Childhood adversity and frequent medical consultations

We assessed possible psychological mediators of the relationship between childhood adversity and frequent medical consultations among new outpatients at neurology, cardiology, and gastroenterology clinics. We assessed whether these differed in patients with and without organic disease that explained their symptoms. At first clinic visit we recorded Hospital Anxiety and Depression scale (HADS--anxiety and depression subscale scores), Illness Perception Questionnaire (IPQ--four subscales: consequences, cure, identity, timeline), Health Anxiety Questionnaire (total score), and Symptom Amplification Scale (total score). Subjects were divided into two groups according to whether they had experienced any type of childhood adversity using the Childhood Experience of Care and Abuse Schedule. Outcome was the (log) number of medical consultations for 12 months before and 6 months after the index clinic visits. Multiple regression analysis was used to determine mediators; this was performed separately for patients with symptoms explained and not explained by organic disease. One-hundred and twenty-nine patients (61% response) were interviewed. Fifty-two (40.3%) had experienced childhood adversity; they made a median of 16 doctor visits compared with 10 for those without adversity (adjusted P=.026). IPQ identity score (number of symptoms attributed to the illness) and HAD depression scores were significantly associated with both childhood adversity and number of medical consultations and these variables acted as mediators between childhood adversity and frequency of consultation in the multiple regression analyses. This association was limited to patients with medically unexplained symptoms and was mediated by IPQ Identity Score (number of symptoms attributed to the patient's illness) and HAD depression score. Sexual abuse and overt neglect were the adversities most closely associated with frequent consultations. In patients with medically unexplained symptoms the association between childhood adversity and frequent medical consultations is mediated by the number of bodily symptoms attributed to the illness. Psychological treatments should be targeted at these patients with a view to reducing their frequent doctor visits.     

Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment

OBJECTIVE: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to functional impairment. METHOD: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and functional impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with functional impairment. RESULTS: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to functional impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of functional impairment. CONCLUSIONS: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.     

Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood

OBJECTIVE: the present study investigated childhood learning experiences potentially associated with the development of elevated hypochondriacal concerns in a non-clinical young adult sample, and examined the possible mediating roles of anxiety sensitivity (i.e., fear of anxiety-related symptoms) and trait anxiety (i.e., frequency of anxiety symptoms) in explaining these relationships. METHOD: 197 university students participated in a retrospective assessment of their childhood instrumental (i.e., parental reinforcement) and vicarious (i.e., parental modeling) learning experiences with respect to arousal-reactive (e.g., dizziness) and arousal-non-reactive (e.g., lumps) bodily symptoms, respectively. Childhood learning experiences were assessed using a revised version of the Learning History Questionnaire (LHQ), anxiety sensitivity levels with the Anxiety Sensitivity Index (ASI), trait anxiety levels with the State-Trait Anxiety Inventory-Trait (STAI-T) scale, and degree of hypochondriacal concerns with the Illness Attitudes Scale (IAS)-Total score. RESULTS: consistent with earlier findings [Watt MC, Stewart SH, Cox BJ. A retrospective study of the learning history origins of anxiety sensitivity. Behav Res Ther 1998; 36: 505-525.], elevated anxiety sensitivity levels were associated with increased instrumental and vicarious learning experiences related to both arousal-reactive and arousal-non-reactive bodily symptoms. Similarly, individuals with elevated hypochondriacal concerns also reported both more instrumental and vicarious learning experiences around bodily symptoms than did students with lower levels of such concerns. However, contrary to the hypothesis, the childhood learning experiences related to hypochondriacal concerns were not specific to arousal-non-reactive symptoms, but instead involved parental reinforcement and modeling of bodily symptoms in general (arousal-reactive and -non-reactive symptoms alike). Anxiety sensitivity, but not trait anxiety, partially mediated the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. CONCLUSIONS: elevated anxiety sensitivity appears to be a risk factor for the development of hypochondriasis when learning experiences have involved both arousal-reactive and arousal-non-reactive bodily symptoms.     

