The Psychological and HRQoL related Aftermaths of Extra Corporeal Membrane Oxygenation Treatment: A Cross‐Sectional Study

ObjectivesTo assess symptoms of post-traumatic stress disorder, anxiety, depression and health related quality of life in a sample of adult patients treated with veno-arterial extracorporeal membrane oxygenation.Design and settingThis is a cross-sectional study. The population were all patients discharged (2008–2018) from a thoracic surgical intensive ward at a tertiary university hospital in Norway. A sample of 20 patients was recruited.Main outcome measuresSymptoms of post-traumatic stress disorder were assessed using Impact of Events Scale-Revised, while symptoms of depression and anxiety were assessed using Hospital Anxiety and Depression Scale. RAND 36-Item Short Form Health Survey was applied to measure health-related quality of life.ResultsSymptoms of post-traumatic stress disorder were reported by 40% of the participants. Twenty percent reported symptoms of depression and anxiety. Compared to the general population, participants reported poorer health-related quality of life on all domains, and significantly worse on the domains physical function, general health and social function.ConclusionPatients in our study reported symptoms of post-traumatic stress disorder, anxiety, depression and impaired health-related quality of life following treatment with veno-arterial extra corporeal membrane oxygenation. Addressing possible emotional and psychological distress could represent a potential major improvement in health care provided to this group. Further research is needed to incorporate prophylactic methods, such as identifying vulnerable patients and implement corresponding interventions, into clinical practice.     

ICU日记对患者及家属心理健康干预效果的Meta分析

目的 评价ICU日记对ICU患者和家属心理健康状况的干预效果。 方法 计算机检索从建库至2019年9月PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方数据库和维普中文期刊数据库中有关ICU日记在ICU患者或家属中应用效果的随机对照研究,使用RevMan 5.3统计软件进行Meta分析。 结果 纳入8项研究进行Meta分析,结果显示,ICU日记对降低患者创伤后应激障碍[RR=0.65（95%CI为0.51~0.82）,P<0.001]及抑郁发生率[RR=0.65（95%CI为0.45~0.92）,P=0.02]有明显作用,对降低患者焦虑发生率[RR=0.69（95%CI为0.31~1.52）,P=0.36]以及患者家属的创伤后应激障碍发生率[RR=0.76（95%CI为0.33~1.74）,P=0.51]无明显作用。描述性分析显示,ICU日记对降低患者家属的焦虑和抑郁发生率也无显著作用。 结论 ICU日记可降低ICU患者创伤后应激障碍和抑郁发生率,但对降低ICU患者焦虑及家属的创伤后应激障碍、焦虑和抑郁的作用不显著。由于纳入研究的方法限制、研究数量较少,未来尚需开展更多高质量、大样本的原始研究,以进一步评价其应用效果。     

Competing interests declared: early interventions and long-term psychological outcomes

Survivors of motor vehicle accidents and/or survivors of critical care unit admission are at increased risk of developing post-traumatic reactions such as post-traumatic stress disorder, depression and anxiety. Examining the possible risk factors for the development of these disorders must consider pre-traumatic, peri-traumatic and post-traumatic factors and must do so across domains relating to the trauma, the person and their circumstances. The present study has found propofol administration in the first 72 hours post motor vehicle accident to confer a higher risk for full or partial post-traumatic stress disorder at 6 months. This study highlights concerns that treatment needed acutely post injury may impact adversely on long-term outcome, albeit in a different domain-the psychological.     

Clinical feasibility of cervical exercise to improve neck pain,body function,and psychosocial factors in patients with post-traumatic stress disorder: a randomized controlled trial

[Purpose] To investigate the effect of cervical exercise on neck pain, disability, and psychosocial factors in patients with post-traumatic stress disorder. [Subjects] Thirty patients with post-traumatic stress disorder, who also complained of neck pain. [Methods] The cervical exercise group (n = 15) participated in cervical exercises for 30 min, 3 times/week for 6 weeks, and the control group (n = 16) underwent conventional physical therapy alone, without exercise. The exercises were performed in the following order: cervical relaxation, local muscle stabilization, and global muscle stabilization using a sling system. [Results] Compared to the control group, the cervical exercise group demonstrated significant decreases as follows: Visual analogue scale score, 4.2 vs. 1.0; Neck disability index, 3.9 vs. 1.9; and depression on the Symptom checklist-90-revised, 9.4 vs. 4.3 and on the Hopkins symptom checklist-25, 6.3 vs. 2.8. However, anxiety on the Symptom checklist-90-revised (3.1 vs. 1.3) was not significantly different. Effect sizes were as follows: Visual analogue scale score, 1.8; Neck disability index, 0.9; depression, 1.0; and anxiety on Symptom checklist-90-revised and Hopkins symptom checklist-25, 0.6 and 0.8, respectively. [Conclusion] Cervical exercise is effective in improving neck pain, disability, and efficacy of psychological treatment for depression in patients with post-traumatic stress disorder.Key words: Post-traumatic stress disorder, Neck pain, Psychosocial factors     

