综合医院住院患者焦虑与抑郁症状调查

目的：调查综合医院中住院患者焦虑抑郁症状的时点发生比率及在不同科室病种的分布情况。方法：采用综合医院焦虑抑郁量表(HADS)，在2003年4月的同一天对综合医院的14个科室中的320例住院患者进行调查。结果：近1／3的患者出现焦虑或抑郁负性情绪；出现焦虑症状阳性者占被调查群体的35．0％，出现抑郁症状阳性者占32．2％，内科患者无论是焦虑和抑郁分，还是出现的焦虑症状和抑郁症状，均显著高于外科患者。焦虑和抑郁症状的发生与患者的年龄密切相关，即随着年龄的增大，其发生率呈增加趋势。结论：综合医院中住院患者的焦虑、抑郁反应是值得重视的现象，应处理这些负性情绪。     

急诊科住院患者抑郁、焦虑症状与生命质量的评估

目的：了解综合医院急诊科住院的躯体疾病患者抑郁、焦虑症状的检出率以及生命质量。方法：总共评估某综合医院急诊科住院的躯体疾病患者278例,意识清楚,自愿合作并完成调查,采用的调查工具包括综合医院焦虑抑郁量表（HADs）、总体健康自评问卷（GHQ-12）、健康状况调查问卷（SF-36）。结果：以HADs评分≥8分者为阳性,抑郁症状阳性者比例为29.9%（n=83）,焦虑症状阳性者比例为25.5%（n=71）;以≥11分为肯定者,肯定有抑郁症状群为12.6%（n=35）,肯定有焦虑症状群7.6%（n=21）。以GHQ-12≥4分者为划界分,可能存在心理障碍者比例为36.3%。SF-36的多个维度分值明显低于正常人群常模。多元线性回归分析显示,年龄、性别、合并有抑郁、焦虑症状、就诊次数与SF-36分值显著相关,提示抑郁焦虑症状越严重,生命质量越低。结论：综合医院的急诊科躯体疾病住院患者频繁罹患抑郁、焦虑症状,抑郁焦虑症状群影响患者生命质量。     

综合医院神经内科门诊患者抑郁症状群及生活质量调查

目的 运用抑郁症状群筛选工具,调查综合医院神经内科门诊患者抑郁症状群的检出率;探讨神经内科门诊伴有抑郁症状群患者的生活质量.方法 使用中文版患者健康问卷(patient health questionnaire,PHQ)的抑郁症状群分量表(PHQ-9)及健康状况调查问卷(the short form-36 health survey,SF-36)对综合医院神经内科门诊患者进行调查.共收集有效问卷306 份.分析了患者抑郁症状群与生活质量的相关性. 结果存在抑郁症状群患者有149 例(占受调查人群的48.7%). 具有抑郁症状群的神经内科门诊患者SF-36 各维度评分低于不伴有抑郁症状群患者.SF-36 各维度评分与PHQ-9 评分呈负相关,具有统计学意义(r值:-0.182～-0.839,P≤0.001).结论 在综合医院神经内科门诊就诊者中,抑郁症状群检出率较高,这类患者生活质量较差.     

上海某综合性医院内科门诊患者焦虑与抑郁症状调查

目的调查综合性医院内科门诊患者的焦虑和抑郁症状的发生率及不同性别、年龄、文化程度和职业间的差异。方法采用综合性医院焦虑抑郁量表（HADS）在上海某三级综合性医院4个普通内科门诊按10∶1随机调查6117例患者,有效回收完整量表6104例。HADS每个亚量表评分大于等于8分即表示存在焦虑或抑郁症状。结果调查对象中焦虑和抑郁的检出率分别为9.5%（95%CI=8.8%～10.2%）和23.0%（21.9%～24.1%）。其中30岁以下、文化程度高、职业为学生或无业者的人群,焦虑检出率较高;男性、60岁及以上、文化程度低、职业为农民或学生的人群抑郁检出率较高。结论上海三级综合性医院内科门诊患者焦虑和抑郁的发生率较高,应提高识别率,给予有效的预防和干预。     

