The association between depression and anxiety disorders following facial trauma—A comparative study

Aim

Although the surgical care provided for patients who have sustained a maxillofacial injury has advanced in recent years, psychological disorders may develop. Anxiety and depression may be a cause of significant morbidity in these patients. Such problems are often unrecognised and untreated.

Patients & methods

We undertook a comparative cross-sectional study in a cohort of adult patients to assess the association between traumatic facial injury and the presence of anxiety and depressive disorders. Study subjects were recruited during the period of June 2008 through August 2008. Fifty consecutive adult patients attending the maxillofacial outpatient clinic following facial trauma were asked to complete the Hospital Anxiety and Depression Scale (HADS). Data gathered from this group of patients were compared to 50 adult control subjects who were under follow-up following elective oral and maxillofacial surgery. We also looked at several demographic and other variables to assess its association with poor mental health outcomes.

Results

Ten patients (20%) in the facial trauma group achieved high scores in both subscales suggesting a probable anxiety and depression state. The mean score for the depression subscale was significantly higher in the facial trauma group compared to the control group (p = 0.006). The mean score for anxiety was also higher but did not reach statistical significance (p = 0.07). Stratified analysis (Mantel-Haenszel) was used to control for possible confounding variables. The odds ratio for probable depression, for facial trauma patients compared with “control” patients, was 9.02, 95% CI = 2.45, 33.1, p < 0.001. Variables with significant associations (p < 0.05) with high depression scores in the facial trauma group were female sex, presence of a permanent facial scar, and a past psychiatric history. There was also significant correlation between patients’ self-perception of facial disfigurement scores and scores obtained in both anxiety subscale (r = 0.41, p = 0.003) and depression subscale (r = 0.46, p = 0.001).

Conclusion

Our results support the findings of previous studies and provide further evidence to clinicians for the critical identification and treatment of anxiety and depression in facial trauma victims.     

The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression

Previous research has indicated a relationship between posttraumatic stress disorder (PTSD) and somatic complaints. We examined whether this relationship is a result of shared comorbidity with anxiety and depression. Local doctors interviewed a random, community sample of 526 tortured and 526 nontortured Bhutanese refugees living in U.N. refugee camps in Nepal. The interview covered demographics, torture, somatic complaints, and PTSD, depression, and anxiety measures. Number of PTSD symptoms, independent of depression and anxiety, predicted both number of reported somatic complaints and number of organ systems involving such complaints. Physicians need to screen for PTSD when survivors of extreme stressors present nonspecific somatic complaints.     

Pain interference may be an important link between pain severity,impairment, and self-reported disability in participants with wrist/hand pain

Study DesignCross-sectional.IntroductionPain severity, sensory and motor impairment, and psychological (distress and anxiety) and social factors have previously been related to self-reported disability in persons with wrist and hand pain.Purpose of the studyThe purpose of this study to determine the relative contribution of pain severity, measures of impairment (sensory and motor function), psychosocial factors, and pain interference on self-reported disability experienced by persons with heterogeneous orthopedic injuries and conditions of the wrist and hand.MethodsMeasures of disability and pain severity as well as measures of sensory (pressure pain thresholds, joint position sense), motor (grip strength, Purdue pegboard), and cognitive performance (Stroop test) and psychosocial variables related to pain and participation (West Haven-Yale Multidimensional Pain Inventory) were administered to 60 participants with wrist and hand pain. Pearson product correlations controlled for age and sex, and multiple linear regression was performed to determine the relationship between measures of impairment, pain severity, psychosocial variables, and pain interference with self-reported disability assessed with the Disability of Arm, Shoulder and Hand (DASH) questionnaire.ResultsThe best-fitting regression model with DASH scores entered as the dependent variable (F_4,50 = 28.8, P < .01) included MPI Pain Interference (β = −0.54), Life Control (β = −0.16), Purdue pegboard scores (β = −0.32), and Stroop test times (β = 0.21). Pain Interference had the strongest correlation with self-reported disability (adjusted R² = 0.67, P < .01).ConclusionPain interference appears to be an important factor explaining the link between impairment, pain severity, and self-reported disability. Addressing pain interference may be important to improve outcomes in this population.     

