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Schmukler J, Malfait AM, Block JA, Pincus T. 36-40% of Routine Care Patients With Osteoarthritis or Rheumatoid Arthritis Screen Positive for Anxiety, Depression, and/or Fibromyalgia on a Single MDHAQ. ACR Open Rheumatol 2024. [PMID: 39011669 DOI: 10.1002/acr2.11711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/19/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024] Open
Abstract
OBJECTIVE Osteoarthritis (OA) and rheumatoid arthritis (RA) are associated with similar patient disease burdens and a high prevalence of comorbid anxiety (ANX), depression (DEP), and fibromyalgia (FM). Nonetheless, these comorbidities are infrequently assessed in routine care, in part because multiple questionnaires are not feasibly completed by patients. We analyzed the prevalence of ANX, DEP, and FM in patients with OA versus patients with RA seen in routine care using indices within a single Multidimensional Health Assessment Questionnaire (MDHAQ) and associations with \ Routine Assessment of Patient Index Data 3 (RAPID3) and its component function, pain, and patient global scores. METHODS A retrospective analysis of MDHAQ data in unselected patients with OA or RA receiving routine care at one setting included four indices within an MDHAQ: MDHAQ ANX screen, MDHAQ DEP screen, Fibromyalgia Assessment Screening Tool, and RAPID3. The prevalence of each comorbidity and associations with RAPID3 and components were analyzed in unadjusted and age-adjusted (Mantel-Haenszel) odds ratios (ORs) and 95% confidence intervals. RESULTS Overall, 40.4% of 361 patients with OA and 36.3% of 488 patients with RA screened positive for ANX, DEP, and/or FM (8.1% and 7% for all three, respectively). RAPID3 and each component were elevated significantly in patients with any positive screen result for ANX, DEP, and/or FM in both diagnoses (ORs of 2.6-35.8). CONCLUSION FM, DEP, and/or ANX rates were 40.4% in patients with OA and 36.3% in patients with RA, associated with significantly poorer patient status measures. Each of these three common comorbidities of patient distress may be feasibly screened for on a single MDHAQ in routine care.
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Affiliation(s)
| | | | - Joel A Block
- Rush University Medical Center, Chicago, Illinois
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Kang G, Zhang H, Zhou J, Wan D. The WeChat platform-based health education improves health outcomes among patients with stable coronary artery disease. PATIENT EDUCATION AND COUNSELING 2023; 111:107704. [PMID: 36906932 DOI: 10.1016/j.pec.2023.107704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/03/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of the WeChat platform-based health education on patients with stable coronary artery disease (CAD) compared with usual care. METHODS We conducted a randomized controlled trial that included patients with stable CAD who were admitted to the Bin Hai Wan Central Hospital of Dongguan between January 2020 and December 2020. Participants in the control group received a standard regimen of care. In the WeChat group, the patients were provided with the WeChat platform-based health education by multidisciplinary team members in addition to usual care. The coprimary outcome of the study was the blood pressure, lipid profile, fasting blood glucose, Hamilton Anxiety Scale (HAMA) scores, Hamilton Depression Scale (HAMD) scores and Seattle Angina Questionnaire (SAQ) scores at 12 months, relative to baseline levels. RESULTS Between January 2020 and December 2020, 200 eligible CAD patients were randomly assigned to WeChat group (n = 100) or usual care group (n = 100). After 12 months, the number of participants who knew the risk factors, symptoms, diagnostic criteria, management methods and treating target of CAD was significantly larger in the WeChat group than at baseline (P < 0.05) and also larger than the post-intervention level of the control group (P < 0.05). The systolic blood pressure after intervention of the WeChat group significantly decreased compared to those of the control group (132.06 ± 8.87 mmHg vs 140.32 ± 9.42 mmHg; P < 0.05). After intervention, the triglycerides, total cholesterol, and low-density lipoprotein cholesterol of the WeChat group significantly decreased compared to those at baseline and significantly decreased than those in the control group (all P < 0.05). After the intervention, scores of HAMA and HAMD both significantly decreased in the two groups. Moreover, the decreases were more significant in the WeChat group than in the control group (5.78 ± 0.98 vs 8.54 ± 1.24; 6.27 ± 1.03 vs 8.63 ± 1.66; P < 0.05). The SAQ scores of WeChat group were significantly higher than those of the control group in all 5 dimensions at the 1-year follow-up (72.71 ± 10.83 vs 59.32 ± 9.86; 80.01 ± 11.56 vs 61.98 ± 11.02; 76.76 ± 12.64 vs 65.22 ± 10.72; 83.17 ± 13.06 vs 67.01 ± 12.86; 71.82 ± 12.78 vs 55.79 ± 11.90; all P < 0.05). CONCLUSION This study showed the high efficacy of the WeChat platform-based health education in improving health outcomes in patients with CAD. PRACTICE IMPLICATIONS This study highlighted the potential of social media as a helpful tool for health education among patients with CAD.