Illness perceptions,affective response,and health-related quality of life in patients with atrial fibrillation

ObjectiveThe purpose of this study was to determine how health-related quality of life (HRQoL), depression, and anxiety change over the first 12 months following diagnosis of atrial fibrillation (AF). In addition, we also aimed to investigate whether illness perceptions and beliefs about medication at the time of diagnosis are associated with HRQoL and affective response over time.MethodsSeventy patients [mean (S.D.) age of 71.4 (9.1) years; 45 (64.3%) were men] with ‘lone’ AF completed the Beck Depression Inventory Short Form (BDI-SF-13), State–Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS), Short-Form Medical Outcomes Survey (SF-36), Illness Perception Questionnaire, and Beliefs about Medication Questionnaire at baseline and the BDI-SF-13, STAI, PSS, and SF-36 at 6 and 12 months after diagnosis of AF.ResultsLone AF patients reported few depressive symptoms, while anxiety symptoms predominated, with a prevalence of elevated state anxiety (STAI-S ≥40) of 38.5%, 30.9%, and 35.7% at baseline and at 6 and 12 months, respectively. There were no significant differences in the levels of depression and mean levels of state and trait anxiety, perceived stress, and HRQoL (except for an increase in energy and decline in general health perception) over time. Baseline state and trait anxiety afforded the best prediction of state anxiety trajectory over 12 months (42% and 5%, respectively). The number of symptoms patients perceived as attributable to AF and specific concerns relating to their medication, at baseline, were independent predictors of physical health trajectories over 12 months after adjustment for age, gender, and AF type (P=.01) and together accounted for 15% of the variance in the slope.ConclusionAnxiety appears to be the main affective response to diagnosis of AF in a cohort of patients without other associated comorbidities. Patients' perceptions of their symptoms and concerns about the necessity of medication at diagnosis should be specifically addressed as part of their medical management.     

Change in mental symptoms in extreme obesity patients after gastric banding, Part II: Six-year follow up

OBJECTIVE: Apart from increased somatic morbidity, extreme obesity causes grave psychosocial and psychopathological problems. We examined a sample of 50 extremely adipose women (BMI < 40 kg/m2) from 2000 to 2003 to find out whether surgical reduction of stomach volume leads to lasting change in Body Mass Index (BMI), psychosocial symptoms, and health related quality of life. We found that positive changes in BMI reduction, psychosocial symptoms, and health related quality of life could be expected three years after gastric banding (Int. J Psychiatry Med 2005; 35:109-122). During the following three years, we continued to observe these patients to determine long-term effects. METHOD: Fifty adipose women who had taken part in the first study from 2004 to 2006 were surveyed. Annual primary outcome measures were BMI, self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), Hospital Anxiety and Depression Scale (HADS-D), and Health Survey (SF-36). RESULTS: At the 6-year mark, significant changes in BMI (p < 0.01), significantly increased employment (0.012) and the existence of a partnership (p < 0.01), plus significant changes on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression: p < 0.011), and all scales of the SF-36 Health Survey (all p < 0.01) were observed. CONCLUSIONS: The positive changes in BMI reduction, i.e., increased employment and subjects living in a partnership, improvement in eating behavior, reduction in anxiety and depressive symptoms, and improvement in health related quality of life were also confirmed as remaining stable over a 3-year observation period, i.e., for a total of six years.     

The Relationship between Depression,Anxiety, Somatization,Personality and Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

This study investigated the relationship of personality, depression, somatization, anxiety with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the International Prostate Symptom Score (IPSS), 44-item Big Five Inventory (BFI), the Patient Health Questionnaire-9 (PHQ-9), the PHQ-15, and 7-item Generalized Anxiety Disorder Scale (GAD-7). The LUTS/BPH symptoms were more severe in patients with depression (p=0.046) and somatization (p=0.024), respectively. Neurotic patients were associated with greater levels of depression, anxiety and somatisation (p=0.0059, p=0.004 and p=0.0095, respectively). Patients with high extraversion showed significantly low depression (p=0.00481) and anxiety (p=0.035) than those with low extraversion. Our exploratory results suggest patients with LUTS/BPH may need careful evaluation of psychiatric problem including depression, anxiety and somatization. Additional studies with adequate power and improved designs are necessary to support the present exploratory findings.     

