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Ogundare T, Adebowale TO, Borba CPC, Henderson DC. Correlates of depression and quality of life among patients with epilepsy in Nigeria. Epilepsy Res 2020; 164:106344. [PMID: 32361406 DOI: 10.1016/j.eplepsyres.2020.106344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To determine the prevalence of Major Depressive Disorders (MDD) and its relationship to Quality of life. DESIGN A cross-sectional observational study. SETTING Out-Patient Clinic of the Neuropsychiatric Hospital, Abeokuta, Nigeria. SUBJECTS Patients with diagnosis of Epilepsy with Electroencephalogram (EEG) confirmation. OUTCOME MEASURES Depression and Quality of life. RESULTS The prevalence of current MDD was 11.9 %, and patients having at least 1 seizure per week were 5 times more likely to develop MDD (OR = 5.104, p = 0.014). The mean (SD) QOLIE-31 scores was 77.98 (13.32), with presence of MDD (β = -11.101, p = 0.0001); having at least 1 seizure/week (β = -6.653, p = 0.037) being independent predictors. CONCLUSION Depression is a common comorbidity in patients with epilepsy and is associated with a lower quality of life.
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Affiliation(s)
- Temitope Ogundare
- Neuropsychiatric Hospital Aro, PMB 2002, Abeokuta, Ogun State, Nigeria; Boston University School of Public Health, Boston, MA, 02118, USA.
| | | | - Christina P C Borba
- Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
| | - David C Henderson
- Boston University School of Medicine, Boston, MA 02118, USA; Department of Psychiatry, Boston Medical Center, Boston, MA 02118, USA
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Ajayi AA, Sofowora GG, Ladipo GO. Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. J Natl Med Assoc 2020; 112:141-157. [PMID: 32165009 DOI: 10.1016/j.jnma.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
The annual heart failure (HF) mortality rate in Africa is 34% according to the INTERHF study. This is twice the world average of 16.5% and 3.7 times that of South America, 9%. We review evidence-based explanations for the Hyper-mortality of HF, by comparison of North American, Caribbean, Afro-Brazilian with Sub-Saharan African (SSA) nations profiles, and suggest amelioration. 1 year HF mortality rates in SSA ranged from 29% to 58%, and intra-hospital mortality rate from 8 to 26% (n = 8). A clustering of adverse genetic single nucleotide polymorphisms (SNP) predisposing to hypertension and/or left ventricular hypertrophy (LVH) in the black diaspora may contribute. A higher prevalence of HF with reduced Ejection Fraction (HF r EF) phenotype, which is associated with greater mortality is more common in SSA nations. Additionally, a worse co-morbidity burden, especially valvular regurgitations causing LV remodeling (LVR), chronic kidney disease (CKD), anemia, lung disease, infections, late presentation in NYHA III/IV, right ventricular disease (RVD) were also common in SSA. Geographic variation in SSA, HF risk factors and co-morbidity was observed. There was sub-optimal use of guideline directed medical therapy (GDMT) and intracardiac device (ICD) unavailability. Gross Domestic Product -per purchasing power parity (GDP-PPP), which is low in SSA, was inversely correlated both to higher intra-hospital mortality rate % (r = -0.73, r 2 = 0.54 p = 0.038) and higher 1 year HF mortality rate % (r = -0.62, r 2 = 0.38, = 0.098). Localized primary prevention, early detection and prompt treatment of hypertension, diabetes, rheumatic fever, early cardiac valve repair and use of cardiovascular polypill, optimal use of GDMT, national health insurance scheme are advocated to stem the dismal mortality and cost burden of HF.