主动脉夹层患者及家属自我分化与焦虑抑郁关系的 主客体互倚模型分析

目的 基于鲍温家庭系统理论,使用主客体互倚模型探查主动脉夹层患者及家属焦虑、抑郁的交互传递情况。方法 采用一般调查问卷、简版自我分化量表、广泛焦虑性量表、患者健康问卷抑郁量表对210对主动脉夹层患者及家属进行调查,建立自我分化、焦虑及抑郁的主客体互倚模型。结果 主动脉夹层患者及家属的自我分化水平分别为（79.95±4.43）分和（81.31±4.55）分,焦虑程度分别为（11.74±3.55）分和（10.98±3.04）分,抑郁程度分别为（12.33±3.34）分和（10.98±3.04）分。主客体互倚模型结果显示,主动脉夹层患者的自我分化水平与自身及对方的焦虑、抑郁水平呈负相关,家属的自我分化水平与自身的焦虑、抑郁和患者的抑郁呈负相关（均P<0.05）。结论 主动脉夹层患者及家属的焦虑、抑郁受双方自我分化水平的共同影响,提示医护人员应重视主动脉夹层患者及家属焦虑、抑郁的传递情况,积极探索以家庭为单位的干预方案。     

The impact of treatment confidence on pain and related disability among patients with low-back pain : results from the University of California, Los Angeles, low-back pain study

BACKGROUND CONTEXT: Although many researchers and practitioners believe that patients' positive expectations of their treatment favorably influence clinical outcomes, there is little scientific evidence to support this belief. PURPOSE: To describe the level of patients' initial confidence in the success of their assigned treatment, by treatment group and other factors; and to estimate the effects of treatment confidence on subsequent changes in low-back pain and related disability. STUDY DESIGN AND PATIENT SAMPLE: Randomized clinical trial involving 681 patients treated for low-back pain in a managed-care facility in Southern California. OUTCOME MEASURES: Treatment confidence; and changes in three clinical measures of low-back pain: average pain, most severe pain and back-pain-related disability. METHODS: Patients were randomly assigned to one of four treatment groups: medical care with and without physical therapy, and chiropractic care with and without physical modalities. Information was collected by questionnaires at baseline, 2 weeks, 6 weeks and 6 months. Treatment confidence was measured just after randomization on a scale of 0 to 10. RESULTS: Treatment confidence was lowest, on average, for patients assigned to medical care only and highest for patients assigned to medical care plus physical therapy. Other predictors of high treatment confidence were having acute pain and being older, female and nonwhite. Although treatment confidence was only weakly associated with subsequent changes in low-back pain or disability in the total sample, high treatment confidence was associated with greater improvement among patients assigned to medical care plus physical therapy. CONCLUSIONS: Initial confidence in treatment for low-back pain varies by type of care and other factors. Higher confidence may have some beneficial effect on the course of low-back pain in certain patients, but this effect may depend on the type of interaction between client and provider.     

冠心病患者焦虑抑郁与冠状动脉斑块稳定性的关系研究

目的探讨冠心病患者焦虑、抑郁与冠状动脉粥样硬化斑块稳定性的关系,为早期筛查负性情绪患者,减少不稳定斑块的发生提供参考。方法采用自编一般资料问卷,焦虑、抑郁自评量表对319例冠心病患者进行调查,通过光学相干断层成像技术行斑块稳定性分析。结果焦虑、抑郁发生率分别为31.3%、30.7%,15.7%患者同时存在焦虑抑郁。Logistic回归分析示,抑郁、低密度脂蛋白胆固醇对斑块稳定性有显著性影响(OR=1.062、1.322,均P<0.05)。结论抑郁及低密度脂蛋白胆固醇是冠状动脉斑块稳定性的主要影响因素。对冠心病患者应及早进行负性情绪及饮食行为的全面调查并实施针对性干预,以减少不稳定斑块的发生,预防心脏不良事件。     

The investigation of the effects of occupation-based intervention on anxiety,depression, and sleep quality of subjects with hand and upper extremity burns: A randomized clinical trial

AimThis study aimed to investigate the effects of occupation-based intervention on psychological factors and sleep quality of subjects with hand and upper extremity burns.MethodsIn this randomized controlled intervention trial, a total of 20 patients were randomly assigned to one of the control group or intervention group. The control group only received traditional rehabilitation. However, the intervention group received traditional rehabilitation and Cognitive Orientation to daily Occupational Performance (CO-OP), respectively (during 18 sessions, 45 min/day in both groups). Occupational therapy sessions were held three times a week for a six-week duration. Occupational performance and satisfaction, anxiety, depression, and sleep quality were measured before the intervention and in weeks 2, 6, and 14 (follow-up) using Canadian Occupational Performance Measure, Beck Anxiety Inventory, Self-rating Depression Scale, and Pittsburgh Sleep Quality Index, respectively.FindingsThe results of the present study show that there were significant changes in all the studied variables in the two groups. However, these changes (P ≤ 0.05) were not statistically significant between these two groups.ConclusionThe results of this study show that occupation-based interventions are as effective as traditional therapeutic interventions on improving the anxiety, depression, and sleep quality in patients with hand burn injuries.     

The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain.

