivers of individuals with disabilities: Relation to Suicidal Ideation

ObjectiveThe mental health of caregivers of individuals with disabilities is frequently neglected. This study investigated mental health status and Suicidal Ideation (SI) among caregivers and examined the predictive factors for SI. MethodCaregivers of individuals with physical or mental disabilities in a tertiary hospital in southern Taiwan were recruited through snowball sampling. They were assessed by self-report questionnaires, consisting of the Taiwanese Depression Questionnaire and a subset of the three-item Chinese Health Questionnaire, to assess probable depression and common mental disorders (CMDs), with cutoff points of 19 and 3, respectively. ResultsAmong 255 caregivers, 32.9% had probable depression, 37.6% had probable CMDs, and 18.8% experienced SI. The level of SI was correlated with primary caregivers (p=0.015), lack of support from co-caregivers (p=0.023), caring for younger patients (p=0.010), caring for patients with mental disability (p=0.019) or catastrophic diseases (p=0.005), and caregivers' probable depression (p<0.001) and CMDs (p<0.001). Regression analysis predicted the greatest SI among caregivers caring for younger patients (odds ratio [OR]=0.98, p=0.048) and for patients with catastrophic diseases (OR=3.15, p=0.008), as well as for caregivers with probable depression (OR=3.90, p=0.010) or CMDs (OR=9.40, p<0.001). ConclusionsWhen examining SI, clinicians should be aware of the mental health of caregivers who are responsible for people with disability. In particular, they should be vigilant regarding caregivers of individuals who are of younger age or have catastrophic diseases and regarding caregivers who exhibit probable depression and CMDs.

A single question regarding mobility in the World Health Organization quality of life questionnaire predicts 3-year mortality in patients receiving chronic hemodialysis

Low quality of life, depression and poor quality of sleep are associated with increased mortality in hemodialysis patients. It is not clear which factor has the highest predictive power and what the core element is to explain the predictability. We thus conducted a prospective cohort study that included 151 hemodialysis adults. Three traits of interest were assessed by World Health Organization Quality of Life questionnaire, an abbreviated version (WHOQOL-BREF), Taiwanese Depression Questionnaire, and Athens Insomnia Scale, respectively. They were followed for more than 3 years and the all-cause mortality was 30.5%. The prevalence of quality of life at the lowest tertile, depression and poor quality of sleep was 19.9%, 43.0% and 74.2%, respectively. Discriminant analysis showed the standardized coefficient of each factor as 0.813, −0.289 and 0.066, indicating the highest discriminating power by quality of life to predict mortality. Question 15 “how well are you able to get around?” in the physical health domain of WHOQOL-BREF independently associated a hazard ratio of mortality 0.623 (95% confidence interval 0.423-0.918). Subjective perception of overall quality of life was more related to psycho-social-environmental factors. In conclusion, mobility is an independent and powerful predictor to long term mortality in patients on chronic hemodialysis.

Psychosocial Evaluation for First Hand Allotransplantation in Taiwan.

Hand transplantation has raised ethical and psychological concerns. Few studies have focused on reasons for not selecting candidates on waiting lists. To describe the psychosocial evaluation of referred prospective hand transplant candidates, we investigated candidate suitability by using 22-month follow-up data regarding the first hand transplant recipient in Taiwan. Pretransplant psychosocial assessments comprised an interview with 2 psychiatrists, a social worker, and a psychologist, followed by intelligence quotient scoring with the Wechsler Adult Intelligence Scale and Taiwanese Depression Questionnaire. After team member consensus, of the 20 patients referred to our team to confirm their hand transplantation suitability during April 26, 2013, to March 19, 2015, 7 potential recipients were placed on the waiting list after completing all prehand transplant evaluations. On September 3, 2014, the left distal forearm and hand of a brain-dead man was transplanted to a 45-year-old man who had undergone traumatic amputation of the distal third of his right forearm 30 years previously. During a 22-month follow-up, he complied with scheduled visits, including routine posttransplant laboratory tests, skin biopsies, and intensive physical therapy. Moreover, he overcame repeated graft rejections, bacterial and viral infections, immunosuppressant side effects, considerable economic stress, and the difficulties associated with the adhesion of hand tendons. Finally, he regained some satisfactory function of the transplanted hand. Considering posttransplantation difficulties, suitable candidates for hand transplantation should have persistent motivation, appropriate expectations, patience, immediate availability, fair intelligence, fair social functioning, and adequate economic and familial support.