综合医院门诊患者焦虑、抑郁症状调查

目的：分析综合医院门诊患者中,焦虑、抑郁症状的发生率及其可能的影响因素。方法：选取4所综合医院2485例门诊患者,采用自编一般情况调查表及综合医院焦虑抑郁量表进行调查。结果：门诊患者中焦虑、抑郁发生率分别达到26.0%、26.6%,焦虑抑郁共发率达12.7%,明显高于普通人群。不同级别医院、科室、男女之间焦虑、抑郁评分有显著差异。结论：综合医院门诊患者中焦虑抑郁有较高的患病率,值得引起关注。     

伴与不伴焦虑症状的难治性抑郁症临床特征的比较

目的 探讨伴焦虑症状的难治性抑郁症的临床特征.方法 将327例难治性抑郁症患者,按照17项汉密尔顿抑郁量表(HAMD17)焦虑/躯体化因子≥7分,分为焦虑组(229例)和无焦虑组(98例),比较2组患者的人口学特征和临床特征;对伴焦虑症状的危险因素进行Logistic回归分析.结果 焦虑组平均年龄、首发年龄、HAMD17总分、汉密尔顿焦虑量表(HAMA)总分高于无焦虑组[(42.58±11.77)岁vs(36.78±11.84)岁,(34.60±11.66)岁vs(30.04±12.60)岁,(27.83±6.93)分vs(23.39±5.59)分,(21.11±6.61)分vs(13.88±4.68)分],差异有统计学意义(P＜0.01).焦虑组和无焦虑组性别(男:女,OR=0.51)、有无强迫症状(OR=3.67)、未成年和成年发病的构成比(OR=0.36)的差异有统计学意义(P＜0.01).年龄(OR=1.05)、HAMD17总分(OR=1.17)、有自杀观念(OR=2.70)和强迫症状(OR=4.59)与难治性抑郁症伴焦虑症状相关(P＜0.05).结论 伴焦虑症状的难治性抑郁症患者具有年龄较大、女性倾向较高、首发年龄较晚、成年发病的倾向较高、抑郁程度更严重、更可能伴强迫症状等特点;年龄、抑郁严重程度、自杀观念和强迫症状可能是难治性抑郁症伴焦虑症状的危险因素.     

对综合医院神经内科门诊患者焦虑症状群及生活质量的调查

目的调查综合医院神经内科门诊患者焦虑症状群的检出率;探讨神经内科门诊伴有焦虑症状群患者的生活质量。方法使用中文版患者健康问卷(patient health questionnaire,PHQ)、焦虑症状群分量表(GAD-7)及健康状况调查问卷(the short form-36health survey,SF-36)对综合医院神经内科门诊患者进行问卷调查。对受调查患者同时进行生活质量评估,采用Pearson简单相关法对资料进行相关性分析,分析焦虑症状群与生活质量之间的相关性。结果具有焦虑症状群患者97例/306例[31.7%(95%CI:26.5%~36.9%)];具有焦虑症状群的神经内科门诊患者的SF-36各维度评分低于不伴有焦虑症状群患者;SF-36各维度评分与GAD-7评分呈负相关,具有统计学意义。结论在综合医院神经内科门诊就诊者中,焦虑症状群检出率较高;具有焦虑症状群的神经内科患者生活质量较差,尤其以精神健康状况差为显著。     

抑郁症患者首次门诊误诊分析

目的:探讨影响抑郁症首次门诊诊断的相关因素.方法:调查111例经抑郁专科门诊确诊的抑郁症患者按首次诊断分误诊组与确诊组,比较两组的一般资料、临床症状、伴随躯体疾病及诊治医师情况,分析影响诊断的主要因素.结果:111例患者中首次误诊者60例,占54.1%;精神病性症状,焦虑,强迫,伴随躯体疾病及与诊治医师年资在误诊组与确诊组组间差异存在显著性(P＜0.05).结论:精神症状、伴随躯体疾病与医师经验是抑郁症患者首次门诊确诊的主要影响因素.     