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Affiliation(s)
- Adesuyi A Ajayi
- Adjunct Professor, Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, 77060, USA.
| | - Gbemiga G Sofowora
- Associate Professor of Cardiology, Cardiovascular Medicine Division, Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Gani O Ladipo
- Retired Professor of Cardiology, Obafemi Awolowo University, Ile -ife, Osun State, Nigeria
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Adebayo PB, Akintunde AA, Adebayo AJ, Asaolu SO, Audu M, Ayodele OE. Comparison of Neuropsychological Patterns in Nigerians with different Heart Failure Phenotypes. Arch Clin Neuropsychol 2017; 32:280-288. [PMID: 28034849 DOI: 10.1093/arclin/acw113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/12/2016] [Indexed: 11/12/2022] Open
Abstract
Objective The aim of this study was to determine the influence of left ventricular dysfunction type on the pattern of neuropsychological dysfunctions among heart failure (HF) subjects. Method A sub-analysis of the data of subjects recruited in a cross-sectional survey of cognitive dysfunction among Nigerians with HF was performed. Cognitive performance on the Community Screening Interview for Dementia (CSI'D), Word List Learning Delayed Recall (WLLDR), Boston Naming Test (BNT), and Modified Token Test (MTT) were compared between heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Clinical and echocardiographic correlation analysis with cognitive performance was performed. Results Subjects with HFpEF were impaired on the WLLDR (71.4% vs. 34.6%, p = .026). The group with HFpEF scored lower on the language domain (definition subscale) of CSI'D (p = .036), and WLLDR (p = .005). The performance on the MTT (p = .185) and BNT (p = .923) were comparable between the two groups. An inverse relationship was found between pulse pressure and delay recall (r = -.565 p = .003) among the cohort with HFpEF whereas body mass index, BMI (r = -.737, p = .023) and tricuspid valve E/A ratio, TVEA (r = -.650, p = .042) showed an inverse relationship with the total CSI'D score in the cohort with HFrEF. Conclusions Cognitive dysfunction is largely similar between the two groups. Delay recall is however poorer among subjects with HFpEF. Regular cognitive screening is advocated among HF subjects to prevent non-adherence with therapeutic options.
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Affiliation(s)
- Philip B Adebayo
- Departments of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria.,Department of Medicine, Ladoke Akintola University of Technology Teaching Hospitals, Ogbomoşo, Nigeria
| | - Adeseye A Akintunde
- Departments of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria.,Department of Medicine, Ladoke Akintola University of Technology Teaching Hospitals, Ogbomoşo, Nigeria
| | - Anthonia J Adebayo
- Department of Clinical Nursing, University College Hospital, Ibadan, Nigeria.,Clinical Psychology Unit, Department of Psychology, University of Ibadan, Nigeria
| | | | - Morenike Audu
- Department of Medicine, Ladoke Akintola University of Technology Teaching Hospitals, Ogbomoşo, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olugbenga E Ayodele
- Departments of Medicine, Faculty of Clinical Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria.,Department of Medicine, Ladoke Akintola University of Technology Teaching Hospitals, Ogbomoşo, Nigeria
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Ogunnubi OP, Olagunju AT, Aina OF, Okubadejo NU. Medication Adherence Among Nigerians with Schizophrenia: Correlation Between Clinico-Demographic Factors and Quality of Life. Ment Illn 2017; 9:6889. [PMID: 28479972 PMCID: PMC5379219 DOI: 10.4081/mi.2017.6889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 11/23/2022] Open
Abstract
Medication adherence contributes significantly to symptom remission, recovery and wellbeing in mental illnesses. We evaluated how medication adherence correlates with clinico-demographic factors and quality of life (QoL) in a sample of Nigerians with schizophrenia. This descriptive cross-sectional study involved 160 randomly selected participants with confirmed diagnosis of schizophrenia based on MINI International Neuropsychiatric Interview. Data on socio-demographic and clinical characteristics of participants were collected with a questionnaire. Medication adherence was assessed with Morisky Medication Adherence Questionnaire, and participants completed the World Health Organization Quality of Life Scale-BREF. The mean age of participants was 38.54 (±11.30) years, and all the participants were on antipsychotics, but only 45% were adherent to their medication. Out of all the participants, 45 (28.2%) considered their overall QoL to be good, 97 (60.6%) considered theirs to be fair, while 18 (11.2%) reported poor QoL. Medication non-adherence correlated negatively with good QoL across multiple dimensions including overall QoL (r=-0.175), health satisfaction (r=-0.161), physical (r=-0.186) and psychological domain (r=-0.175). Again, participant's age (r=-0.190) and age of onset of illness (r=-0.172) correlated negatively with medication non-adherence, and a trend towards relapse delay with medication adherence was also observed (r=-0.155). The effect size of these correlations were however small. Our findings suggest a link between medication adherence and QoL in schizophrenia, such that strategy that addresses medication non-adherence and its determinants may have potential benefits on wellbeing. Further hypotheses-driven studies are desirable.