Depression,anxiety and quality of life in parents of children with epilepsy

0bjectives – To assess the impact of childhood epilepsy on parental quality of life (QOL) and psychological health, and to investigate possible correlations between parental QOL and background variables as well as parental anxiety and depression. Subjects and methods – Parents having an epileptic child (n = 263) and parents having a healthy child (n = 270) were enrolled. Groups were in balance for background variables. Short‐Form Health Survey (SF‐36) Questionnaire, Zung Depression Scale (ZDS) and Zung Anxiety Scale (ZAS) were applied to all parents. Patients were divided into the first visit group (newly diagnosed epilepsy) and follow‐up visit group. Results – The parents of children with epilepsy had significantly lower QOL scores in SF‐36 for all subscales and higher levels of depression and anxiety by using ZDS and ZAS. The factors correlated with parental QOL were seizure control, visit status, anxiety, depression, employment, cost of epilepsy, status epilepticus, drug side effect and age of parents. Conclusions – Childhood epilepsy has a severe impact on parental QOL and psychological health, and recognition of possible correlations between parental QOL and background variables will be helpful to improve parental QOL.     

Venlafaxine extended release in the short-term treatment of depressed and anxious primary care patients with multisomatoform disorder

OBJECTIVE: This pilot study explored the efficacy and tolerability of extended-release venlafaxine (venlafaxine ER) in anxious and/or depressed patients with multisomatoform disorder (MSD). METHOD: This 12-week, multicenter, randomized, double-blind study evaluated adult primary care outpatients with MSD and comorbid major depressive disorder, generalized anxiety disorder, or social anxiety disorder (DSM-IV criteria). The intent-to-treat population included 112 patients (venlafaxine ER, N = 55; placebo, N = 57). The primary efficacy variable was the change in the 15-item Patient Health Questionnaire (PHQ-15) somatic symptom severity score. Secondary outcomes included the Hamilton Rating Scale for Depression (HAM-D-17) and for Anxiety (HAM-A), Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales, McGill Quality of Life Questionnaire Physical Symptoms Scale (MQOL-PS), and Medical Outcomes Study Short-Form 36-Item questionnaire (MOS SF-36). Data were collected from April 2003 to December 2003. RESULTS: The decline by week 12 in PHQ-15 scores was significant (p < .0001) in both groups; however, the difference between the venlafaxine ER and placebo groups (-8.3 vs. -6.6, respectively) was not (p = .097). Improvement was greater with venlafaxine ER than placebo on the PHQ-15 pain subscale (p = .03), SF-36 bodily pain scale (26.1 vs. 14.5, p = .03), MQOL-PS (-11.7 vs. -6.0, p = .02), HAM-A psychic anxiety subscale (p = .02), SF-36 mental component summary (p = .03), time to response (54 vs. 71 days, p = .01), and CGI-I scale (p = .009). Venlafaxine ER was generally well tolerated. CONCLUSION: These results suggest that venlafaxine ER may be effective in relieving some types of somatic physical symptoms, particularly pain, in patients with depression and/or anxiety disorders.     

Anxiety enhances the detrimental effect of depressive symptoms on health status following percutaneous coronary intervention

OBJECTIVE: We examined whether anxiety has incremental value to depressive symptoms in predicting health status in patients undergoing percutaneous coronary intervention (PCI) treated in the drug-eluting stent era. METHODS: A series of consecutive patients (n=692) undergoing PCI as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital registry completed the Hospital Anxiety and Depression Scale at 6 months and the Short-Form Health Survey (SF-36) at 6 and 12 months post-PCI. RESULTS: Of 692 patients, 471 (68.1%) had no symptoms of anxiety nor depression, 62 (9.0%) had anxiety only, 59 (8.5%) had depressive symptoms only, and 100 (14.5%) had co-occurring symptoms. There was an overall significant improvement in health status between 6 and 12 months post-PCI (P<.001); the interaction effect for time by psychological symptoms was also significant (P=.003). Generally, patients with co-occurring symptoms reported significantly poorer health status compared with the other three groups (Ps <.001). Patients with co-occurring symptomatology were also at greater risk of impaired health status on six of the eight subdomains of the SF-36 compared with the other three symptom groups, adjusting for baseline characteristics and health status at 6 months. CONCLUSION: Patients with co-occurring symptoms of anxiety and depression reported poorer health status compared with anxious or depressed-only patients and no-symptom patients, showing that anxiety has incremental value to depressive symptoms in identifying PCI patients at risk for impaired health status treated in the drug-eluting stent era.     

