THIS ARTICLE HAS BEEN RETRACTEDA psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Aim. To evaluate further the psychometric properties of the Chinese version of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depression in Chinese patients with coronary heart disease in Xian, China. Background. There is considerable evidence that anxiety and depression are common in patients with coronary heart disease (CHD) and are associated with increased morbidity and mortality. A valid, reliable and sensitive screening tool that can be used readily on this group of patients would be useful for assessment, intervention and outcome evaluation. Design. A single group, cross‐sectional study. Method. Measurement performance was tested on 314 Chinese patients with coronary heart disease and repeated on 173 of them two weeks later. Results. The Chinese version of HADS (C‐HADS) had acceptable internal consistency and test‐retest reliability, with a Cronbach alpha of 0·85 and intraclass correlation coefficient of 0·90, respectively. There was acceptable concurrent validity with significant (p < 0·05) correlations between the anxiety and depression subscales of the C‐HADS and CHD patients’ perceived health status as measured by the Chinese Mandarin version of the Short Form‐36 health survey (CM:SF‐36). Principal components analysis revealed a three‐factor solution accounting for 53% of the total variance. The three underlying sub‐scale dimensions are depression, psychic anxiety and psychomotor anxiety. The responsiveness of the C‐HADS was also satisfactory with significant correlation between the changes in the C‐HADS score and the changes in the Mental Health domain of the CM:SF‐36 (p < 0·01). Finally, over one‐third of the patients demonstrated psychological distress. Conclusion. Empirical data support the C‐HADS as a reliable and valid screening instrument for the assessment of anxiety and depression in Chinese‐speaking patients with CHD. A tri‐dimensional scoring approach should be considered as potentially clinically useful for this group of patients. Relevance to clinical practice. The C‐HADS can guide and evaluate the delivery of psychological care for Chinese patients with CHD.     

Health‐related quality of life,anxiety and depression related to mammography screening in Norway

Aim and objectives. To measure health‐related quality of life, anxiety and depression ahead of mammography screening and to assess any differences in health‐related quality of life compared to reference population. Background. The study of health‐related quality of life among attendees prior to mammography screening has received little attention, and increased knowledge is needed to better understand the overall health benefits of participation. Design. A two‐group cross‐sectional comparative study was performed. Methods. The samples comprised 4,249 attendees to mammography screening and a comparison group of 943 women. We used the SF‐36 Health Survey to assess health‐related quality of life. Linear regression was used to study any differences between the groups with adjustment for age, level of education, occupation, having children and smoking status. Other normative data were also used. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Results. Attendees scored statistically significant higher on the SF‐36 than the comparison group but were in line with normative data. Attendees had anxiety mean 4 · 1 and depression mean 2 · 6. Conclusions. The majority of the attendees have a high health‐related quality of life, low anxiety and depression ahead of screening. Anxiety and depression were less than shown in normative data from Norway. Despite a high health‐related quality of life, low anxiety and depression among the majority, healthcare workers should pay special attention to the few women who are anxious and depressed, and have a lower health‐related quality of life. Omitted from mammography screening may be women who are unemployed, have lower socioeconomic status, are anxious and are depressed. Further research should be performed with non‐attendees and subgroups to improve the screening programme. Relevance to clinical practice. It is important to identify which patients have the greatest need for support and caring in an organised mammography screening and who may be overlooked.     

Anxiety and depression levels of inpatients in the city centre of Kirşehir in Turkey

Ünsal A, Ünaldi C, Baytemir Ç. International Journal of Nursing Practice 2011; 17 : 411–418 Anxiety and depression levels of inpatients in the city centre of Kir?ehir in Turkey The aim of this study was to determine the anxiety and depression levels of inpatients. A cross‐sectional study was conducted in K?r?ehir in the middle part of Turkey with a sample of 433 inpatients. As the data‐gathering tools, a questionnaire form and Hospital Anxiety and Depression Scale (HADS) were used. Statistical analyses were performed using Kruskal–Wallis Variance analysis and Mann–Whitney U‐test. The mean HADS‐depression scores of patients were compared according to the clinics they were in, and the difference was found to be significant for HADS‐depression (P < 0.01) scores. The mean HADS‐anxiety score of participants was 9.07, and the mean HADS‐depression scores was 8.88. Among the participants in this study, 44.3% had an anxiety disorder (HADS‐anxiety score of ≥ 10) whereas the 73.7% showed depression (HADS‐depression score of ≥ 7). Results indicate that support, counselling, and routine screening for anxiety and depression should be provided to inpatients.     