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Affiliation(s)
- Oluseun P Ogunnubi
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria
| | - Andrew T Olagunju
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria.,Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
| | - Olatunji F Aina
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria.,Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos, Nigeria.,Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Nigeria
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Ahaneku H, Ross MW, Nyoni JE, Selwyn B, Troisi C, Mbwambo J, Adeboye A, McCurdy S. Depression and HIV risk among men who have sex with men in Tanzania. AIDS Care 2016; 28 Suppl 1:140-7. [PMID: 27002772 PMCID: PMC4859320 DOI: 10.1080/09540121.2016.1146207] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Studies have shown high rates of depression among men who have sex with men (MSM) in developed countries. Studies have also shown association between depression and HIV risk among MSM. However, very little research has been done on depression among African MSM. We assessed depression and HIV risk among a sample of MSM in Tanzania. We reviewed data on 205 MSM who were recruited from two Tanzanian cities using the respondent driven sampling method. Demographic and behavioral data were collected using a structured questionnaire. HIV and sexually transmitted infections data were determined from biological tests. Depression scores were assessed using the Patient Health Questionnaire (PHQ-9). For the analysis, depression scores were dichotomized as depressed (PHQ > 4) and not depressed (PHQ ≤ 4). Bivariate and multivariable Poisson regression analyses were conducted to assess factors associated with depression. The prevalence of depression in the sample was 46.3%. The mean (±SD) age of the sample was 25 (±5) years. In bivariate analysis, depression was associated with self-identifying as gay (p = .001), being HIV positive (p < .001: <8% of MSM knew they were HIV infected) and having a high number of sexual partners in the last 6 months (p = .001). Depression was also associated with sexual (p = .007), physical (p = .003) and verbal (p < .001) abuse. In the Poisson regression analysis, depression was associated with verbal abuse (APR = 1.91, CI = 1.30-2.81). Depression rates were high among MSM in Tanzania. It is also associated with abuse, HIV and HIV risk behaviors. Thus, reducing the risk of depression may be helpful in reducing the risk of HIV among MSM in Africa. We recommend the colocation of mental health and HIV preventive services as a cost-effective means of addressing both depression and HIV risk among MSM in Africa.
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Affiliation(s)
- Hycienth Ahaneku
- a Department of Epidemiology, Human Genetics and Environmental Sciences , The University of Texas School of Public Health , Houston , TX , USA
| | - Michael W Ross
- b Department of Family Medicine and Community Health , University of Minnesota , Minneapolis , MN , USA
| | - Joyce E Nyoni
- c Department of Sociology and Anthropology , University of Dar es Salaam , Dar es Salaam , Tanzania
| | - Beatrice Selwyn
- a Department of Epidemiology, Human Genetics and Environmental Sciences , The University of Texas School of Public Health , Houston , TX , USA
| | - Catherine Troisi
- d Department of Management, Policy and Community Health , The University of Texas School of Public Health , Houston , TX , USA
| | - Jessie Mbwambo
- e Department of Psychiatry , Muhimbili University of Health Sciences , Dar es Salaam , Tanzania
| | - Adeniyi Adeboye
- f Department of Health Promotion and Behavioral Sciences , The University of Texas School of Public Health , Houston , TX , USA
| | - Sheryl McCurdy
- f Department of Health Promotion and Behavioral Sciences , The University of Texas School of Public Health , Houston , TX , USA