OBJECTIVE: This study was designed to determine the relationship between interstitial cystitis (IC), endometriosis (endo), and chronic pelvic pain (CPP) in individuals in whom nongynecological and nonurological problems had been previously ruled out. METHODS: A prospective study of 162 consecutive women with a complaint of chronic pelvic pain seen in the clinic was performed between August 2002 and December 2005. These patients underwent a workup to exclude other causes of pelvic pain, had PUF (Pain Urgency and Frequency) questionnaires filled out, and underwent a laparoscopy and a cystoscopy with hydrodistention. Pain levels were determined, and treatment was reviewed and enumerated. Results were obtained and quantified. RESULTS: In this study, 123 (76%) patients were diagnosed with active endometriosis, 133 (82%) were diagnosed with interstitial cystitis, and 107 (66%) had both disease entities simultaneously. Thirteen (8%) patients were diagnosed with pathologies unrelated to endometriosis and interstitial cystitis. Pain levels were seen to decrease at 6 months in all groups of patients with the exception of those patients with endometriosis only. CONCLUSION: CPP is a difficult, taxing, and frustrating concern for many women in the United States. These individuals have traditionally been difficult to treat. A large number of women with CPP in our patient population have been shown to have endometriosis, interstitial cystitis, or both. Therefore, a workup for premenopausal individuals with CPP involves obtaining a history that keys into possible nongynecologic causes of pain, a complete accounting of urinary problems, and a thorough history of gynecological problems. A physical examination with a comprehensive history should be performed, and the investigation may include the possibility of a simultaneous laparoscopy and cystoscopy if warranted. These procedures can serve as both a means for diagnosis and treatment of these problems when encountered.     

焦点解决短程治疗联合正念训练对干眼患者焦虑抑郁及生活质量的影响

目的 探讨改善干眼患者焦虑抑郁及生活质量的有效方法。方法 将92例干眼患者随机分为观察组和对照组各46例,对照组给予常规眼科护理,观察组在对照组基础上实施焦点解决短程治疗联合正念训练心理干预。干预前和干预8周,分别采用Zung焦虑自评量表和抑郁自评量表、五因素正念评估量表及生活质量问卷对两组患者进行效果评价。结果 干预后,观察组焦虑、抑郁评分显著低于对照组,正念及生活质量评分显著高于对照组(均P<0.05)。结论 焦点解决短程治疗联合正念训练可改善干眼患者焦虑抑郁情绪,提升正念水平及生活质量。     

The effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing changes in burn patients: A randomized controlled trial

Pain and anxiety caused by burn dressing change are one of the major issues in burn patients. In this regard, guided imagery as a complementary method can be effective in reducing the levels of anxiety and pain. This method is the process of creating mental images and using sensory features through the individual's imagination and memory that facilitate the achievement of desired therapeutic outcomes. Therefore, this study was aimed at determining the effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing change in burn patients. This is a single-blinded randomized controlled trial in which a total of 70 burn patients were enrolled using convenience sampling and randomly allocated to two groups of intervention and control (n = 35 in each group). Each patient in the intervention group received four sessions of guided imagery during four consecutive days (one session a day) using a headphone. Then in both groups, the level of pain was assessed after the dressing change and the level of pain-related anxiety was assessed before the dressing change (between the end of the intervention and the initiation of dressing change). Data were collected using a demographic questionnaire, the Visual Analog Scale (VAS), the short-form McGill Pain Questionnaire (SF-MPQ), and the Burn Specific Pain Anxiety Scale (BSPAS). Data were first entered into the IBM SPSS Statistics for Windows, version 25.0 and then analyzed using repeated-measures Analysis of Variance. The repeated measures ANOVA indicated the mean score of the quality and severity of pain and pain-related anxiety differed statistically and significantly after the intervention (during the four sessions) compared to before it (baseline) in the intervention group (p < 0.001). The independent-samples t-test indicated a statistically significant difference in the mean scores of the quality and severity of pain and pain-related anxiety between the two groups (p < 0.001). This difference was found to be significant from the second session onwards (p < 0.001). Medical staff, including physicians, nurses and other healthcare professionals, are responsible for developing strategies to manage complications of burn injuries. Considering the effectiveness of guided imagery in reducing anxiety and pain in burn patients, it is recommended to use this method of complementary medicine to manage stress, anxiety, and pain in these patients.     