膀胱癌根治术患者不同治疗阶段负性心理与生活质量的关系

目的探讨膀胱癌根治术患者不同治疗阶段负性心理与生存质量的关系。方法选取2017年1月-2018年5月在我院治疗的膀胱癌患者84例,采用癌症患者生活质量量表(European organization for research and treatment of cance quality of life questionnaire-core 30,EORTC QLQ-C30)、抑郁自评量表(self-rating depression scale,SDS)和焦虑自评量表(self-rating anxiety scale,SAS)评估患者不同治疗阶段的生活质量、抑郁和焦虑情况。结果术前、术后3个月和术后6个月SDS、SAS评分比较,差异均有统计学意义(F=28.644,P<0.001;F=29.501,P<0.001);术前、术后3个月及术后6个月总体生活质量评分比较,差异有统计学意义(F=33.033,P<0.001);且SAS、SDS评分与总体生活质量评分均呈负相关(r=-0.380,P<0.001;r=-0.315,P<0.001)。结论膀胱癌患者术后抑郁、焦虑和生存质量均较术前改善,且抑郁、焦虑评分与患者生活质量呈负相关,应针对患者不同治疗阶段的心理特点给予有针对性的干预,以提高其生活质量。     

Whiplash and post-traumatic stress disorder

Purpose: This study examined the comorbidity of whiplash and post-traumatic stress disorder (PTSD) following motor vehicle accidents. A treatment strategy in cases with both disorders is proposed.

Method: A review of the literature on psychological consequences of motor vehicle accidents and on risk factors associated with developing chronic whiplash complaints is given. A case report is presented to illustrate the treatment strategy.

Results: Traffic accidents lead to psychological complaints more often than is realized in clinical practice. It is estimated that PTSD occurs in at least 25% of traffic accident victims who sustain physical injuries. This number is probably higher in patients with chronic whiplash complaints. The case report shows that improvement in relation with the post-traumatic stress symptoms can have a beneficial effect on coping with the chronic whiplash complaints.

Conclusions: The psychotherapeutic treatment of patients with chronic whiplash complaints and PTSD should be aimed primarily at coping with the trauma and not at the chronic pain complaints.     

A randomised comparative trial of yoga and relaxation to reduce stress and anxiety

OBJECTIVE: To compare yoga and relaxation as treatment modalities at 10 and 16 weeks from study baseline to determine if either of modality reduces subject stress, anxiety, blood pressure and improve quality of life. DESIGN: A randomised comparative trial was undertaken comparing yoga with relaxation. PARTICIPANTS: One hundred and thirty-one subjects with mild to moderate levels of stress were recruited from the community in South Australia. INTERVENTIONS: Ten weekly 1- h sessions of relaxation or hatha yoga. MAIN OUTCOME MEASURES: Changes in the State Trait Personality Inventory sub-scale anxiety, General Health Questionnaire and the Short Form-36. RESULTS: Following the 10 week intervention stress, anxiety and quality of life scores improved over time. Yoga was found to be as effective as relaxation in reducing stress, anxiety and improving health status on seven domains of the SF-36. Yoga was more effective than relaxation in improving mental health. At the end of the 6 week follow-up period there were no differences between groups in levels of stress, anxiety and on five domains of the SF-36. Vitality, social function and mental health scores on the SF-36 were higher in the relaxation group during the follow-up period. CONCLUSION: Yoga appears to provide a comparable improvement in stress, anxiety and health status compared to relaxation.     

Post-traumatic stress reactions following motor vehicle accidents.

Despite improvements in road conditions, vehicle safety and driver education, over 3 million persons are injured in motor vehicle accidents each year. Many of these persons develop post-traumatic stress symptoms that can become chronic. Patients with post-traumatic stress disorder experience disabling memories and anxiety related to the traumatic event. Early identification of these patients is critical to allow for intervention and prevent greater impairment and restriction. The family physician is in an ideal position to identify, treat or refer patients with traumatic responses to traffic accidents. The physician's awareness of patient characteristics and pre-accident functioning allows him or her to critically evaluate symptoms that may begin to interfere with the resumption of daily activities.     