Cognitive vulnerability in fear of flying: the role of anxiety sensitivity

Previous research has indicated that more than 50% of air travel passengers experience hypoxia above clinical threshold. This condition produces a number of aversive somatic sensations such as difficulty breathing, elevated heart rate, dizziness, etc. Because these symptoms closely resemble the somatic symptoms of anxiety, it is interesting to look into a possible relationship between hypoxia-related symptoms and fear of flying. More specifically, the aim of this study is to clarify the role of anxiety sensitivity as a cognitive vulnerability marker in this relationship. Anxiety sensitivity is the specific tendency to interpret bodily sensations as threatening or harmful. Our hypothesis is that anxiety sensitivity moderates the relationship between hypoxia-related symptoms and fear of flying. When people with high anxiety sensitivity fly and experience somatic symptoms, they will make threatening interpretations causing fear and as a possible consequence avoidance behaviour leading to flight anxiety. About 160 participants were asked to complete the Flight Anxiety Situations Questionnaire, the Flight Anxiety Modality Questionnaire and the Anxiety Sensitivity Index. Results of a moderator analysis indicated that the relationship between somatic sensations and in-flight anxiety is stronger for people with high anxiety sensitivity than for people with low anxiety sensitivity. So it seems that anxiety sensitivity does indeed function as a moderator between the experience of somatic sensations while flying and in-flight anxiety. Clinical implications are discussed, as well as suggestions for further research.     

Health anxiety and fear of fear in panic disorder and agoraphobia vs. social phobia: a prospective longitudinal study

Background: This study is aimed to evaluate the role of two vulnerability factors, health anxiety and fear of fear, in the prediction of the onset of panic disorder/agoraphobia (PDA) relative to a comparison anxiety disorder. Methods: Young women, aged between 18 and 24 years, were investigated at baseline and, 17 months later, using the Anxiety Disorders Interview Schedule‐Lifetime and measures of health anxiety and fear of bodily sensations (subscale disease phobia of the Whiteley Index, and total score of the Body Sensations Questionnaire). First, 22 women with current PDA were compared to 81 women with current social phobia and 1,283 controls. Second, 24 women with an incidence of PDA were compared to 60 women with an incidence of social phobia and 1,036 controls. Results: Multiple logistic regression analyses adjusted for history of physical diseases, somatic symptoms, and other psychological disorders revealed that (a) fear of bodily sensations was elevated for women with PDA vs. controls as well as women with social phobia, and (b) health anxiety (and history of physical diseases) was elevated in women who developed PDA vs. controls and vs. women who developed social phobia. Conclusions: These results suggest that health anxiety, as well as history of physical diseases, may be specific vulnerability factors for the onset of PDA relative to social phobia. Whereas fear of bodily sensations was not found to be a risk factor for the onset of panic disorder/agoraphobia, it was a specific marker of existing PDA relative to social phobia. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Patients with extreme obesity: change in mental symptoms three years after gastric banding