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Kimani K, Namukwaya E, Grant L, Murray SA. What is known about heart failure in sub-Saharan Africa: a scoping review of the English literature. BMJ Support Palliat Care 2016; 7:122-127. [DOI: 10.1136/bmjspcare-2015-000924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 11/10/2015] [Accepted: 12/17/2015] [Indexed: 11/03/2022]
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Travers KU, Pokora TD, Cadarette SM, Mould JF. Major depressive disorder in Africa and the Middle East: a systematic literature review. Expert Rev Pharmacoecon Outcomes Res 2014; 13:613-30. [PMID: 24138647 DOI: 10.1586/14737167.2013.838026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
With major depressive disorder (MDD) associated with significant clinical, economic and health-related quality of life impact, we sought to systematically review and synthesize information relevant to the burden of MDD in Africa and the Middle East, from which published evidence is slim. Our literature search identified 54 publications assessing epidemiological (43), humanistic (5), clinical/treatment (7) or economic outcomes (2). General population MDD prevalence and that among chronic disease populations were similar in Africa and the Middle East. No MDD-related economic literature specific to Africa or the Middle East was identified. Five studies of humanistic outcomes were identified; four African studies documented significant reduction of health-related quality of life related to MDD. The frequency of certain risk factors for MDD, such as disease, trauma and associated stress, as well as patterns of MDD treatment, suggest the potential for a higher burden of disease in Africa and the Middle East than in western countries.
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Affiliation(s)
- Karin U Travers
- Evidera, 430 Bedford St. Suite 300, Lexington, MA 02420, USA
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Chien CL, Lee CM, Wu YW, Wu YT. Home-based exercise improves the quality of life and physical function but not the psychological status of people with chronic heart failure: a randomised trial. J Physiother 2013; 57:157-63. [PMID: 21843830 DOI: 10.1016/s1836-9553(11)70036-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
QUESTIONS Are anxiety and depression correlated with physical function, disability, and quality of life in people with chronic heart failure? Does 8 weeks of home-based exercise improve anxiety, depression, physical function, disability, and quality of life in these patients? Do the changes in these outcomes correlate? DESIGN Randomised trial. PARTICIPANTS 51 people with clinically stable chronic heart failure were randomised into an experimental group (n=24) or a control group (n=27). INTERVENTION The experimental group undertook an individualised home-based exercise program, 30 minutes per session, 3 sessions per week for 8 weeks, with regular telephone follow-up and consultations. The control group maintained their usual activity during this period. OUTCOME MEASURES The Hospital Anxiety and Depression Scale, six-minute walk test, Groningen Activity Restriction Scale, and Minnesota Living with Heart Failure Questionnaire were administered at baseline and 8 weeks. RESULTS At baseline, anxiety and depression were inversely moderately correlated with walking distance, activity, and quality of life. Compared with controls, the experimental group improved significantly more in their walking distance (by 21m, 95% CI 7 to 36) and their quality of life (by 7 points on the 105-point Minnesota score, 95% CI 1 to 12). In the experimental group, the changes in quality of life correlated moderately strongly with changes in anxiety (r=0.539, p=0.01). CONCLUSIONS Anxiety and depression were associated with physical function, disability, and quality of life in people with chronic heart failure. Home-based exercise improved quality of life and physical function significantly but not psychological status in these patients.