The effectiveness of joint-protection programs on pain,hand function,and grip strength levels in patients with hand arthritis: A systematic review and meta-analysis

Study DesignSystematic review with meta-analysis.IntroductionJoint protection (JP) has been developed as a self-management intervention to assist people with hand arthritis to improve occupational performance and minimize joint deterioration over time.Purpose of the StudyWe examined the effectiveness between JP and usual care/control on pain, hand function, and grip strength levels for people with hand osteoarthritis and rheumatoid arthritis.MethodsA search was performed in 5 databases from January 1990 to February 2017. Two independent assessors applied Cochrane's risk of bias tool, and a Grading of Recommendations Assessement, Development and Evaluation (GRADE) approach was adopted.ResultsFor pain levels at short term, we found similar effects between JP and control standardized mean difference (SMD; −0.00, 95% confidence interval [CI]: −0.42 to 0.42, I² = 49%), and at midterm and long-term follow-up, JP was favored over usual care SMD (−0.32, 95% CI: −0.53 to −0.11, I² = 0) and SMD (−0.27, 95% CI: −0.41 to −0.12, I² = 9%), respectively. For function levels at midterm and long-term follow-up, JP was favored over usual care SMD (−0.49, 95% CI: −0.75 to −0.22, I² = 34%) and SMD (−0.31, 95% CI: −0.50 to −0.11, I² = 56%), respectively. For grip strength levels, at long term, JP was inferior over usual care mean difference (0.93, 95% CI: −0.74 to 2.61, I² = 0%).ConclusionsEvidence of very low to low quality indicates that the effects of JP programs compared with usual care/control on pain and hand function are too small to be clinically important at short-, intermediate-, and long-term follow-ups for people with hand arthritis.     

The relationship between cardiovascular complications of estrogen therapy and fibrinolysis in patients with prostatic cancer.

To determine the relationship between cardiovascular complications of estrogen therapy and fibrinolysis, fibrinolysis parameters plasminogen, urokinase-type plasminogen activator (u-PA), tissue-type plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1), were assessed in 12 prostatic cancer patients before and 6 weeks after the onset of estrogen therapy. The levels of plasminogen, u-PA, and PAI-1 in the patients treated with the estrogen therapy were significantly higher than those in the patients before the therapy. The t-PA level in the patients during the therapy was significantly lower than that before the treatment. Cardiovascular complications were found in two patients (16.7%) during estrogen therapy. In the two patients, marked elevation of PAI-1 and decreased level of t-PA were observed during the therapy. These results indicate that cardiovascular complications of estrogen therapy in patients with prostatic cancer may be related to hypofibrinolysis resulting from changes of PAI-1 and t-PA.     

血液透析与腹膜透析患者微炎症反应比较及其与营养状况、心血管疾病关系的研究

目的 研究血液透析、腹膜透析两种透析方式对慢性肾衰尿毒症患者微炎症状态的影响,探讨微炎症状态与营养状况、心血管疾病的关系.方法 选择2011年1月至2012年6月沈阳市红十字会医院肾内科住院的尿毒症患者64例(血液透析30例、腹膜透析34例)及健康对照者30例,检测C反应蛋白、白介素6、尿素氮、肌酐、白蛋白、前白蛋白、血红蛋白,计算体重指数.根据主观综合性营养评价将患者分为营养良好组、营养不良组.记录透析处方和心血管并发症.结果 本组尿毒症患者C反应蛋白、白介素6较对照组显著升高(P＜0.01),血液透析组C反应蛋白、白介素6显著高于腹膜透析组(P＜0.05).尿毒症各组内营养良好组C反应蛋白、白介素6较营养不良组显著升高(P＜0.05),合并慢性心衰组C反应蛋白、白介素6较无心衰并发症组显著升高(P＜0.05).C反应蛋白与白蛋白、前白蛋白呈显著负相关,与尿素氮、肌酐、血红蛋白无显著相关性.结论 血液透析患者微炎症状态比腹膜透析患者严重,尿毒症患者微炎症状态与营养不良及心血管疾病密切相关.     

Healthcare resource utilization,treatment patterns,and cost of care among patients with thermal burns and inpatient autografting in two large privately insured populations in the United States

The current standard of care for severe burns includes autografting; however, there is scarce knowledge regarding the long-term economic burden associated with thermal burns and inpatient autografting. The objective of this study was to characterize healthcare resource utilization, treatment patterns, and cost of care for thermal burn patients in two large privately insured populations in the United States who underwent inpatient autografting between 01/01/2011 and 06/30/2016. Patient demographics, clinical characteristics, healthcare resource utilization, and total cost were examined during baseline (one year before the initial hospitalization with autografting) and two-year evaluation period. There was a substantial economic burden on thermal burn patients who received inpatient autografts (HIRD® database [HIRD]: N = 371, mean age = 39.6 years, male = 67.1%; MarketScan® database [MarketScan]: N = 698, mean age = 38.2 years, male = 63.3%) in the year 1 evaluation period (HIRD: mean = $184,805; MarketScan: mean = $155,272), which was mainly driven by the initial hospitalization with autografting (HIRD: mean = $157,384 and MarketScan: mean = $131,470). The percentage of patients with burn-related healthcare resource utilization and average burn-related costs were considerably reduced in the year 2 evaluation period (HIRD: mean = $3020; MarketScan: mean = $1990). Consistent with previous studies, mean length of hospital stay (days) and mean total medical costs generally increased as the percentage of total body surface area burned increased.