Comparison of the domains of anxiety and mood of the University of Washington Head and Neck Cancer Questionnaire (UW-QOL V4) with the CES-D and HADS

BACKGROUND: Version 4 of the University of Washington Head and Neck Cancer Questionnaire (UW-QOLv4) includes items on mood and anxiety. The aim of this study was to compare the responses to these single items with the Centre for Epidemiology Studies Depression Scale (CES-D) and the Hospital Anxiety Depression Scale (HADS). METHODS: A cross-sectional postal survey was undertaken in April 2003. The survey was composed of all patients treated for oral and oropharyngeal squamous cell carcinoma between 1992 and 2002 who were alive and disease free. RESULTS: We distributed 306 questionnaires; there were 197 replies (65%) from 110 male and 87 female patients. Most patients reported relatively little depression, with 170 of 190 (89%) reporting a HADS depression score of less than 11. Similarly, most patients were not anxious, with 158 of 183 (86%) reporting a HADS anxiety score of less than 11. UW-QOL mood, UW-QOL anxiety, HADS anxiety, HADS depression, and CES-D scores were all moderately intercorrelated (Spearman correlations from 0.39-0.68 ignoring the signs, all p < .001). The UW-QOL mood correlated with the scores and "case-ness" categories of the HADS depression and CES-D scales, whereas the UW-QOL anxiety correlated with the scores and "case-ness" of the HADS anxiety. CONCLUSIONS: Questions on mood and anxiety can help identify significant psychological morbidity, taking a score of less than 75 for UW-QOL mood and less than 70 for UW-QOL anxiety. This could be used to trigger formal psychological assessment and with a view to possible therapeutic intervention.     

The prevalence and predictors of psychological distress in patients with early localized prostate cancer

OBJECTIVE: To determine the level of psychopathology, traumatic distress and quality of life in men with newly diagnosed clinically localized prostate cancer, the effect on these of a consultation in a combined-specialist early-prostate clinic, and predictors of psychopathology. PATIENTS AND METHODS: Eighty-eight patients were recruited from the combined clinic; they completed a battery of questionnaires including the Hospital Anxiety and Depression Scale (HADS), the revised Impact of Event Scale (IES) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, before their first appointment. Two weeks later they completed the HADS, IES and a patient-satisfaction survey. RESULTS: The overall level of psychopathology varied among the questionnaires used, from 0% on the HADS depression scale, 8% on the HADS anxiety scale and 14% on the IES. Anxiety and traumatic stress symptoms were commoner than depressive symptoms. The quality-of-life scores showed a relatively good level of functioning. Pre-morbid factors and disease status did not predict psychological distress. Younger age was mildly predictive of poorer psychological functioning. Anxiety symptoms reduced slightly after a joint clinic appointment, whereas depressive symptoms showed a slight increase. CONCLUSION: This study suggests that men with early localized prostate cancer have low levels of psychopathology overall. However, some men experience distressing psychological symptoms and it is important that future research is conducted to help develop clear guidelines on the optimal methods of detecting and managing men with prostate cancer who have mental health difficulties.     

Cross-sectional assessment of psychiatric disorders in renal transplantation patients in Turkey: a preliminary study

BACKGROUND: Psychiatric disorders such as depression and anxiety may be seen after a successful renal transplantation (RTx). The aim of this cross-sectional study was the assessment of psychiatric disorders after RTx in Turkey. The value of self-report scales in predicting depression and anxiety was also assessed. PATIENTS AND METHODS: The study group consisted of 20 male and 20 female RTx patients (mean age 35.42 +/- 10.09 years), with a mean duration of 61.65 +/- 48.30 months of follow-up after transplantation. All patients were assessed with the validated Turkish versions of Structured Clinical Interview for the DSM-IV (SCID-I), Beck Depression Inventory (BDI), Hospital Anxiety Depression Scales (HADS), Spielberger Trait Anxiety Inventory (STAI-I), and Beck Hopelessness Scale (BHS). RESULTS: Twenty of the 40 patients warranted a DSM-IV psychiatric diagnosis with SCID-I evaluation. Major depression was observed in 25% of patients. The remaining diagnoses were within the affective and/or anxiety spectrum disorders. The set of age, gender, education, income, marital status, employment, type of transplantation, duration of illness, and duration after the transplantation was not significantly different between patients with or without psychiatric diagnoses. BDI, HADS, STAI-I, and BHS were significantly higher among patients with psychiatric diagnoses at P = .001 level using Student t test. Even after control of the variance explained by the set of demographic variables, hierarchical regression analysis revealed that HADS scores significantly predicted the psychiatric morbidity (P = .003). CONCLUSION: The frequency of psychiatric disorders is quite high in renal transplantation patients. Additionally, HADS, which significantly predicts depression and anxiety, may be used for screening purposes.     