内科住院患者抑郁障碍现状及相关因素的横断面研究

目的探讨内科住院患者抑郁障碍的发生率、内科医师的识别率及其可能的影响因素。方法采用横断面的研究方法，首先应用ZUNG氏抑郁自评量表（SDS）对符合入组条件的371例内科住院患者进行筛查，对筛查阳性者（SDS粗分≥40分）和209／6的筛查阴性者（SDS粗分〈40分），再以美国《精神障碍诊断与统计手册第四版》DSM-Ⅳ作为金标准进行抑郁症的诊断，估算抑郁障碍的发生率及内科医师的识别率，并对相关的因素进行分析。结果内科患者抑郁检出率为占37．34％；SDS筛选阳性者118人和随机抽查20％的SDS筛选阴性者40人中经SCID诊断，现患抑郁障碍者共120人。内科医师识别率仅为3．33％。单因素分析发现：性别、年龄、文化程度、经济状况、躯体疾病既往史、住院时间、病程与抑郁的发生有关。多因素Logistic回归分析显示：性别、年龄、经济状况、疾病复发情况及住院时间是影响抑郁发生的主要因素。结论内科住院患者抑郁发生率高。性别、年龄、经济状况、疾病复发情况及住院时间是主要的影响因素。内科医师识别率低，提高内科医师对抑郁症的识别率和治疗率是当务之急。     

神经科门诊抑郁症伴躯体症状分析

目的探讨综合医院神经科门诊抑郁症伴躯体症状的特点.方法对符合CCMD-2-R抑郁症诊断标准,抑郁自评量表(SDS)评分≥40分,汉密顿抑郁量表(HAMD)评分≥17分的73例神经科门诊患者进行临床及量表分析.结果头痛头晕为本组突出的躯体症状,成为第一主诉者占43.8%.患者均肯定有抑郁表现,各种抑郁症状出现率为67.1%～97.3%,且以兴趣减退者居多.SDS平均总粗分为(5038±8.50)分,HAMD平均(19.50±7.43)分.医院焦虑情绪自评量表(HAD-A)≥9分者明显多于<9分者,前者的SDS评分明显高于后者.结论神经科门诊抑郁症伴躯体症状患者以头痛头晕为第一主诉最多.抑郁常见症状以兴趣减退为常见.多为轻度抑郁,常伴焦虑,伴焦虑者的抑郁程度较重.     

Validation of the Hospital Anxiety and Depression Scale in Arab patients.

The Hospital Anxiety and Depression Scale (HADS) was administered to psychiatric outpatients with various diagnoses to assess its validity. The study was also designed to find out whether HADS can differentiate between diagnostic groups based on depression and anxiety symptoms. HADS was able to discriminate patients from controls at a sensitivity of 79% and specificity of 87%. HADS was much less sensitive, specific and diagnostically accurate in identifying anxiety and depressive disorders in the experimental group at a cut-off point of 13 and 10 respectively for both conditions. Possible psychological, social and psychiatric reasons for the results are discussed.     

Reliability and validity of a Chinese version of the HADS for screening depression and anxiety in psycho-cardiological outpatients

Aim

The Hospital Anxiety and Depression Scale (HADS) has been used widely with cardiovascular patients. This study aims to examine the reliability and validity of a Chinese version of HADS among psycho-cardiological outpatients.

Methods

One hundred psycho-cardiological outpatients were asked to complete the Chinese version of HADS and were then interviewed according to the Mini International Neuropsychiatric Interview, Version 5 (MINI).

Results

According to the MINI, 38 outpatients were diagnosed with major depression and 15 outpatients were diagnosed with an anxiety disorder. Compared with the MINI diagnoses, the optimum cutoff value of the anxiety subscale (HADS-A) was six (6) with a sensitivity of 81.6%, specificity of 75.8%, positive predictive value (PPV) of 54.0% and negative predictive value (NPV) of 91.9%; at the optimum cutoff value of nine (9), the depression subscale (HADS-D) had a sensitivity of 80.0%, specificity of 92.9%, PPV of 52.2% and NPV of 96.1%. The Cronbach's alpha coefficients of the HADS-A and HADS-D subscales were 0.753 and 0.764, respectively. The areas under the ROC curves of the HADS-A and the HADS-D subscales, as compared to MINI diagnoses of anxiety and depression, were 0.81 (SE = 0.05, 95%CI: [0.73, 0.90]) and 0.86 (SE = 0.05, 95%CI: [0.77, 0.94]), respectively.

Conclusions

The HADS was found to be a reliable measurement tool for excluding depression and anxiety in psycho-cardiological outpatients.     

Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression.