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Affiliation(s)
- Chen-Lin Chien
- College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
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9
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Khatibzadeh S, Farzadfar F, Oliver J, Ezzati M, Moran A. Worldwide risk factors for heart failure: a systematic review and pooled analysis. Int J Cardiol 2012. [PMID: 23201083 DOI: 10.1016/j.ijcard.2012.11.065] [Citation(s) in RCA: 164] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Heart failure risk factors are diverse and likely to vary among world regions. Systematic review and pooled analysis were used to describe contributions of major underlying risk factors for heart failure in six world regions. METHODS Electronic databases were systematically searched, and 37 clinic-based studies representing 40 countries published in 1980-2008 and reporting underlying risk factors for heart failure were included. Risk factors were classified as ischemic heart disease (IHD), hypertension, rheumatic/other valvular heart disease, cardiopulmonary disease, cardiomyopathy, and "other". Crude and age- and sex-adjusted risk factor prevalences were estimated for each region using a regression analysis, under specifications of overlapping as well as additive contributions. RESULTS Many heart failure cases were assigned multiple underlying risk factors, leading to a considerable overlap. Crude IHD prevalence among heart failure patients was >50% in Europe and North America, approximately 30-40% in East Asia and Latin America and the Caribbean, and <10% in Sub-Saharan Africa. Age and sex adjustment attenuated regional differences in IHD-as-risk factor but IHD remained rare in Sub-Saharan Africa. Hypertension prevalence was high in heart failure patients of all regions but the highest in Eastern and Central Europe and Sub-Saharan Africa (age- and sex-adjusted, 35.0% and 32.6%, respectively). Cardiomyopathy was most common in Latin America, the Caribbean and Sub-Saharan Africa (age- and sex-adjusted, 19.8% and 25.7%). CONCLUSIONS Heart failure risk factors vary substantially among world regions. More detailed regional heart failure epidemiology studies are needed in order to quantify the global burden of heart failure and identify regional prevention and treatment strategies.
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Predictors of Group Cognitive Behaviour Therapy outcomes for the treatment of depression in Malaysia. Asian J Psychiatr 2011; 4:125-8. [PMID: 23051078 DOI: 10.1016/j.ajp.2011.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 03/14/2011] [Accepted: 04/09/2011] [Indexed: 11/19/2022]
Abstract
The aim of this study was to identify predictors of response to treatment for depression in Malaysia, using demographic and cognitive predictors. 113 patients, that were diagnosed with depression, were randomly assigned to the Treatment-As-Usual (TAU) (n=55), or TAU plus eight sessions of Group Cognitive Behaviour Therapy (TAU+GCBT; n=58). Pre-treatment using the Beck Hopelessness Scale (BHS), the Automatic Thoughts Questionnaire-Malay (ATQ-Malay), the Dysfunctional Attitude Scale-Malay (DAS-Malay), a quality of life scale, and demographic characteristics, were used in a series of multiple regression models, as potential predictors of the Beck Depression Inventory-Malay (BDI-Malay) post-assessment scores. Regression results revealed that age, the quality of life scale, and all three cognitive measures were significant predictors of outcomes in the Group Cognitive Behaviour Therapy (GCBT) group, showing that Beck's cognitive model for depression could be applied in Malaysia.
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Yohannes AM, Willgoss TG, Baldwin RC, Connolly MJ. Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. Int J Geriatr Psychiatry 2010; 25:1209-21. [PMID: 20033905 DOI: 10.1002/gps.2463] [Citation(s) in RCA: 293] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review evidence regarding the prevalence, causation, clinical implications, aspects of healthcare utilisation and management of depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease. DESIGN A critical review of the literature (1994-2009). FINDINGS The prevalence of depression and anxiety is high in both chronic obstructive pulmonary disease (8-80% depression; 6-74% anxiety) and chronic heart failure (10-60% depression; 11-45% anxiety). However, methodological weaknesses and the use of a wide range of diagnostic tools make it difficult to reach a consensus on rates of prevalence. Co-morbid depression and anxiety are associated with increased mortality and healthcare utilisation and impact upon functional disability and quality of life. Despite these negative consequences, the identification and management of co-morbid depression and anxiety in these two diseases is inadequate. There is some evidence for the positive role of pulmonary/cardiac rehabilitation and psychotherapy in the management of co-morbid depression and anxiety, however, this is insufficient to guide recommendations. CONCLUSIONS The high prevalence and associated increase in morbidity and mortality justifies future research regarding the management of anxiety and depression in both chronic heart failure and chronic obstructive pulmonary disease. Current evidence suggests that multi-faceted interventions such as pulmonary and cardiac rehabilitation may offer the best hope for improving outcomes for depression and anxiety.