Psychological distress in Japanese men with localized prostate cancer

OBJECTIVE: To investigate: (i) the level of psychological distress; and (ii) the relationships between the level of psychological distress and general or disease-specific HRQOL of Japanese men with localized prostate cancer following surgery or radiotherapy. PATIENTS AND METHODS: The study was a retrospective cross-sectional survey of 253 men with localized prostate cancer treated with radical prostatectomy and 87 with external beam radiotherapy were collected. The measures used four questionnaires including: (i) the Medical Outcomes Study 36-Item Health Survey; (ii) The University of California, Los Angeles Prostate Cancer Index; (iii) International Prostate Symptom Score; and (iv) Hospital Anxiety and Depression Scale (HADS). RESULTS: Mean anxiety and depression scores were 4.0 and 4.7, respectively (standard deviation, 3.3 and 3.7). On the anxiety section of HADS, 291 patients (85%) scored 7 points or less; and on the depression scale, 183 (54%) patients scored 4 points or less. Those 'cases' (HADS total, >10) with psychological distress scored lower in all domains of the general and disease related health-related quality of life (HRQOL) than the 'non-cases' (HADS total, 相似文献   

Validity of Self-rating Screening Scales for the Diagnosis of Depression and Anxiety in Adult Patients With Bronchiectasis

BackgroundThere are no previous studies aimed at assessing the validity of the screening scales for depression and anxiety in adult patients with bronchiectasis.AimsTo analyze the psychometric properties of Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI) and Hamilton Anxiety Scale and to evaluate the concordance for the diagnosis of depression and anxiety between these screening scales and the structured clinical interview in adult patients with bronchiectasis.MethodCross sectional study. 52 patients with bronchiectasis completed HADS, BDI and Hamilton Anxiety Scale; afterwards, were individually interviewed by a mental health care professional using the structured Mini International Neuropsychiatric Interview (MINI), which evaluates for depression and anxiety according to DSM-IV criteria.ResultsBased on MINI, 18 subjects (34.6%) had a diagnosis of depression and 25 (48.1%) had anxiety. Optimal cut-off values to detect depression were ≥9 for the HADS-D (sensitivity 0.833, specificity 0.971, AUC 0.962 [95% CI 0.918–1]), and 17 for BDI (sensitivity 0.889, specificity 0.912, AUC 0.978 [95% CI 0.945–1]). Optimal cut-off values to detect anxiety were ≥4 for the HADS-A (sensitivity 0.960, specificity 0.593, AUC 0.833 [95% CI 0.723–0.943]), and 17 for Hamilton Anxiety Scale (sensitivity 0.800, specificity 0.852, AUC 0.876 [95% CI 0.781–0.970]).ConclusionThe self-rating screening scales HADS, BDI and Hamilton Anxiety Scale are reliable tools to screen for depression and anxiety in adult patients with bronchiectasis. However, the use of specific cut-off values may improve the diagnostic accuracy of the previous scales in this specific group of patients.     