Coronavirus disease 2019 crisis in Paris: A differential psychological impact between regular intensive care unit staff members and reinforcement workers

BackgroundIntensive care unit (ICU) healthcare workers (HCWs) are at the forefront of the coronavirus disease 2019 pandemic. To overcome the lack of human resources during this crisis, some ICUs had to mobilise staff from a reinforcement pool, with no or outdated ICU experience. This study aimed to investigate and to compare the psychological impact of the pandemic on regular ICU staff members and reinforcement workers.Material and methodsSelf-assessment questionnaires were completed by HCWs who worked from March 1 to April 30, 2020, in our 16-bed neurological ICU at La Pitié-Salpêtrière Hospital in Paris, France, which was converted to a COVID ICU. The Hospital Anxiety and Depression Scale, the Post-traumatic Stress Disorder Checklist for DSM-5, McGill Quality of Life Questionnaire-Revised, and 10-item Connor-Davidson Resilience Scale were used to assess anxiety, depression and post-traumatic stress disorder, quality of life, and resilience, respectively.ResultsSixty-nine ICU HCWs completed the survey (37 from the team of regular staff members, i.e., from the public health service, and 32 from a reinforcement pool, either from non-ICU public health service or from private healthcare interim employment agencies). Prevalence of anxiety, depression, and post-traumatic stress disorder symptoms was high, at 19%, 9%, and 16%, respectively, with limited impairment in quality of life or resilience scores. Depression symptoms were observed more in regular staff members than in welcomed reinforcement workers, at 16% and 0%, respectively.ConclusionsThese results revealed that during the pandemic, HCWs from the team of regular staff members were at greater risk of developing psychological disorder compared with reinforcement workers, with higher levels of depressive symptoms.     

Functional impact and health utility of anxiety disorders in primary care outpatients

OBJECTIVE: The objective of this study was to examine the relative impact of anxiety disorders and major depression on functional status and health-related quality of life of primary care outpatients. METHOD: Four hundred eighty adult outpatients at an index visit to their primary care provider were classified by structured diagnostic interview as having anxiety disorders (panic disorder with or without agoraphobia, social phobia, and posttraumatic stress disorder; generalized anxiety disorder was also assessed in a subset) with or without major depression. Functional status, sick days from work, and health-related quality of life (including a preference-based measure) were assessed using standardized measures adjusting for the impact of comorbid medical illnesses. Relative impact of the various anxiety disorders and major depression on these indices was evaluated. RESULTS: In multivariate regression analyses simultaneously adjusting for age, sex, number of chronic medical conditions, education, and/or poverty status, each of major depression, panic disorder, posttraumatic stress disorder, and social phobia contributed independently and relatively equally to the prediction of disability and functional outcomes. Generalized anxiety disorder had relatively little impact on these indices when the effects of comorbid major depression were considered. Overall, anxiety disorders were associated with substantial decrements in preference-based health states. CONCLUSIONS: These observations demonstrate that the presence of each of 3 common anxiety disorders (ie, panic disorder, posttraumatic stress disorder, and social phobia)-over and above the impact of chronic physical illness, major depression, and other socioeconomic factors-contributes in an approximately additive fashion to the prediction of poor functioning, reduced health-related quality of life, and more sick days from work. Greater awareness of the deleterious impact of anxiety disorders in primary care is warranted.     

综合护理干预对广泛性焦虑障碍患者疗效的影响

目的 通过综合护理干预在广泛性焦虑障碍患者的应用,了解临床疗效.方法 将80例广泛性焦虑障碍患者随机分为观察组和对照组各40例.两组的治疗方法相同.对照组予以精神科一般常规护理,观察组在此基础上,给予综合护理干预,两组的疗程均为6周.在治疗前和治疗后第1、2、4、6 周末采用汉密顿焦虑量表(HAMA)及Zung焦虑自评量表(SAS)以评定疗效;治疗6周后,用HAMA减分率评定总体疗效.结果 治疗第2、4、6周末,两组患者的SAS比较,差异有统计学意义(P<0.01);治疗第4、6周末,两组患者的HAMA比较,差异有统计学意义(P<0.01);治疗6周末,观察组的总有效率为92.5%,对照组的总有效率为75%,两组比较,差异有统计学意义(P<0.05).结论 综合护理干预对广泛性焦虑障碍患者有良好的疗效,有利于减缓或消除患者的焦虑状态,提高生活质量.     