Psychometric properties of MacNew Heart Disease Health-related Quality of Life Questionnaire: Brazilian version

Title. Psychometric properties of MacNew Heart Disease Health‐related Quality of Life Questionnaire: Brazilian version. Aim. This paper is a report of a study to test the psychometric properties of the Brazilian Version of the MacNew Heart Disease Health‐related Quality of Life Questionnaire. Background. Evidence of acceptable psychometric properties of the original MacNew questionnaire has been reported. However, the psychometric performance of the Brazilian version has not been extensively studied. Method. Between November 2004 and June 2005, 159 patients with myocardial infarction completed the Brazilian version of the instrument. Reliability was determined with Cronbach’s alpha coefficient; convergent validity with Pearson’s correlation between the Brazilian MacNew questionnaire and the SF‐36; and the ‘known‐group’ approach was used to test discriminant validity. Ceiling and floor effects and practicality were analyzed. Findings. It took an average of 8·9 minutes to complete the instrument. A ceiling effect was detected in the subscales and global scores, with no floor effect. Cronbach’s alpha coefficient ranged from 0·87 to 0·92. Scores on similar domains of the SF‐36 and the MacNew questionnaire were correlated (r = 0·66; 0·78 and 0·53 for the physical, emotional, and social domains). Correlation between the dissimilar SF‐36 mental health and MacNew physical domains was lower at 0·45; correlation between the dissimilar SF‐36 physical functioning and MacNew emotional domain was 0·64. Individuals without regional ventricular dysfunction or symptoms had statistically significantly higher scores than those with regional ventricular dysfunction or symptoms. Conclusion. The Brazilian version of the MacNew questionnaire has acceptable levels of validity, reliability and practicality. Further studies are advisable to confirm its divergent validity and to test its responsiveness.     

Factor structure of the Hospital Anxiety and Depression Scale in coronary heart disease patients in three countries

Background Depression and anxiety in patients with coronary heart disease (CHD) is associated with a poorer prognosis. Therefore, the screening for psychological distress is strongly recommended in cardiac care and rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. The factor structure of the HADS was investigated in CHD populations across three countries (Germany, Hong Kong, United Kingdom). Methods In total, HADS data from 1793 patients with CHD were explored using confirmatory factor analysis to establish the underlying factor structure of the instrument. Results Three‐factor models were found to offer a superior fit to the data compared with two‐factor (anxiety and depression) models in all countries. The anxiety items can be separated in a factor labelled autonomic anxiety and negative affectivity. Conclusions The HADS offers good possibilities to detect distressed patients with somatic illnesses, but the construct validity of the originally proposed two factors (depression, anxiety) remains unclear. In outcome studies, more precise scales should be used to reduce measurement errors based on the scales used.     

Could SF‐36 be used as a screening instrument for depression in a Swedish youth population?

Scand J Caring Sci; 2011; 25; 262–268
Could SF‐36 be used as a screening instrument for depression in a Swedish youth population? Objective: Depression among youth is a condition associated with serious long‐term morbidity and suicide. The aim of this study was to investigate whether a HRQoL instrument, the short form 36 version 1.0 (SF‐36), could be used to screen for depression in a clinical Youth Centre (YC). A second purpose was to describe self‐reported health and depression. Setting: A clinical YC at a University hospital. Design: A sample of 660 youths, 14–20 years old was assessed with SF‐36 and Montgomery Åsberg Depression Rating Scale, self‐screening version (MADRS‐S). Answers to all the questions in both instruments were given by 79% (519/660; 453 women and 66 men). Mean age in the sample was 17.5 ± 1.6 years. Results: Strong correlations were found between all the SF‐36 subscales and the depression ratio scale MADRS‐S. Receiver operating characteristic (ROC) curve analysis confirmed that the SF‐36 subscales mental health (MH) and vitality (VT) could correctly predict depression on the individual level with Area Under the ROC Curve values 0.87 and 0.84 in ROC curves. Individuals scoring 48 or lower on MH and 40 or lower on VT should be followed up with a clinical interview concerning possible depressive disorder. Mild to moderate depression was common (35.5%), especially among women (37.5%). Men scored higher than women on all SF‐36 subscales except for physical functioning. Conclusions: The SF‐36 can be used to screen for suspect depression in a youth population followed by interview. This gives an opportunity to detect and treat emerging depressive symptoms early.     