Psychological assessment of ICU survivors: a comparison between the Hospital Anxiety and Depression scale and the Depression, Anxiety and Stress scale

Recovery from a critical illness can be delayed by persistent anxiety and depression. To identify such patients, a new self-report questionnaire (the Depression, Anxiety and Stress scale, DASS) was used alongside an established instrument (the Hospital Anxiety and Depression scale, HADS) in those who had spent a minimum of 3 days (median 9 days) in a general intensive care unit. Fifty-one patients were studied 3 months later, and 45 survivors were reviewed at 9 months. High Cronbach alpha values (0.92-0.95) for each subscale of DASS confirmed its internal consistency, and likewise for HADS (0.82-0.86). HADS and DASS correlated strongly at each time point both for anxiety (r = 0.88) and depression (r = 0.93), with few discrepant values on a Bland and Altman plot. DASS performs as consistently as HADS in screening for anxiety and depression, and its psychometric properties support its use in an intensive care setting.     

The role of psychological interventions in dialysis: an exploratory study

Patients suffering from end-stage renal disease (ESRD) have a very reduced quality of life accompanied by a severe emotional distress (high worries-anxiety-depression). However, in Belgium, no regular psychological intervention is proposed to dialyzed patients. Our objective is to show that psychological intervention can significantly decrease the emotional distress of patients with ESRD. Eleven sessions of structured interventions are proposed to ESRD patients. Eligibility criteria are to be major, to not present confusion or/and dementia, to have been on dialysis treatment for at least 3months, to have obtained 14 or more on HAD-scale. Interventions carry on the management of anxious and depressive symptoms and of the disease itself. This constitutes three independent modules. Questionnaires are filled in by the patients at various stages to evaluate the anxiety and the depression (HADS), the worries (Penn State) and the quality of life (KDQoL-SF). Results for the 47?ESRD patients show a significant reduction of the scores of anxiety, depression and worries and a significant growth of quality of life. In parallel, a decrease in the serum calcium-phosphorus product analyzed before dialysis has been noted.     

The effect of the psychological status of breast cancer patients on the short-term clinical outcome after mastectomy

PURPOSE: to analyze the effect of anxiety and depression on the postoperative complications and length of hospitalization of patients with breast cancer. Beck's Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were filled out by the patients pre-operatively. Patients were asked to rate their pain by the visual analogue scale (VAS) after surgery. Age, seroma volume, day of drain withdrawal, complications, and pathological stages were noted. The median age of 49 patients with the diagnosis of breast cancer was 51 (36-80). There was a significant correlation between the pain score and Beck, HADS, HADS (anxiety) and HADS (depression) (8 hours ; p = 0.021, 0.001, 0.004, 0.005 and 24 hours ; p = 0.005, 0.012, 0.006, 0.120). The mean HADS depression score in those patients with complications was 9.1 +/- 4.2 and that of patients with no complications was 6.6 +/- 3.1 (p = 0.047). The mean hospital stay of patients with a normal HADS score (< 19) was 2.9 +/- 1.1 days, whilst that of patients with an abnormal HADS score was 3.8 +/- 1.2 days (p = 0.016). Patients with abnormal HADS anxiety and abnormal HADS (total) scores had an earlier stage of breast cancer (p = 0.077, p = 0.063). The psychological status of breast cancer patients effects their postoperative recovery period and it is easy to diagnose these patients by some brief questionnaires.     

Psychological distress in patients undergoing surgery for urological cancer: A single centre cross-sectional study

Purpose

Interest in the disease-specific psychological well-being of patients with cancer has increased, and it has been estimated that less than half of all patients with cancer are properly identified and subsequently treated for anxiety or depression. The aim of this study is to evaluate psychological distress in uro-oncological patients undergoing different surgeries: radical cystectomy, radical prostatectomy, radical nephrectomy, or transurethral resection (TUR) before the surgery.

Evaluation of the emotional status of patients on a waiting list for thoracic surgery during the outbreak of Severe Acute Respiratory Syndrome (SARS)