理情行为疗法在脑卒中伴心理障碍患者中应用的效果观察

目的：探讨理情疗法在脑卒中伴心理障碍患者中应用的效果。方法：选取接受治疗的脑卒中伴心理障碍患者50例,随机分为观察组（n=25）和对照组（n=25）,对照组实施常规的药物治疗及护理干预,观察组在常规治疗基础上,实施每周3次,每次30 min的理情行为治疗干预,观察比较两组患者的康复训练依从性,焦虑、抑郁负性心理评分以及生活质量评分。结果：观察组患者的康复训练依从性高于对照组,患者的焦虑、抑郁负性心理评分均低于对照组,患者的生活质量评分则高于对照组, 差异有统计学意义（P<0.05）。结论：理情行为疗法能提高脑卒中患者的康复训练依从性,改善患者的焦虑、抑郁心理症状,有助于改善患者的认知功能,提高患者的生活质量。     

腹膜透析患者精神症状和健康状况的相关性分析及护理干预

目的:探讨腹膜透析患者的精神症状即焦虑、抑郁症状与健康状况的关系及相应的护理干预措施。方法:选取75例透析>3个月的稳定腹膜透析患者,调查其主观生存质量、睡眠质量、乏力程度;记录Karnofsky评分(代表患者的客观生存质量/健康状况);分别使用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估患者的抑郁、焦虑症状,并分为抑郁组与非抑郁组、焦虑组与非焦虑组,同时比较各项指标在组间差异。结果:本组抑郁症状的发生率为37.3%,焦虑症状的发生率为49.3%。抑郁、焦虑评分与乏力程度、睡眠质量、主观生存质量、客观生存质量负相关,精神症状越重健康状况越差(P<0.05,P<0.01)。各项指标在抑郁组、焦虑组均低于无相应精神状况组的患者(P<0.05,P<0.01)。结论:本研究表明腹膜透析患者的精神症状较常见,并且与健康状况相关。     

新型冠状病毒肺炎出院患者生活质量及影响因素研究

目的:了解新型冠状病毒肺炎(COVID-19)患者出院后的生活质量及其影响因素,为优化早期干预方案,预防社区生活受限,制定相应社区康复措施提供依据。方法:选择2020年3—4月在武汉华润武钢总医院治愈出院的COVID-19患者57例,于2020年4—5月通过"问卷星"平台采用简明健康状况调查量表(SF-12V2)调查患者的生活质量;采用焦虑自评量表(SAS)调查患者的焦虑状态;采用抑郁自评量表(SDS)调查患者的抑郁状态;采用呼吸困难指数量表(mMRC)调查患者的呼吸困难程度。比较不同特征COVID-19患者生活质量的差异;分析患者生活质量与焦虑、抑郁和呼吸困难程度的相关性及其相关的影响因素。结果:共发放57份调查问卷,剔除重复及无效问卷3份,获得有效问卷54份,问卷有效率达94.74%。(1)COVID-19出院后患者生活质量情况:生理总评分和心理总评分分别为(37.02±12.32)分、(38.46±14.42)分;呼吸困难等级0~3级的分别为3例(5.56%)、45例(83.33%)、5例(9.26%)、1例(1.85%);有19例(35.19%)存在焦虑情绪(SAS≥50分)和抑郁情绪(SDS≥53分)。(2)不同特征COVID-19患者生活质量比较:不同疾病分型的患者在生理总评分方面差异有统计学意义(P<0.05)。(3)生活质量与焦虑、抑郁和呼吸困难程度的相关性分析:Pearson相关分析结果显示,SF-12V2生理总评分与焦虑程度(r=-0.34,P=0.011)和呼吸困难程度(r=-0.39,P=0.003)之间存在负相关性,SF-12V2心理总评分与焦虑程度(r=-0.46,P=0.001)和抑郁程度(r=-0.40,P=0.002)之间存在负相关性。(4)COVID-19患者生活质量的影响因素分析:多元线性回归分析显示,性别(β=8.27)、抑郁程度(β=-0.34)和疾病分型(β=-11.68)是患者SF-12V2生理总评分的重要决定因素(P<0.05);焦虑程度(β=-0.62)是患者SF-12V2心理总评分的重要决定因素(P<0.05)。结论:COVID-19出院患者存在呼吸困难、焦虑抑郁情绪和生活质量下降的问题;性别、疾病分型、抑郁程度和焦虑程度是COVID-19患者生活质量下降的重要因素。COVID-19患者(特别是女性患者和重型患者)出院后要尽早进行抑郁症和焦虑症的筛查和干预,减少患者负性情绪,鼓励患者适当参与康复训练,提高呼吸功能,从而促进生活质量提高。     

Do post-traumatic stress symptoms predict reactions of adaptation to disability after a sudden-onset spinal cord injury?