Few studies have been specifically carried out to characterize the dimensional structure of the Hospital Anxiety and Depression Scale (HADS) and those that have, have yielded contradictory results. We have examined the factor structure and sensitivity to change of the HADS in a large French outpatient primary care population treated with sertraline for major depression (DSM-IV criteria). Factor analysis of the HADS was performed in 2669 outpatients and in subsamples using a principal component procedure with Varimax rotation. Concurrent change sensitivity of the HADS was compared with that for the Hamilton Depression Rating Scale (HDRS) after at least 45 days of sertraline treatment. Three distinct factors emerged from the HADS factor analysis: a "depression" factor and two separate anxiety subscales: "psychic anxiety" and "psychomotor agitation" whose mean reductions in scores from baseline were significantly correlated (0.36-0.45) with the reduction of the HDRS baseline score. These new data provide support for the use of the HADS's three-dimensional structure to measure improvement of selected symptoms of anxiety during antidepressant therapy.     

Positive correlation between anxiety severity and plasma levels of dehydroepiandrosterone sulfate in medication-free patients experiencing a major episode of depression

Although numerous studies have identified a correlation between dehydroepiandrosterone sulfate (DHEAS) levels and anxiety or depression, those findings remain controversial. The purpose of the present study was to determine whether a correlation exists between depression severity and anxiety severity and serum DHEAS concentrations in medication-free patients experiencing a major depressive episode. Twenty-eight medication-free major depressive outpatients (Hamilton Rating Scale for Depression 17 [HAM-D 17] score >or=17) were enrolled consecutively. Plasma DHEAS levels of all subjects were measured. Blood from subjects was drawn at 0900-1100 h Depression severity was assessed with the HAM-D 17 and the Hospital Anxiety and Depression Scale (HADS) depression subscale. Anxiety was assessed using the HADS anxiety subscale. Serum concentrations of DHEAS were measured immediately following the HAM-D 17 and HADS assessments. A significant, positive correlation was identified between HADS anxiety subscale total score and morning serum DHEAS concentration (P = 0.013) after controlling for age, gender and body mass index (BMI). No statistically significant correlations were found between depression ratings and morning serum DHEAS concentrations. This preliminary study provides pilot data indicating that morning serum DHEAS concentrations were positively correlated with HADS anxiety subscale score (anxiety severity) after controlling for age, gender and BMI in medication-free outpatients experiencing a major depressive episode. It is not known if morning serum DHEAS levels would show similar or dissimilar changes in non-depressed subjects. The present result needs subsequent replication.     

Dimensionality of the Chinese hospital anxiety depression scale in psychiatric outpatients: Mokken scale and factor analyses

Objective: The hospital anxiety and depression scale (HADS) is a widely used scale of anxiety and depression. However, recent studies have challenged the bi-dimensional scoring of the HADS. The present study was to examine the dimensionality of the Chinese HADS.

Methods: We recruited a convenience sample of 214 adult psychiatric outpatients at a medical centre in Taiwan, and they completed the Chinese HADS. We used Mokken scale analysis (MSA), exploratory factor analysis (EFA), exploratory bifactor analysis (EBA) and confirmatory factor analysis (CFA) to examine the dimensionality of the Chinese HADS.

Results: The Chinese HADS was a moderate Mokken scale (H_s?=?0.44), and had a two-factor structure. EBA showed that one general factor, emotional distress, explained 68% of the common variance of the Chinese HADS. CFA confirmed that the bifactor model had the best fit statistics. The items 5 and 7 of the Chinese HADS contributed to structural ambiguity in the Chinese HADS subscales.

Conclusions: The sum scores of the Chinese HADS were a reliable and valid unidimensional measure of emotional distress. The Chinese HADS subscales were incapable of differentiating between anxiety and depression. Clinicians and researchers should choose other scales that are specifically designed for measuring anxiety and depression.     

Factor structure of the hospital anxiety and depression scale in older patients with major depression

OBJECTIVE: Symptomatic anxiety has prognostic significance in major depression. In theory, the Hospital Anxiety and Depression Scale (HADS) should be a useful instrument for measuring the severity of symptomatic anxiety in late-life depression. However, the dimensional structure of the HADS has not been evaluated in elderly depressed patients; it is not known whether the scale actually functions as a bidimensional measure of anxiety and depression in this population. The purpose of this exploratory study, therefore, was to examine the factor structure of the HADS in older patients with major depression. METHOD: The HADS was completed by 213 patients, aged 60 years or older, with DSM-III-R unipolar major depression. Principal components analysis was performed on the full 14-item HADS and on each of its subscales. RESULTS: Two distinct factors, which corresponded to the instrument's depression and anxiety subscales, emerged. The two-factor structure proved reasonably stable when the study group was randomly divided into two halves. Analysis of the subscales resulted in a single factor for each. The subscales had high internal reliability. CONCLUSIONS: These findings confirm that the HADS functions as a bidimensional measure of depression and anxiety in older patients with major depression. The results suggest that the HADS is a valid instrument for measuring severity of anxiety, independent of other depressive symptoms, in this population.     