Factors associated with sexual dysfunction in Taiwanese females with rheumatoid arthritis

BackgroundPatients with rheumatoid arthritis (RA) may experience sexual dysfunction because of symptoms or adverse effects from treatments. Data on female sexual dysfunction (FSD) in Asian females with RA issue are limited. This study investigated the prevalence and factors associated with FSD in Taiwanese patients with RA.MethodsThis cross-sectional study used a purposive sampling method to recruit 195 females with RA from a single hospital in southern Taiwan. Demographic and clinical characteristics were obtained by review of medical records and a structured questionnaire. The Chinese version of the Female Sexual Function Index and the Taiwanese Depression Questionnaire were also administered. Multiple logistic regression analysis was used to identify factors associated with FSD.ResultsThe crude and age-standardized prevalence of FSD were 66.8% and 48.2%, respectively. Patients who were older, with a comorbid condition, with more depressive symptoms, and with greater disease activity had a significantly higher risk of FSD.ConclusionOur findings indicate that FSD is more common in Taiwanese individuals with RA who have certain specific demographic and clinical characteristics. These findings may help to identify and facilitate the provision of appropriate interventions to ensure better sexual health in female patients with RA.

Overlap of Dyspepsia in Patients with Gastroesophageal Reflux Disease: Impact of Clinical, Metabolic, and Psychosocial Characteristics

Gastroesophageal reflux disease (GERD) and dyspepsia are highly prevalent in the general population with significant symptom overlap, while the interaction between both remains poorly understood. To examine whether GERD overlapping dyspepsia would have an impact on clinical and psychological features as compared with GERD alone. We performed a cross-sectional study in a GERD cohort (n=868) that was previously recruited from a population-based GERD survey (n=2752). We compared the clinical and psychological factors between patients with and without dyspeptic symptoms "epigastric pain or burning." All participants were evaluated with Reflux Disease Questionnaire score, Pittsburgh Sleep Quality Index score, Taiwanese Depression Questionnaire score, and State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification. Among the GERD population, 107 subjects had overlapping "epigastric pain or burning" (GERD-D), and 761 did not have these symptoms (GERD alone). GERD-D subjects had more severe GERD symptoms and were more often associated with irritable bowel syndrome (IBS) (OR 3.54, 95% CI 1.92-6.52) as compared subjects with GERD alone. In addition, GERD-D subjects had lower quality of sleep (OR 1.11, 95% CI 1.01-1.21), higher depression (OR 1.06, 95% CI 1.02-1.10), lower blood pressure (OR 0.45, 95% CI 0.22-0.95), and higher serum total cholesterol levels (OR 2.78, 95% CI 1.36-5.67) than GERD alone. GERD-D subjects are characterized with worsening clinical symptoms as well as higher psychosocial, IBS, and metabolic comorbidities, but less erosive esophagitis. Our results indicate that clinical awareness of such overlapping condition would help optimize the management of GERD in clinical practice.

Using the Affiliate Stigma Scale with caregivers of people with dementia: psychometric evaluation.

BackgroundIn this study, we examined the psychometric properties of the Affiliate Stigma Scale to measure affiliate stigma for caregivers of family members with dementia, a topic scantily covered in the literature.MethodsTwo hundred seventy-one caregivers were recruited. Each completed the Affiliate Stigma Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, Beck Anxiety Inventory, and 28-item World Health Organization Quality of Life questionnaire. The data were evaluated for internal consistency and concurrent validity, and they were analyzed using Rasch statistics and confirmatory factor analysis (CFA).ResultsCFA and Rasch analysis suggested that the Affiliate Stigma Scale contains three underlying unidimensional concepts (cognition, affect, and behavior). The three concepts had satisfactory internal consistency (α = 0.822–0.855) and concurrent validity (r = 0.290–0.628 with caregiver burden, 0.391–0.612 with depression, 0.367–0.467 with anxiety, and −0.590 to −0.365 with quality of life).ConclusionsThe Affiliate Stigma Scale is a promising instrument with sound psychometric properties for measuring affiliate stigma. Healthcare providers might want to use it to understand the caregivers’ perspectives and to design appropriate interventions to decrease their affiliate stigma.

Use of the Hospital Anxiety and Depression Scale and the Taiwanese Depression Questionnaire for screening depression in head and neck cancer patients in Taiwan.

ObjectiveThe purposes of this study are 1) to estimate the prevalence of common mental disorders including depressive disorder in patients with head and neck cancer (HNC) at baseline and at the 6-month follow-up and 2) to test the validity of two self-reported questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Taiwanese Depression Questionnaire (TDQ), for screening depression in patients with HNC.MethodsParticipants were recruited from the outpatient collaborative care clinic for HNC of a tertiary hospital in Taiwan between January 2010 and January 2011. Ninety-three patients with HNC were enrolled and assessed using the HADS, TDQ, and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Patient edition, at baseline and at the 6-month follow-up. Conventional validity indices of the HADS and TDQ were examined.ResultsOur results showed that the validity of the TDQ was satisfactory and comparable to that of both the HADS depression subscale and the HADS total scale. The cutoff scores of the HADS and TDQ for screening possible depressive disorders were 8 and 15, respectively. The areas under the receiver operating characteristic curve of the HADS and TDQ were mean 0.975±0.015 and 0.966±0.019, respectively. Thirteen participants (14%) were diagnosed with depressive disorders at the 6-month follow-up, compared with 8.5% at baseline.ConclusionOur results indicate that both the HADS and TDQ are valid instruments for screening depression in patients with HNC.