Based on the perspective that post-traumatic stress disorder (PTSD) reflects a reaction of adaptation to trauma, the goal of this research was to examine the ability of PTSD symptom clusters (re-experiencing, avoidance, and hyperarousal) to predict eight reactions of adaptation to disability (shock, anxiety, denial, depression, internalized anger, externalized hostility, acknowledgment, and adjustment) among individuals with non-congenital spinal cord injuries. Individuals (all of whom attended either a specialized civilian or a veteran spinal cord injury clinic in Texas) completed two self-report questionnaires--the Reactions to Impairment and Disability Inventory (RIDI) and the Purdue Posttraumatic Stress Disorder Scale Revised (PPTSD-R). According to the statistical fit indices, five of the fit indices suggested that the revised model was a good fit to the data, whereas one fit index and the chi/df ratio indicated that the revised model fit the data poorly. The model provided information on the ability of PTSD clusters to predict reactions of adaptation, which suggested a specific pattern of vacillation of post-traumatic responses during the process of adaptation. These findings need replication before proposing interventions for post-traumatic stress responses after the onset of a spinal cord injury.     

克罗恩病患者焦虑抑郁状况及其影响因素分析

目的 分析克罗恩病（Crohn’s disease, CD）患者的焦虑和抑郁状况、相关影响因素及其对患者健康生命质量的影响。方法 选择2021年2月至2022年2月就诊于复旦大学附属中山医院的CD患者共100例,采集其人口学资料及疾病相关信息。研究对象填写焦虑自评量表(SAS)、抑郁自评量表（SDS）、患者报告结局（PRO）、炎症性肠病患者生活质量问卷（IBDQ）和慢性病治疗功能评估-疲劳量表（FACIT-F）。采用卡方检验和logistic回归分析焦虑、抑郁相关影响因素;采用独立样本t检验分析焦虑、抑郁对IBDQ和FACIT-F评分的影响。结果 CD患者合并焦虑、抑郁的比例明显高于健康对照组（焦虑：58.0%vs 9.4%,P<0.001;抑郁：43.0%vs 11.8%,P<0.001）,SAS和SDS评分升高。患者为女性、具有肠外表现、疾病处于活动期（PRO2=1）为焦虑危险因素（P<0.05）;文化程度较高和疾病处于活动期（PRO2=1）是抑郁危险因素（P<0.05）。具有焦虑和抑郁情绪患者的IBDQ和FACIT-F评分明显降低（P<0.05）。结...     

叙事护理干预对下肢骨关节置换术后患者焦虑、抑郁及创伤后成长的影响

目的：探究叙事护理干预对下肢骨关节置换术后患者焦虑、抑郁及创伤后成长的影响。方法：将86例行下肢骨关节置换术患者随机分为观察组和对照组,各43例。对照组实施常规护理,观察组在此基础上实施叙事护理。观察比较两组患者干预前后焦虑、抑郁及创伤后成长情况。结果：干预前,两组患者焦虑、抑郁及创伤后成长比较差异无统计学意义（P＞0.05）;干预后,观察组患者各项得分均明显优于干预前（P＜0.01）;对照组患者干预后焦虑、抑郁得分低于干预前（P＜0.01）,创伤后成长得分与干预前比较差异无统计学意义（P＞0.05）;观察组患者干预后焦虑、抑郁得分低于对照组,创伤后成长得分高于对照组（P＜0.01）。结论：叙事护理可有效改善下肢骨关节置换术后患者心理状态,提高其创伤后成长水平,是一种较理想的心理健康促进方法。     

A prospective study on paediatric traffic injuries: health-related quality of life and post-traumatic stress

OBJECTIVES: To examine children's reports of their health-related quality of life (HRQoL) following paediatric traffic injury, to explore child and parental post-traumatic stress, and to identify children and parents with adverse outcomes. DESIGN: Prospective cohort study. Assessments: shortly after the injury, three months and six months post injury. SETTING: Department of Traumatology, University Hospital. SUBJECTS: Fifty-one young traffic injury victims aged 8-15 years. MAIN MEASURES: TNO-AZL Children's Quality of Life questionnaire and the Impact of Event Scale. RESULTS: Short-term adverse changes in the child's HRQoL were observed for the child's motor functioning and autonomy. At three months, 12% of the children and 16% of the parents reported serious post-traumatic stress symptoms. Increased stress at three months, or across follow-up, was observed among hospitalized children, children with head injuries, and children injured in a motor vehicle accident. Parental stress was related to low socioeconomic status and the seriousness of the child's injury and accident (hospitalization, head injury, serious injury, motor vehicle involved, others injured). CONCLUSIONS: The children reported only temporary effects in their motor functioning and autonomy. Post-traumatic stress symptoms following paediatric traffic injury were not only experienced by the children, but also by their parents.