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Affiliation(s)
- A M Yohannes
- Department of Health Professions, Manchester Metropolitan University, Elizabeth Gaskell Campus, Manchester, UK.
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van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Quality of life and non-pain symptoms in patients with cancer. J Pain Symptom Manage 2009; 38:216-33. [PMID: 19564094 DOI: 10.1016/j.jpainsymman.2008.08.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 08/25/2008] [Accepted: 09/09/2008] [Indexed: 01/29/2023]
Abstract
To measure the prevalence of non-pain physical symptoms and psychological symptoms in patients with cancer, to investigate the impact of physical and psychological symptoms on their quality of life (QoL), and to inquire whether treatment had been received for the complaints/symptoms, a representative sample of 1,429 cancer patients were recruited and classified according to tumor type and treatment status [i.e., (1a) curative treatment >6 months ago, (1b) curative treatment <or=6 months ago, (2) palliative antitumor treatment, and (3) treatment no longer feasible]. QoL and non-pain symptoms were measured by the European Organisation for Research and Treatment of Cancer (EORTC)-C30 version 3. We added two items: (1) Did you have a dry mouth? and (2) Did you feel listless? We also asked whether the patients had received treatment for their symptoms. Depression and anxiety were measured by the Dutch version of the Hospital Anxiety and Depression Scale. One-way analysis of variance (ANOVA) was used to detect differences in global QoL between patients with different types of cancer. When ANOVA was significant, post hoc tests (Tukey) were performed to identify significant differences among cancer types. Linear regression analyses (forced entrance procedure) were performed to investigate the influence of physical and psychological symptoms on global QoL. The prevalence of moderate-to-severe symptoms increased significantly with each disease group. Vomiting and irritability were the least prevalent symptoms, and fatigue and worries were the most prevalent symptoms in all groups. Patients in Group 1 (curative treatment) experienced symptoms that were independent of cancer type. Patients in Group 2 (palliative treatment) experienced symptoms that varied with cancer type. QoL decreased significantly each step from Group 1 through 3. Fatigue, appetite loss, constipation, dry mouth, depression, and anxiety had independent negative influences on QoL. Patients with gastrointestinal cancer, malignant lymphoma, and other hematological malignancies had significantly poorer QoL than patients with prostate cancer. In 45%-90% of patients, symptoms remained untreated. Non-pain physical symptoms and psychological symptoms are frequent in patients with cancer at all disease phases. Many symptoms remain untreated. Systematic recording of symptom intensity should be mandatory, irrespective of the phase of disease.
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Corvera-Tindel T, Doering LV, Roper J, Dracup K. Emotional Functioning Drives Quality of Life in Men with Heart Failure. ACTA ACUST UNITED AC 2009; 24:2-11. [DOI: 10.1111/j.1751-7117.2009.00026.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monahan PO, Shacham E, Reece M, Kroenke K, Ong'or WO, Omollo O, Yebei VN, Ojwang C. Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya. J Gen Intern Med 2009; 24:189-97. [PMID: 19031037 PMCID: PMC2629000 DOI: 10.1007/s11606-008-0846-z] [Citation(s) in RCA: 330] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 06/30/2008] [Accepted: 10/08/2008] [Indexed: 12/27/2022]
Abstract
BACKGROUND Depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings. OBJECTIVE To assess the validity/reliability of PHQ-9 and PHQ-2. DESIGN Observational, two occasions 7 days apart. PARTICIPANTS A total of 347 patients attending psychosocial support groups. MEASUREMENTS Demographics, PHQ-9, PHQ-2, general health perception rating and CD4 count. RESULTS Rates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%, 21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 > or =3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18-35, 36-61) subgroups. CONCLUSIONS PHQ-9 and PHQ-2 appear valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya.
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Affiliation(s)
- Patrick O Monahan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-3002, USA.