Evaluation of the hospital anxiety and depression scale in patients with Parkinson's disease

The purpose of this study was to evaluate the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in patients with Parkinson's disease (PD) and to assess the prevalence of symptoms of anxiety and depression in this population. The HADS was sent to 205 patients with PD, together with three quality-of-life (QoL) instruments, i.e. the Parkinson's Disease Questionnaire (PDQ-39), the EQ-5D, and a visual analogue scale (VAS). Hospital Anxiety and Depression Scale scores were also compared with Hoehn-Yahr (H&Y) scores. Eighty-six percent of the patients returned the questionnaires. The quality of the data was good. Cronbach alpha for the HADS was 0.88. Test-retest reliability over 2 weeks was 0.84 for the sum score of the HADS (intraclass correlation coefficient) and ranged from 0.42-0.76 for individual items (weighted kappa). Factor analysis revealed two factors, accounting for 51.9% of the variance. One factor represented anxiety, the other depression. Correlations with PDQ-39, EQ-5D, VAS, and H&Y were 0.72, -0.59, -0.59, and 0.32, respectively (p values < 0.001). Depression scores accounted for 52% of the variance in QoL, whereas disease severity explained 24%. Using the cut-off values proposed by the developers indicated that possible and probable anxiety were present in 29.4% and 19.8% of the patients, respectively. Percentages for possible and probable depression were 21.5 and 16.9. The psychometric performance of the HADS in patients with PD is satisfactory. In addition, almost 50% of the patients displayed symptoms of anxiety, whereas nearly 40% showed signs of depression.     

Prevalence and effects of depressive and anxiety symptoms in internal medicine inpatients during the first year after hospital discharge

In a prospective follow-up study the German version of the Hospital Anxiety and Depression Scale (HADS) was used to determine the prevalence of anxiety and depressive symptoms in internal medicine inpatients. From a total cohort of 376 admitted study patients questionnaires were completed at admission and after one year follow-up. The data demonstrated that the mean HADS score on the anxiety subscale decreased significantly from 6.7 3.5 at study inclusion to 5.8 3.8 after one year (p < 0.0005) while the mean HADS score on the depression subscale was relatively stable (5.3 3.6 versus 5.4 4.3, p = n.s.). Odds ratios for the prediction of positive HADS results at follow-up were 4.1 (95%-CI 2.0-8.4) for anxiety symptoms and 8.2 (95%-CI 4.6-14.6) for depressive symptoms. Patients with abnormal HADS anxiety scores were significantly more frequently rehospitalized (Odds ratio 1.9; p = 0.028) and also more frequently reported pain symptoms (Odds ratio 2.0; p = 0.019). These results demonstrate the persistence of depressive symptoms and the frequent utilization of health care in internal medicine inpatients with psychiatric disorders in the first year after hospital discharge.     

综合医院焦虑抑郁量表在内科门诊患者中的应用

目的了解综合性医院内科门诊患者中焦虑与抑郁的现状以及综合医院焦虑抑郁量表（hospital anxiety and depression scale,HAD）在此类人群中调查的特点。方法采用10∶1连续病例抽查,自填相关问卷的方法。对6 172例门诊患者使用HAD进行调查。结果内科门诊患者中有6.93%患者存在焦虑症状,3.66%的患者存在抑郁症状,1.31%的患者共病焦虑与抑郁。焦虑部分得分高的条目分别是＂我感到紧张（或痛苦）＂和＂我心中充满了烦恼＂;抑郁部分＂我对以往感兴趣的事情还是一样感兴趣＂得分最高。女性的焦虑抑郁得分明显高于男性。结论综合性医院内科门诊小部分患者存在焦虑、抑郁症状,HAD量表结构大致符合＂抑郁＋焦虑＋不安＂的三因子模型。     

Factors associated with anxiety and depression in the management of acoustic neuroma patients

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.