The objective of this study was to examine the emotional status of patients on the waiting list for thoracic surgery operations during the outbreak of Severe Acute Respiratory Syndrome (SARS) in Hong Kong. Telephone interviews were conducted on patients awaiting thoracic surgery including major lung resection, mediastinal, pleural, tracheal and chest wall operations during the outbreak of SARS in April 2003 at the Prince of Wales Hospital, Hong Kong. The anxiety and depressive symptoms were assessed by the Hospital Anxiety and Depression Scale (HADS). Fifty‐seven patients participated in the interview (31.67 per cent response rate) of whom 18 were female. On the HADS, using the cut‐off point for psychiatric cases, 17 patients (29.82 per cent) scored above 15 for the full scale indicating significant psychiatric problems. Within the anxiety sub‐scale, 24 patients (42.11 per cent) reached the level of high anxiety (HADS score > 5). Fifteen patients (26.3 per cent) were above the cut‐off score of significant depression (HADS score > 8) for the depression sub‐scale. There was no relationship between the waiting time on the list and the level of depression and anxiety. The outbreak of SARS and the anticipation of surgery contributed to the high levels of anxiety and depression among patients awaiting thoracic surgical operations. A multi‐disciplinary and holistic approach to the management of this group of patients should be considered. Copyright © 2004 John Wiley & Sons, Ltd.     

Symptoms of anxiety or depression and risk of fracture in older people: the Hertfordshire Cohort Study

Summary

The aim of this study was to examine the prospective association between symptoms of anxiety and depression and risk of fracture in older people. Results showed that men, but not women, with probable anxiety at baseline had an increased risk of fracture.

Introduction

The use of psychotropic drugs has been linked with an increased risk of fracture in older people, but there are indications that the conditions for which these drugs were prescribed may themselves influence fracture risk. The aim of this study was to investigate the relation between symptoms of anxiety and depression and risk of fracture in older people. The study design is a prospective cohort study.

Methods

One thousand eighty-seven men and 1,050 women aged 59?C73?years completed the Hospital Anxiety and Depression Scale (HADS). Data on incident fracture during an average follow-up period of 5.6?years were collected through interview and a postal questionnaire.

Results

Compared to men with no or few symptoms of anxiety (score ??7 on the HADS anxiety subscale), men with probable anxiety (score ??11) had an increased risk of fracture: After adjustment for age and potential confounding factors, the odds ratio (OR) (95?% confidence interval) was 4.03 (1.55, 10.5). There were no associations between levels of anxiety and fracture risk in women. Few men or women had probable depression at baseline (score ??11 on the HADS depression subscale). Amongst men with possible depression (score 8?C10), there was an increased risk of fracture that was of borderline significance: multivariate-adjusted OR 3.57 (0.99, 12.9). There was no association between possible depression and fracture risk in women.

Conclusions

High levels of anxiety in older men may increase their risk of fracture. Future research needs to replicate this finding in other populations and investigate the underlying mechanisms.     

Psychological counselling in patients with a peripheral facial palsy: initial experience from an expert centre

Background: The aims of this pilot study were to evaluate the psychologist's role on the multidisciplinary team during peripheral facial palsy (PFP) patient care and to identify the potential predictors of anxiety and depressive symptoms/disorders in PFP patients.Methods: Using the prospective non-controlled study design, PFP patients aged 18–75 years who presented to the Radboud Facial Palsy Expert Centre, the Netherlands, were enrolled during a 1-year interval. The main outcome variables were 1) anxiety and depression in relation to PFP using the Hospital Anxiety and Depression Scale (HADS) and 2) the outcome of psychological counselling in patients with a HADS score ≥ 8.Results: A sample comprised 25 patients (68% females, 56% right-side PFP, 16% House–Brackmann scale I–II) with a mean age of 50 ± 14 years were referred to a psychologist. The proportion of patients with a HADS score ≥8, were 16 (64%) and 13 (52%), respectively. Especially, coping (in general or coping with the disease, 48%) and/or help with the choice of possible surgery (8.0%) were important reasons for counselling. In one case, a patient had chronic fatigue syndrome and was therefore referred to a psychological specialist centre. One patient was treated with acceptance and commitment therapy (ACT) with good results.Conclusions: Despite a small sample size and limited statistical analyses, the results of this study suggest that one-eighth of the PFP patients require psychological evaluation and treatments. This pilot study emphasises the important role of psychological screening and counselling in PFP patient care.     