OBJECTIVE: Extreme obesity causes grave psychosocial and psychopathological problems in addition to somatic morbidity. One possible treatment is gastric banding, a surgical reduction of stomach volume. The aim of this study was to investigate whether gastric banding leads to lasting change in: 1) the Body Mass Index (BMI); 2) social factors such as work and partnerships, eating behavior, anxiety and depression symptoms; and 3) health related quality of life. METHOD: We surveyed a sample of 50 adipose women (BMI > 40 kg/m2). Primary outcome measures were self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), the Hospital Anxiety and Depression Scale (HADS-D), and the Health Survey (SF-36). RESULTS: In comparison with the control group, we observed significant changes in BMI (p < 0.01) and the existence of a partnership (p < 0.01), on all three scales of the TFEQ (p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression:p < 0.01), and on all scales of the SF-36 Health Survey (p between < 0.05 and < 0.01 in every case). The most marked changes in all the qualities investigated occurred within the first 12 months of surgery. CONCLUSIONS: Three years after gastric banding, positive changes in BMI reduction, partnership, eating behavior, anxiety, depressive symptomatology, and health related quality of life could be observed. There was also a significant correlation between BMI reduction and reduction firstly on the depression scale (HADS-D) and secondly on the SF-36 scales for physical functioning (PHFU), role physical (ROPH), mental health (PSYC), and vitality (VITA).     

Integrated medical care for patients with serious psychiatric illness: a randomized trial.

BACKGROUND: This randomized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders. METHODS: A total of 120 individuals enrolled in a Veterans Affairs (VA) mental health clinic were randomized to receive primary medical care through an integrated care initiative located in the mental health clinic (n = 59) or through the VA general medicine clinic (n = 61). Veterans who obtained care in the integrated care clinic received on-site primary care and case management that emphasized preventive medical care, patient education, and close collaboration with mental health providers to improve access to and continuity of care. Analyses compared health process (use of medical services, quality of care, and satisfaction) and outcomes (health and mental health status and costs) between the groups in the year after randomization. RESULTS: Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care visits than those in the usual care group. They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines. Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic (4.7 points vs -0.3 points, P<.001). There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs. CONCLUSION: On-site, integrated primary care was associated with improved quality and outcomes of medical care.     

Causal illness attributions in somatoform disorders: associations with comorbidity and illness behavior

OBJECTIVE: To compare causal illness beliefs between patients with unexplained physical symptoms and different comorbid disorders and to assess the association of causal illness beliefs with illness behavior. METHODS: We examined a sample of 233 patients attending treatment in primary care. Inclusion criteria were "unexplained physical symptoms." All patients were investigated using structured interviews and self-rating scales [Screening for Somatoform Symptoms (SOMS), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and a 12-item instrument to assess causal attributions]. By means of factor analysis, the following illness attributions were considered: vulnerability to infection and environmental factors, psychological factors, organic causes including genetic and aging factors, and distress (including exhaustion and time pressure). RESULTS: Most patients reported multiple illness attributions. The more somatoform symptoms patients had, the more explanations in general they considered. Especially for vulnerability and organic illness beliefs, patients with somatoform symptoms had increased scores. Comorbidity with depression and with anxiety disorders was associated with more psychological attributions. Even when the influence of somatization, depression, and anxiety is controlled for, illness beliefs still showed associations with illness behavior. Organic causal beliefs and vulnerability attributions were associated with a need for medical diagnostic examinations, increased expression of symptoms, increased illness consequences, and bodily scanning. CONCLUSIONS: Multiple causal attributions can coexist demonstrating different associations with comorbid depression and illness behavior.     

Association between defense mechanisms and psychiatric symptoms in North Korean Refugees

ObjectiveDefense mechanism may contribute to psychiatric symptoms. Refugees are vulnerable to various psychiatric symptoms, such as depression, anxiety, somatization, and those associated with post-traumatic stress disorder (PTSD), due to their traumatic or stressful experiences. We aimed to investigate the mediating role of each defense mechanism in the occurrence of specific psychiatric symptoms in North Korean refugees.MethodAmong 213 North Korean refugees initially recruited, 201 completed the following questionnaires: the Defense Style Questionnaire, the Center for Epidemiological Studies-Depression Scale (CES-D), the State–Trait Anxiety Inventory-State (STAI-S), the somatization subscale of Symptom Check-List-90-Revised (SCL-90-R), and the Impact of Event Scale-Revised (IES-R). Stepwise regression analysis was performed to determine the defense mechanisms more predominantly associated with specific psychiatric symptoms after controlling for age, sex, number of traumatic experiences, and other psychiatric symptoms (depressive symptoms and/or anxiety).ResultsHigher levels of depression were independently predicted by greater use of resignation. More use of acting out and less use of humor and sublimation independently predicted higher levels of anxiety. Somatization was independently predicted by more use of inhibition. PTSD symptoms were independently predicted by more use of undoing and isolation.ConclusionsSpecific psychiatric symptoms were associated with specific defense mechanisms in North Korean refugees. Our findings suggest that the manifest psychiatric symptoms of refugees may be mediated by their dominant defense mechanism.     