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Fraguas R, da Silva Telles RM, Alves TCTF, Andrei AM, Rays J, Iosifescu DV, Wajngarten M. A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: the relevance of the placebo effect and psychological symptoms. Contemp Clin Trials 2009; 30:205-11. [PMID: 19470312 DOI: 10.1016/j.cct.2009.01.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 01/10/2009] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Little is known about the treatment of depression in older patients with heart failure. This study was developed to investigate the effectiveness of antidepressant treatment for major depressive disorder (MDD) in the elderly with heart failure. METHODS We enrolled 72 older outpatients with ejection fraction <50 and diagnosed with MDD by the structured clinical interview for DSM-IV. Thirty-seven patients, 19 on citalopram and 18 on placebo, initiated an 8-week double-blind treatment phase. Measurements were performed with the 31-item Hamilton Rating Scale for Depression (Ham-D-31), the Montgomery-Asberg rating scale (MADRS) and the Systematic Assessment for Treatment Emergent Effects (SAFTEE). A psychiatrist followed up the patients weekly, performing a consultation for about 20 min to field complaints after the measurements. RESULTS A trend toward superiority of citalopram over placebo in reducing depression was observed in MADRS scores (15.05+9.74 vs 9.44+9.25, P=.082) but not on HAM-D scores. The depressive symptomatology significantly decreased in both groups (P < .001). The high rate of placebo response during the double-blind phase (56.3%) led us to conclude the study at the interim analysis with 37 patients. CONCLUSION Citalopram treatment of MDD in older patients with heart failure is well-tolerated with low rates of side effects, but was not significantly more effective than placebo in the treatment of depression. Weekly psychiatric follow-up including counseling may contribute to the improvement of depression in this population. Scales weighted on psychological symptoms such as the MADRS are possibly better suited to measure depression severity and improvement in patients with heart failure.
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Affiliation(s)
- Renerio Fraguas
- Department and Institute of Psychiatry, Clinics Hospital, Faculty of Medicine, University of Sao Paulo, SP, Brazil.
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Kengne AP, Dzudie A, Sobngwi E. Heart failure in sub-Saharan Africa: a literature review with emphasis on individuals with diabetes. Vasc Health Risk Manag 2008; 4:123-30. [PMID: 18629376 PMCID: PMC2464771 DOI: 10.2147/vhrm.2008.04.01.123] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Heart failure is the ultimate complication of cardiac involvements in diabetes. The purpose of this review was to summarize current literature on heart failure among people with diabetes mellitus in sub-Saharan Africa (SSA). METHOD Bibliographic search of published data on heart failure and diabetes in sub-Saharan Africa over the past 26 years. RESULTS Heart failure remains largely unexplored in general population and among people with diabetes in Africa. Heart failure accounts for over 30% of hospital admission in specialized cardiovascular units and 3%-7% in general internal medicine. Over 11% of adults with heart failure have diabetes. Risk factors for heart failure among those with diabetes include classical cardiovascular risk factors, without evidence of diabetes distinctiveness for other predictors common in Africa. Prevention, management, and outcomes of heart failure are less well known; recent data suggest improvement in the management of risk factors in clinical settings. CONCLUSIONS Diabetes mellitus is growing in SSA. Related cardiovascular diseases are emerging as potential health problem. Heart failure as cardiovascular complication remains largely unexplored. Efforts are needed through research to improve our knowledge of heart failure at large in Africa. Multilevel preventive measures, building on evidences from other parts of the world must go along side.
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Affiliation(s)
- Andre Pascal Kengne
- The George Institute for International Health, University of Sydney, Australia.
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Kim AR, Seo BB, Kim JM, Bae JI, Jang YH, Lee YC, Kang CH, Jung SW, Hong JH. Beck Depression Inventory Score and Associated Factors in Korean Patients with Lumbar Spinal Stenosis. Korean J Pain 2007. [DOI: 10.3344/kjp.2007.20.2.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ae Ra Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
| | - Bo Byoung Seo
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
| | - Jin Mo Kim
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
| | - Jung In Bae
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
| | - Young Ho Jang
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
| | - Yong Cheol Lee
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
| | - Chul Hyung Kang
- Department of Orthopedic Surgery, Keimyung University School of Medicine, Korea
| | | | - Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University School of Medicine, Korea
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