The quality of life and hormonal disturbances in testicular cancer survivors in Cisplatin era

OBJECTIVES: To assess the degree of hormonal abnormalities in testicular cancer survivors and the effect of these changes on patients' quality of life. METHODS: Men with complete remission of testicular cancer for over 2 yr were eligible. Patients completed the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), the International Index of Erectile Function (IIEF), and the Sexual Functioning Questionnaire (SFQ), and rated their physical and psychological well-being, quality of life, and relationship with their partner. Levels of the hormones testosterone, estradiol, thyreotropin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin were determined. Relationships between hormone levels and questionnaire results were assessed. RESULTS: A total of 326 men were tested, of whom 269 were treated with platinum-based chemotherapy. The most common endocrine abnormalities were above-normal gonadotropin levels (LH, 55%, and FSH, 49% of cases) and lowered testosterone (15%). Twenty-seven percent (STAI) and 28% (HADS) of the patients had abnormal anxiety levels, while the depression rate was 15% (BDI) and 18% (HADS); 40% of patients had erectile dysfunction. Linear regression analysis excluding the influence of age showed higher depression levels in the BDI among patients with elevated LH (p=0.010) or FSH (p=0.017). Patients with above-normal LH showed increased sexual problems in the SFQ (p=0.030). Elevated gonadotropins correlated with deteriorated physical well-being (p=0.028). Men with abnormal estradiol were more prone to erectile dysfunction (p=0.009). CONCLUSIONS: Hormonal abnormalities have a negative impact on the quality of life of testicular cancer survivors.     

Co-morbid anxiety and depression among pulmonary tuberculosis patients

The need to recognize and manage psychiatric co-morbidity in tuberculosis (TB) patients in primary care settings in order to improve adherence to the treatment is now well documented. Pulmonary TB patients at the District TB Control Office and TB Centre in Haripur from December 2007 to March 2008 were evalute in order to assess the frequency of anxiety and depression and continuation of treatment. Forty seven out of 65 (72%) TB patients had severe/moderate level of anxiety and depression according to Hospital Anxiety and Depression Scale (HADS). Fourteen (22%) TB patients with co-morbid anxiety and depression showed multi drug-resistance (MDR-TB).     

Anxiety and depression: a comparison between renal transplant recipients and hemodialysis patients

BACKGROUND: Anxiety and depression are known causes of morbidity among patients with chronic illnesses. There is controversy whether hemodialysis or renal transplanted subjects have less severe anxiety or depression symptoms. We designed this study to evaluate these symptoms in the two groups of subjects. METHODS: In a case-control study performed in 2006, we randomly selected 32 transplant recipients and 39 hemodialysis patients. The two groups were matched for gender, age, marital status, educational background, and somatic comorbidities. Symptoms of anxiety and depression were compared between the groups using the Hospital Anxiety Depression Scale. RESULTS: Anxiety score was significantly lower among transplant recipients compared with hemodialysis patients (8.61 +/- 3.09 vs 10.41 +/- 2.77; P=.01). There was no significant difference between the two groups in the score for depression (P>.05). In transplant recipients, the severity of anxiety was higher among those with a history of graft rejection and those <35 years at the time of transplantation (P<.05). The severity of depressive symptoms was higher among subjects with lower educational status (P<.05). CONCLUSION: Depressive symptoms did not seem to improve after renal transplantation, which highlights the need for screening and appropriate treatment of depression. Transplant recipients with a history of rejection or a young age at the time of transplantation should receive more attention for psychiatric problems.     

Screening for abdominal aortic aneurysms does not increase psychological morbidity.

Screening can lead to harmful psychological effects in the screened population--an argument used against abdominal aortic aneurysm (AAA) screening. However, there is no evidence for this in AAA screening. We applied the Hospital Anxiety and Depression Scale (HADS) to a group of men undergoing screening for AAA. The HADS questionnaire was completed by subjects found not to have AAA, subjects with known small aneurysms attending for follow-up scans, subjects with known AAA on waiting lists for surgery, and controls not involved in the screening programme. The groups were well matched for age and the number of additional diseases. There was no significant difference in the distribution of patients for anxiety and depression according to the HADS questionnaire (chi 2 test, P > 0.1). The results from this study suggest that AAA screening does not increase anxiety or depression in the screened subjects--contrary to the argument put forward against screening for this condition.     