综合心理干预对社区慢性病患者的效果评价：一项源于社区的整群、随机、对照试验

背景：抑郁与焦虑经常出现在慢性躯体疾病患者中,通常这会加深这些躯体疾病所造成的损失,但是在中低等收入国家中这一问题却很少受到关注。
　　目标：评估非专业临床人员和志愿者进行以社区为基础的心理干预对缓解慢性躯体疾病患者抑郁和焦虑症状的疗效。
　　方法：将共计10,164名接受糖尿病或高血压治疗的上海社区居民任意分配到常规治疗组(n=2042)或干预组(n=8122),对干预组的干预包括社区范围的心理健康教育、同伴支持小组和个人咨询。采用自评患者健康问卷(Paitent Health Quesitonnaire, PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder scale, GAD-7)和12项健康状况调查问卷(12-item Short-Form Health Survey, SF-12)来评定基线和干预6个月后的抑郁症状、焦虑症状和生活质量。
　　结果：8813人完成了基线评估,其中16%的人有轻度或较严重的抑郁或焦虑症状（PHQ-9或GAD-7>5）,并有4%的人伴有中度或重度抑郁或焦虑症状（PHQ-9或GAD-7>10）。本研究有效实施了干预内容中的健康教育部分,但是在符合条件成为同伴支持小组的成员中仅31%的对象接受了干预措施,接受个人咨询的仅9%。本研究脱落率较高(51%),并且在完成和没有完成随访评估的人群之间存在显著差异。经过这些混杂因素的调整后,在完成两项评估的对象中,结果表明抑郁症状(F=9.98, p<0.001)、焦虑症状(F=12.85, p<0.001)以及SF-12中的心理部分总分(F=16.13, p<0.001)均得到显著改善。然而,自我报告未受控制的糖尿病或高血压的率没有显著变化。
　　结论：这些结果支持了以社区为基础的干预措施的可行性,以降低在精神科人力资源有限的中低等收入国家中慢性疾病患者抑郁和焦虑症状的严重程度。然而,在确认该措施广泛大规模实施前还有大量方法学上的挑战需在未来研究中解决。     

Hypochondriacal concerns and somatization in panic disorder

To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood–injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis. Depression and Anxiety 6:78–85, 1997. © 1997 Wiley-Liss, Inc.     

The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus

OBJECTIVE: This study examined the interrelationships of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in adults with Type 2 diabetes. METHODS: One hundred eighty-four consecutive patients with Type 2 diabetes mellitus completed the Illness Perception Questionnaire (IPQ), the Well-Being Scale (WBQ) and the Short Form 36 Health Survey Questionnaire (SF-36). Demographic characteristics, details of diabetes status (duration of diabetes, treatments and complications) and glycosylated haemoglobin (HbA1c) were recorded. RESULTS: Depression was correlated with greater perceived symptom load (r = .48, P < .01), worse anticipated consequences (r = -.41, P < .01) and perceived lack of control of diabetes (r = .28, P < .01). After controlling for demographic and illness characteristics, personal illness representations relating to symptom load and anticipated consequences were independently associated with the SF-36 physical functioning score, contributing an additional 15% to the variance. WBQ depression and anxiety scores, along with IPQ control and consequences, were independently associated with SF-36 mental function score, contributing a further 51% to the variance after controlling for demographic and illness details. Neither IPQ nor WBQ scales were associated with HbA1c after controlling for demographic and medical illness details. CONCLUSION: Anxiety, depression and negative beliefs about illness influence physical and mental functioning, but not metabolic control in patients with diabetes.