The effects of gender and age on health-related quality of life following kidney transplantation

Aims and objectives. To evaluate whether gender, age and their interaction affect health‐related quality of life and overall health status following kidney transplantation. Background. Some investigators have examined the main effects of gender and/or age on health‐related quality of life following kidney transplantation, but the potential interaction effect of these measures on this outcome has not been reported. Design. This was a cross‐sectional, single‐centre study, based in one US geographic area. Methods. Self‐report survey data were provided by adult kidney transplant recipients using the SF‐36 Health Survey (SF‐36) and a visual analogue scale of overall health. SF‐36 physical and mental component summary and individual scales and overall health were measured prospectively at one time point post‐transplant. All adult patients were eligible to participate and rolling enrolment was employed. Statistical effects were tested using analysis of covariance (controlling for time post‐transplant). Results. Subjects (n = 138) included 66 women and 72 men. There were no effects of gender, age group, or their interaction on MCS or overall health scores (all p ≥ 0·12). Physical component summary scale data demonstrated: (i) a significant effect of gender (p = 0·025); (ii) a statistically marginal effect of age group (p = 0·068); and (iii) a statistically marginal gender by age group interaction effect (p = 0·066). Women reported poorer scores on the SF‐36 physical functioning (p = 0·049), role physical (p = 0·014) and bodily pain scales (p = 0·028). There was an effect of age group on physical functioning (p = 0·005), with younger patients reporting higher scores. Conclusions. Women report lower scores on several physical measures and may experience a greater reduction with age in physical health‐related quality of life than men. Physical functioning declines with age following kidney transplantation. Relevance to clinical practice. Findings may help healthcare professionals to develop gender‐ and age‐specific interventions to optimize health‐related quality of life of kidney transplant patients.     

Psychopathology in Patients with ICDs over Time: Results of a Prospective Study

Introduction: The effects of implantable cardioverter defibrillators (ICDs) and ICD shocks on psychological state have previously been studied. However, it is still unclear how health‐related quality‐of‐life changes over time using standardized assessments. We sought to characterize the effects of ICDs and ICD shocks on psychological outcomes. Methods: Three hundred‐eight patients receiving ICDs were prospectively identified. Baseline QOL assessments including standardized psychological surveys [Hospital Anxiety and Depression Scale (HADS), Impact of Events Scale‐Revised (IES‐R), and Short Form 36 Health Survey (SF‐36)] were obtained within 2 months of device implantation and at 6 and 12 months, respectively. Outcomes including ICD shocks were followed over the 12‐month study period. Results: The number of patients meeting criteria for anxiety or posttraumatic stress disorder (PTSD) at baseline (78/223, 35%) was higher than at 6 (34/223, 15%) or 12 (34/223, 15%) months (P < 0.01). There was a significant improvement over time in HADS (P < 0.001) and IES‐R (PTSD) scores (P < 0.001). Amongst the 20 patients who received ICD shocks, no significant differences were observed in IES‐R, SF‐36, or HADS scores when compared with those who did not receive shocks at any time point. Patients who experienced electrical storms (N = 5) had significantly higher baseline PTSD scores (29.6 ± 11.4 vs 14.6 ± 11.6, P < 0.01). Conclusions: Patients receiving ICDs have significant rates of baseline psychopathology after implantation. However, psychological assessment scores tend to improve with time. ICD shocks do not appear to significantly impact psychological state. These results suggest the importance of close screening and referral for possible psychopathology in patients receiving ICDs, especially in the peri‐implant period. (PACE 2010; 33:198–208)     

Evaluation of an educational programme for family members of patients living with heart failure: a randomised controlled trial

Aims and objectives. To evaluate the effect of a group‐based multi‐professional educational programme for family members of patients with chronic heart failure with regard to quality of life, depression and anxiety. The secondary aim was to investigate the impact of social support and sense of coherence on changes in quality of life, anxiety and depression during the period of the study. Background. When a person is diagnosed with heart failure, the daily life of the family members is also affected. Design. Randomised controlled trial. Methods. A total of 128 family members were randomly assigned to participate in a multi‐professional educational programme or a control group. Analysis of variance and regression analysis were used. Results. There were no significant differences in anxiety, depression or quality of life between the intervention group and control group. Adequacy of social network was the only independent variable that explained levels of anxiety and depression after 12 months beyond baseline levels of anxiety (p < 0·001, R² = 0·35) and depression (p = 0·021, R² = 0·37). Younger family members were found to have a higher quality of life (p < 0·01). Conclusion. Improved disease‐related knowledge may need to be combined with other target variables to induce desired effects on depression, anxiety and quality of life of family members. Antecedents of depression and anxiety, such as sense of control, may need to be specifically targeted. Our results also suggest that intervention aimed at enhancing social support may be beneficial for family members. Relevance to clinical practice. Anxiety and depression did not decrease nor did quality of life improve after the intervention. An educational programme for family members with a component specifically targeting anxiety, depression and quality of life warrants testing. Furthermore, it is important that health care providers understand the influence of social support on anxiety, depression and quality of life when interacting with family members.     

Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure

Rationale, aims and objectives Heart failure (HF) is a severe chronic disease and impairs health‐related quality of life (HRQL). While validated specific HRQL instruments are required for evaluation of treatment and rehabilitation in patients with HF, a single validated measure to document changes in HRQL for patients with different heart disease diagnoses would be invaluable. The purpose of this analysis was the psychometric analysis of the German MacNew Heart Disease Questionnaire (MacNew) in HF patients, which has previously been shown to be reliable and valid in patients with myocardial infarction, angina pectoris and arrhythmia. Methods We recruited 89 patients (61.7 ± 11.5 years; 84.3% male) in two Austrian and one Swiss cardiology department with documented HF (effect sizes 28.9 ± 10.1%). The self‐administered MacNew, the Short Form‐36 (SF‐36) and the Hospital Anxiety and Depression Scale were completed. Internal consistency reliability (Cronbach's α), discriminative and evaluative validity were assessed. Results Cronbach's α exceeded 0.80. Each MacNew scale differentiated between patients with and without anxiety (3.9 ± 1.0 vs. 5.3 ± 0.8, all P < 0.001), with and without depression (4.2 ± 1.2 vs. 5.2 ± 0.9 all P < 0.03) and by the SF‐36 health transition item (deteriorate = 4.39, no change = 4.95, improve = 5.45, all P < 0.02). Evaluative validity was demonstrated with effect sizes >0.70 for a subsample attending a 12‐week outpatient rehabilitation programme. Conclusions The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential ‘core’ HRQL measure, at least in the German language.     

Can the Hospital Anxiety and Depression Scale be used in patients with schizophrenia?

Rationale, aims, objectives The Hospital Anxiety and Depression Scale (HADS) was developed explicitly for use in non‐psychotic populations, yet is routinely used for screening patients with psychotic illness. The utility of the HADS as a screening instrument for use in patients with schizophrenia was investigated. Method Exploratory factor analysis and confirmatory factor analysis were conducted on the HADS to determine its psychometric properties in 100 patients with a primary ICD‐10 diagnosis of schizophrenia. Results Three distinct factors were identified within the HADS. Support was found for the clinical use of the HADS anxiety subscale to assess anxiety in patients with schizophrenia; however, evidence was also found that the HADS depression subscale may not be a unidimensional measure of depression in this clinical group. Conclusions Caution should be used when using the HADS depression subscale in this clinical group. The direction of future research in this area is indicated, in particular comparison of HADS anxiety and depression measures to determine further the validity or otherwise of these subscale domains.     

Psychometric testing of the Chinese Mandarin version of the Mental Health Inventory among Chinese patients with coronary heart disease in Mainland China

This study aimed to develop a Chinese Mandarin version of the Mental Health Inventory (CM:MHI). The English version MHI was translated into Chinese (simple Chinese character) using the forward‐backward translation method while establishing the semantic equivalence and content validity. A convenience sample of 204 coronary heart disease (CHD) patients was recruited to evaluate the internal consistency, concurrent validity and construct validity of the CM:MHI. Forty patients completed the CM:MHI to evaluate the test–retest reliability after 2 weeks. The CM:MHI demonstrated good semantic equivalent rate (92%) and satisfactory content validity index (0.91). The internal consistency was acceptable for total and all subscales with Cronbach's alpha greater than 0.70, with the exception of the subscale of Emotional Ties (Cronbach's alpha = 0.64). The test–retest reliability was also satisfactory with intraclass correlation coefficients higher than 0.75. The concurrent validity was acceptable with significantly strong correlations between the CM:MHI and the Chinese Mandarin versions of Short Form 36 Health survey and Hospital Anxiety and Depression Scale. Confirmatory factor analysis further supported the five‐factor structure of the CM:MHI. The CM:MHI demonstrated to be a valid and reliable measure for assessing psychological distress and well‐being in Chinese‐speaking CHD patients.     

Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation

Scand J Caring Sci; 2012; 26; 219–227 Relapse of health related quality of life and psychological health in patients with chronic obstructive pulmonary disease 6 months after rehabilitation Aims: This study aimed to evaluate the short‐ and long‐term effects of 4‐week inpatient rehabilitation on health‐related quality of life (HRQL), anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) and investigate the influence of clinical and socio‐demographical factors on unaltered or improved HRQL after discharge. Methods: A total of 111 consecutive cases with mild‐to‐very severe COPD were recruited from three rehabilitation centres and measured at baseline (t1), 4 weeks (t2) and 6‐month follow‐up (t3). Disease severity was assessed by spirometric tests, HRQL by The St. George’s Respiratory Questionnaire (SGRQ) and anxiety and depression by The Hospital Anxiety and Depression Scale (HADS). Socio‐demography and co‐morbidity was also reported. Changes in SGRQ and HADS scores from baseline to follow‐up were analysed by paired‐sample t‐test, and logistic regression was used to investigate the influence of different factors on HRQL after discharge. Results: Health‐related quality of life and depression improved between t1 and t2: a change of ?3.6 for the SGRQ impact score (p= 0.009), ?2.8 for the SGRQ total score (p = 0.012), a clinical relevant change of ?4.0 for the SGRQ symptom score (p = 0.012) and a reduction of ?0.7 for the HADS depression score (p = 0.011). Between t2 and t3, all SGRQ and HADS scores deteriorated with enhancement of SGRQ impact score (+3.5, p = 0.016), SGRQ total score (+2.5, p = 0.029), HADS anxiety score (+1.1, p = 0.000), HADS depression score (+0.6, p = 0.022) and HADS total score (+1.7, p = 0.000). No significant differences between t1 and t3 were found, except for HADS anxiety score (+0.9, p = 0.003). Patients living alone were 2.9 times more likely to maintain or improve HRQL 6 months after rehabilitation than patients living with someone (95% CI 1.1–7.8, p = 0.039). Conclusion: Short‐term benefits on HRQL and depression after rehabilitation relapsed at 6‐month follow‐up, but without any further deterioration from baseline. Living alone may be beneficial to maintain or improve HRQL after discharge.     

Value of leads V4R and CM5 in the detection of coronary artery disease during exercise electrocardiographic test

The usefulness of the right precordial unipolar leads and the value of the bipolar lead CM5 in the detection of coronary artery disease (CAD) with exercise electrocardiographic (ECG) test are not well documented. The objective of this study was to evaluate the diagnostic performance of leads V4R and CM5. The study population comprised 579 patients referred for a bicycle exercise ECG test in the Finnish Cardiovascular Study. Patients were divided into three groups: angiographically proven CAD (CAD, n = 255), no CAD by angiography (NoCAD, n = 126), and low likelihood of CAD (LLC, n = 198). The maximum ST‐segment depression at peak exercise was used as a parameter, and the diagnostic accuracy of different leads was assessed by receiver operating characteristic (ROC) analysis. Sensitivity and specificity values at a cut‐off criterion of ?0·10 mV ST‐segment, 1‐mm ST depression, were determined. According to the results, incorporating lead V4R with the standard leads decreased the ROC area from 0·71 to 0·69 (comparison CAD versus LLC) and from 0·55 to 0·53 (comparison CAD versus NoCAD) and had no effect on sensitivity or specificity. Adding lead CM5 to the standard leads did not affect the ROC area but increased the sensitivity and decreased the specificity. In conclusion, the use of right precordial lead V4R along with the standard 12‐lead system does not improve the performance of the exercise ECG in diagnosing CAD. Adding lead CM5 to the standard leads increases the sensitivity but does not change the overall diagnostic performance.     

Translation and validation of a Chinese version of the Self-Control Schedule in Chinese childbearing women