Quality of life in patients with Cystic Fibrosis: Association with anxiety and depression

BackgroundFew studies of patients with CF have looked at the association between patient reported Health-Related Quality of Life (HRQoL) and anxiety and depression. This study investigated whether CF patients with symptoms of anxiety or depression reported lower Health-Related Quality of Life (HRQoL) scores.Methods57 adult CF patients completed the Hospital Anxiety and Depression Scale (HADS) and the Cystic Fibrosis Questionnaire, a CF-specific measure of HRQoL. Analyses of variance with lung function as a covariate were used to investigate differences in HRQoL between groups of patients with and without symptoms of anxiety and depression.ResultsMean age was 26.7 years (SD 8.1), mean FEV1 %predicted was 65.09 (SD 22.18). Anxiety and depression scores were low and similar to normative scores. After controlling for lung function, patients with symptoms of anxiety reported lower on vitality, emotional functioning, social, treatment burden, health perceptions and respiratory symptoms. Those with depressive symptoms reported lower HRQoL scores for emotional functioning, eating disturbances and body image.ConclusionsPreliminary evidence was found of the role of anxiety and depression in different areas of quality of life in CF, which may help in the development of appropriate medical and psychosocial treatment programs.     

Screening for breast cancer is associated with a low degree of psychological distress

Psychological distress was measured among women on the day of recall after mammography in an official screening programme, and 4 weeks after the diagnosis was given. The Hospital Anxiety and Depression Scale (HADS) and a questionnaire to assess reactions to the examination were completed by 213 (97%) women aged 50-69 years. Among those without cancer, there were 45 (24.3%) who were anxiety cases and eight (4.3%) depression cases (HADS) on the day of recall mammography and 12 (7.3%) and three (1.8%) respectively after 4 weeks (P<0.001). Among those with cancer, the corresponding figures were seven (28.0%) and one (4.8%) before and six (24.0%) and three (12%) after screening (n.s.). A total of 194 (97%) women were definitely satisfied with the screening programme, and 195 (98%) would recommend others to participate. In conclusion, recall after mammography is associated with transiently increased levels of anxiety and depression in women without cancer. For those with cancer, the psychological distress continues. The women were almost unanimously content with participating in the screening programme.     

The measurement of psychological distress in men being investigated for the presence of prostate cancer

High levels (>50%) of anxiety are reported in patients undergoing screening for prostate cancer, which may affect health-related quality of life. We aimed to determine the level and prevalence of anxiety and depression and to identify those aspects of the diagnostic pathway that induce the most stress in men being investigated for prostate cancer. A total of 159 prostate-specific antigen-unscreened men undergoing a transrectal ultrasound-guided biopsy of the prostate (TRUS-B) completed two questionnaires, prior to their biopsy and before receiving results, containing the Hospital Anxiety and Depression Scale (HADS) and a 10-point Visual Analogue Scale (VAS). Median scores and prevalence of anxiety (4-5, 4-7%) and depression (1-2, 1.4%) respectively were low for both questionnaires. Waiting for biopsy results received the highest median VAS score (6) and was the most stressful event in 65% of men. There is a low incidence of clinically significant anxiety and depression in men being investigated for prostate cancer but questionnaires such as HADS identify patients with psychological distress who may benefit from early counselling. Uncertainty about the future while awaiting biopsy results after TRUS-B seems to be the most stressful event in patients' lives and minimizing this wait should help optimize patient care.     

全膝关节置换术前心理状态与术后早期膝关节功能的相关性研究

  目的 探讨全膝关节置换术前患者心理状态与术后膝关节功能的相关性。方法 2010年7至10月接受全膝关节置换且符合纳入标准的骨关节炎患者 111例（155膝）,按照医院焦虑抑郁量表（Hospital Anxiety and Depression Scale,HADS）对术前心理状态进行评估。HADS≥8分（有焦虑、抑郁）者纳入心 理组（21例）,HADS0.05）;与术后6个月膝关节疼痛呈正相关（r=0.613,0.530,0.500,0.473;P0.05）。结论 患者术前的焦虑、抑郁状态对全膝关节置 换术后膝关节功能的恢复有负面影响。