Predictors of Hyperglycemic Women's Perinatal Health Status.

Hyperglycemic women face dramatic physiological and psychosocial changes during the perinatal period; however, studies examining hyperglycemic women's health are few, and limited to cross-sectional designs. This study aimed to examine changes in hyperglycemic women's stress, social support, depression, and health status from pregnancy to 1 year postpartum, and to identify factors predicting hyperglycemic women's perinatal health. Ninety-nine participants with positive results in a 50-g glucose challenge test were recruited in a medical center in southern Taiwan. A repeated measures study was conducted; measurements were made at 28 weeks of pregnancy, and 1 week, 6 weeks, 6 months, and 1 year after childbirth. The Social Support Scale, the Perceived Stress Scale, the Taiwanese Depression Questionnaire, and the Chinese Health Questionnaire were used. Compared with hyperglycemic women's depression at 28 weeks of pregnancy, significant decreases in mean depression scores were found at 1 week and 1 year postpartum. Hyperglycemic women's health status improved at 6 months and 1 year postpartum. Depression significantly predicted hyperglycemic women's perinatal health status. Stress and depression are associated with perinatal health status in hyperglycemic women. Healthcare providers should more closely assess stress and depression levels in hyperglycemic women from pregnancy to 1 year postpartum. Interventions promoting the psychological well-being of hyperglycemic women are required.

Clinical characteristics and psychosocial impact of different reflux time in gastroesophageal reflux disease patients.

Gastroesophageal reflux disease (GERD) is an emerging disease, and can impair quality of life and sleep. This study aimed to investigate whether GERD patients with different timings of reflux symptoms have different clinical characteristics. This study prospectively enrolled individuals who underwent upper gastrointestinal endoscopy during a health checkup. Each participant completed all questionnaires including Reflux Disease Questionnaire, Nighttime GERD questionnaire, Pittsburg Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory. Combined reflux was defined as the timing of reflux symptoms occurring at both daytime and nighttime. A total of 2604 participants were enrolled. Of them, 651 symptomatic GERD patients, according to the Reflux Disease Questionnaire score, were recruited for final analysis. Of them, 224 (34.4%) had erosive esophagitis on endoscopy. According to the timing of reflux symptoms, 184 (28.3%) were assigned to the daytime reflux group, 71 (10.9%) to the nighttime reflux group, and 396 (60.8%) to the combined reflux group. In post hoc analysis, the combined reflux group had a significantly higher Reflux Disease Questionnaire score than the daytime reflux group (p<0.0001). Combined and nighttime reflux groups had higher body mass index and longer duration (> 12years) of education than the daytime reflux group (p<0.05). There was no difference in Pittsburg Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory scores among three groups. GERD patients with combined daytime and nighttime reflux of have more troublesome symptoms than those with daytime reflux. GERD patients with different timings of reflux symptoms have different clinical characteristics in terms of body mass index and duration of education, but not in terms of esophageal inflammation, quality of sleep, and psychosocial status.

Effects of a strengths-based perspective support group among Taiwanese women who left a violent intimate partner relationship.

To examine the effects of an 8-week strengths-based perspective group intervention on hope, resilience and depression in Taiwanese women who lefta violent intimate partner relationship. Studies on interventions for abused women have primarily focused on psychological problems. However, the effect of group intervention on the psychological strengths of abused women is still unknown. A two-group, quasi-experimental design using repeated measures was used in this study. Twenty-nine Taiwanese women who leftviolent intimate partner relationships were assigned to two groups and five participants did not complete the study. The experimental group (n=8) underwent an 8-week strengths-based perspective group intervention developed by the investigators; the control group (n=16) received no intervention. The effects of the intervention on the participants' hope, resilience and depression levels were evaluated as a pretest, post-test 1 (8th week) and post-test 2 (12th week) and were compared. The Chinese version of the State Hope Scale, the 25-item Resilience Scale, and the Taiwanese Depression Questionnaire were used in this study. On the eighth and twelfth weeks after the strengths-based perspective group intervention, we found significantly lower scores on the depression scale in the experimental group. In the eighth week, participants in the experimental group had significantly lower scores on the pathway of hope subscales than those in the control group. A strengths-based perspective support group intervention designed specifically for women who lefta violent intimate partner relationship significantly reduced the participants' level of depressive symptoms and improved the pathway component of hope. This research highlights the importance of nurses not only focused on problems but also on the psychological strengths in practice of abused women survivors.