Aims. The aims of this study were to translate and evaluate the psychometric properties of the Chinese version of the Self‐Control Schedule (C‐SCS) in Chinese childbearing women. Background. The SCS was developed to measure learned resourcefulness, which facilitates people's coping under adversity. Promoting learned resourcefulness in childbearing women facilitates positive adaptation to motherhood, which is essential to both maternal and child health. Thus, a reliable and valid C‐SCS is crucial for the development of interventions to promote learned resourcefulness in Chinese childbearing women. Design and methods. In phase one, the SCS was translated into Chinese using the technique of translation and back‐translation and was reviewed by an expert panel for cultural equivalence. In phase two, psychometric testing of the C‐SCS was conducted by using a convenience sample of 360 childbearing women recruited from an antenatal clinic of a regional hospital. Four instruments including the C‐SCS, General Self‐Efficacy Scale (GSE), Rosenberg's Self‐Esteem Scale (RSES) and Edinburgh's Postnatal Depression Scale (EPDS) were administered to the participants. Ninety‐two women participated in the four‐week retest. Results. The C‐SCS demonstrated good internal consistency (Cronbach's alpha = 0·83) and test–retest reliability (ICC = 0·91). Factor analysis revealed the presence of three factors supporting the conceptual dimension of the original instrument. Significant correlations with GSE (r = 0·48, p < 0·01), RSES (r = 0·41, p < 0·01) and EPDS (r = ?0·46, p < 0·01) demonstrated good construct validity. Conclusion. The findings suggest that the C‐SCS is a reliable and valid instrument for measuring learned resourcefulness in Chinese childbearing women. Relevance to clinical practice. The C‐SCS provides midwives with a useful tool in the evaluation of interventions designed to strengthen Chinese women's learned resourcefulness and promote maternal well‐being during childbearing.     

Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus

Title. Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus Aim. This paper is a report of a study to examine the relationship between health literacy, complication awareness and diabetic control among patients with type 2 diabetes mellitus, and to validate a Chinese version of the Short‐form Test of Functional Health Literacy in Adults. Background. There is a rapidly increasing trend in the prevalence of diabetes mellitus in Asian countries. Alongside the considerable progress in recent decades of health education in the field of diabetes care, the effects of health literacy and complication awareness have received increasing attention over the past 10 years. Method. This study was conducted from September 2005 to February 2006 with 149 Chinese patients (mean = 59·8 years, range: 27–90 years) who were undergoing/had undergone diabetic complication assessment. Survey data were collected using a structured questionnaire incorporating demographics; assessment of complication awareness in two sections: a self‐developed 10‐item patient awareness score and a modified Chinese version of the Summary of Diabetes Self‐Care Activities measure; and health literacy as measured by the Chinese version of the Short Test of Functional Health Literacy in Adults. Diabetic control was assessed by the most recent HbA1c level. Findings. Health literacy (P < 0·001) and patient awareness scores were negatively correlated to diabetic control (P = 0·035), but management of treatment in the Summary of Diabetes Self‐Care Activities measure (P = 0·030), gender (P = 0·023) and duration of diabetes (P < 0·001) were positively correlated to HbA1c. Conclusion. To develop effective patient education and improve patients’ diabetic control and own complications, educational strategies need to consider patients’ health literacy levels and self‐care skills.     

Prevalence,severity, and chronicity of pain and general health‐related quality of life in patients with localized prostate cancer

Aims: To analyze the prevalence and the severity spectrum of pain and its relationships to health‐related quality of life and the bio‐psycho‐social consequences of pain among patients scheduled for radical prostatectomy. Methods: Urological inpatients completed an epidemiological pain questionnaire extensively exploring pre‐operative acute and chronic pains in 21 body regions. The severity of pain was determined using von Korff's Pain Grading (CPGQ). Pain chronicity was estimated employing the Mainz Pain Staging System (MPSS). Anxiety and depressive symptoms were identified with the HADS and the Habitual Well‐Being Questionnaire (FW‐7). Health‐related quality of life was measured using the SF‐12. Comorbidities and comorbidity‐related interferences with daily activities were ascertained with the Weighted Illness Checklist (WICL). Results: Eighty of 115 patients (69.6%) reported about pain during the last 3 months pre‐operatively. 28.7% of the pain patients had pain related to urological disease. Severe dysfunctional pain was identified by pain Grades 3 and 4 of the CPGQ in 20% and 13.8%, respectively. Advanced pain chronicity characterized by pain Stages II and III of the MPSS was present in 38.8% and 11.3%. Patients with localized prostate cancer without pain complaints had significantly better health‐related quality of life and habitual well‐being and lower anxiety and depression scores and fewer comorbidities. Patients with cancer‐related and non‐cancer pain did not differ in pain chronicity, pain severity, pain intensities, anxiety, comorbidities and physical health (SF12‐PCS). Conclusions: The high prevalence of severe and chronic pain in cancer patients before scheduled radical prostatectomy – combined with considerable disability effects and markedly reduced quality of life necessitate a short routine screening‐analysis of the severity spectrum of pain and psychopathology. Patient self‐rated pain chronicity staging and psychological distress analysis will allow a disorder severity‐guided treatment and the prevention of suffering and additional new chronic post‐surgical pain.