Altered anorectal function in rotating shift workers: Association with autonomic dysfunction and sleep disturbance

Summary Background We aimed to investigate whether disruption of the circadian rhythm in rotating shift work (RSW) workers would change anorectal motility and cardiac autonomic function. We also determined whether sleep and psychological status (e.g., anxiety and depression) would affect anorectal motility in RSW workers. Methods Sixteen RSW workers and 11 control individuals were involved in the study. All study participants underwent anorectal manometry and spectral analysis of heart rate variability. All participants completed three questionnaires: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) questionnaire, and the Taiwanese Depression Questionnaire (TDQ). Results The RSW workers had a lower threshold volume for maximal urge ( p = 0.006) and greater rectal compliance ( p = 0.02), compared to the controls. The RSW workers had a greater PSQI score ( p = 0.002) and TDQ score ( p = 0.003), compared to the controls. The RSW workers had a significantly increased low-frequency power percentage (LF%), compared to the controls ( p = 0.03). The RSW workers had a significant correlation between the resting anal sphincter pressure and high-frequency power percentage (HF%; r = –0.62, p = 0.01), and between the R-R interval and the threshold for maximal urge ( r = 0.51, p = 0.04). The PSQI score was significantly correlated with the threshold volume for urge ( r = 0.55, p = 0.03) and for compliance ( r = 0.51, p = 0.04) in the RSW workers. Conclusion Rotating shift workers have anorectal dysmotility and cardiac sympathetic hyperactivity. Anorectal dysmotility in RSW workers has a close relationship with cardiac autonomic dysfunction, sleep disturbance, and depression, but not with anxiety.

Psychiatric symptoms and leptin in obese patients who were bariatric surgery candidates.

ObjectiveThere is a significant relationship between obesity and common mental symptoms (depression and anxiety symptoms). But the association between depression (or anxiety symptoms) and serum leptin is still unclear and controversial, despite the growing body of evidence supporting the existence of “leptin resistance” in obese persons. So we investigated whether common mental symptoms, obesity, and the interactive effect of these two factors have a relationship with leptin in obese patients who were candidates for bariatric surgery.MethodsIn all, 139 participants (mean age: 31.4 years, standard deviation: 9.3 years, 73.4% female) were enrolled at an obesity treatment center in southern Taiwan. Serum leptin levels and body mass index (BMI) were measured. The Chinese Health Questionnaire and Taiwanese Depression Questionnaire were administered.ResultsThe mean BMI of our participants was 39.4 kg/m2 (±6.8), and the mean leptin level was 24.5 ng/mL (±9.4). In the multivariate regression models, Chinese Health Questionnaire-by-BMI and Taiwanese Depression Questionnaire-by-BMI interaction terms remained significant predictors of leptin level (β=0.16, P<0.0001; β=0.04, P<0.0001, respectively), after adjustment for age, sex, and history of hypertension, diabetes, and hyperlipidemia, despite the inverse correlation between Chinese Health Questionnaire (or Taiwanese Depression Questionnaire) and leptin. In addition, female patients had significantly higher leptin levels than male patients.ConclusionThe present findings confirmed that the relationship between common mental symptoms and leptin is modulated by obesity in severely obese patients. Future studies should focus on further measures of leptin receptors or signaling on the basis of these interactive effects in psychiatry.

Clinical, metabolic, and psychological characteristics in patients with gastroesophageal reflux disease overlap with irritable bowel syndrome.

Gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are highly prevalent in the general population, with significant symptom overlap, whereas the interaction between both remains poorly understood. We aim to identify the clinical and psychological factors that contribute toward the overlap of GERD and IBS. We carried out a case-control study among 806 GERD and 176 IBS patients from a health check-up cohort (n=2604). All participants were evaluated using the Reflux Disease Questionnaire score, the Pittsburgh Sleep Quality Index score, the Taiwanese Depression Questionnaire score, and the State-Trait Anxiety Inventory score. Endoscopic findings were classified according to the Los Angeles classification. IBS was diagnosed on the basis of Rome III criteria, and metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III definition. Among the study population, 727 individuals had GERD, 97 individuals had IBS, and 79 individuals had a diagnosis of both GERD and IBS (GERD-I). GERD-I patients had more severe GERD symptoms compared with patients with GERD or IBS alone (P<0.0001). Moreover, GERD-I patients had more frequent healthcare-seeking behavior, decreased quality of sleep, and higher depression scores than patients with GERD (P<0.0001) or IBS alone (P<0.05). In addition, GERD-I patients had lower blood pressure, waist-to-hip ratio, and higher serum high-density lipoprotein levels than those with GERD alone (P<0.05). GERD patients overlapping with IBS have different clinical and psychological profiles than those with GERD or IBS alone. Our study suggests that awareness of these symptom presentations will help optimize the treatment of these conditions.