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Affiliation(s)
- GuanYang Kang
- Department of Cardiology, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), Dongguan, Guangdong, China.
| | - HuiQing Zhang
- Department of Clinical Pharmacy, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), Dongguan, Guangdong, China
| | - Jian Zhou
- Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - DeLi Wan
- Department of Cardiology, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), Dongguan, Guangdong, China
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Depressive Symptoms After Acute Myocardial Infarction and Its Association With Low Functional Capacity and Physical Activity. J Cardiopulm Rehabil Prev 2022; 42:442-448. [PMID: 35383650 DOI: 10.1097/hcr.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Depressive symptoms after acute myocardial infarction (AMI) are related with adverse health outcomes. However, the risk factors and course of depressive symptoms after AMI have not been widely investigated, especially in Asian populations. We aimed to evaluate changes in the prevalence of depressive symptoms and the associated risk factors at 3 mo after AMI. We also investigated the associations among functional capacity, physical activity (PA), and depressive symptoms. METHODS This cross-sectional study was conducted for 1545 patients who were admitted for AMI and referred to cardiac rehabilitation (CR) between August 2015 and March 2019. Of these patients, 626 patients completed the Patient Health Questionnaire-9 (PHQ-9), the Korean Activity Scale Index (KASI), and the International Physical Activity Questionnaire (IPAQ) 3 mo following AMI. A PHQ-9 score of ≥5 was considered to indicate depressive symptoms. RESULTS The prevalence of depressive symptoms was 30% at baseline and decreased to 12% at 3 mo after AMI. Depressive symptoms were significantly associated with low functional capacity (OR = 2.20, P = .004) and unemployment status (OR = 1.82, P = .023). After adjusting for variables including functional capacity, depressive symptoms exhibited a significant relationship with low PA after AMI (OR = 1.80, P = .023). CONCLUSION Systematic screening and treatment for depressive symptoms and efforts to promote CR may help to improve PA and functional capacity in Korean patients with AMI. Such efforts may aid in reducing the depressive symptoms and related adverse outcomes.
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Linden W, Young S, Ignaszewski A, Con A, Terhaag S, Campbell T. Psychosocial and medical predictors of 1-year functional outcome in male and female coronary bypass recipients. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_64_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vlastra W, Delewi R, Rohling WJ, Wagenaar TC, Hirsch A, Meesterman MG, Vis MM, Wykrzykowska JJ, Koch KT, de Winter RJ, Baan J, Piek JJ, Sprangers MAG, Henriques JPS. Premedication to reduce anxiety in patients undergoing coronary angiography and percutaneous coronary intervention. Open Heart 2018; 5:e000833. [PMID: 30275956 PMCID: PMC6157563 DOI: 10.1136/openhrt-2018-000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/09/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022] Open
Abstract
Aims In this study, we examined the effects of the routinely administration of benzodiazepines on reducing periprocedural anxiety versus no premedication. Methods In this open label study, we enrolled 1683 patients undergoing diagnostic coronary angiograms (CAG) or percutaneous coronary interventions (PCI). Randomisation was simulated by systematically allocating patients in monthly rotational periods to lorazepam 1 mg/sl, oxazepam 10 mg/po, diazepam 5 mg/po, midazolam 7.5 mg/po or no premedication. Anxiety was measured at four different time points using the one-item Visual Analogue Scale for Anxiety (VAS score) ranging from 0 to 10. The primary outcome was the difference in anxiety reduction (ΔVAS, preprocedure to postprocedure), between the different premedication strategies versus no premedication. Results Anxiety reduction was larger in patients premedicated with lorazepam (ΔVAS=−2.0, SE=1.6, P=0.007) or diazepam (ΔVAS=−2.0, SE=1.5, p=0.003) compared with patients without any premedication (ΔVAS=−1.4, SE=1.2). The use of midazolam or oxazepam did not lead to a significant reduction in anxiety compared with patients who did not receive premedication. Additionally, a high number of patients treated with midazolam (N=39, 19.8%) developed side effects. Conclusions In this study, the use of lorazepam or diazepam was associated with a significant, but modest anxiety reduction in patients undergoing CAG or PCI. This study does not support the standard use of oxazepam or midazolam as premedication to reduce anxiety.
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Affiliation(s)
- Wieneke Vlastra
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ronak Delewi
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Wim J Rohling
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Tineke C Wagenaar
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Alexander Hirsch
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Martin G Meesterman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Marije M Vis
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Joanna J Wykrzykowska
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Karel T Koch
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jan Baan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jan J Piek
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - José P S Henriques
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Carson AJ, Dawson H, Marshall D, Stafford K. Twenty-eight years of liaison psychiatry at a general hospital. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.22.12.754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodA questionnaire was used to measure physician satisfaction with the unit and comparison of referral numbers and diagnoses with 1967, when the unit was new, and in 1985 when it was re-audited.ResultsDespite physicians' satisfaction with the service, the referral rate remains unchanged.Clinical implicationsLiaison psychiatry should not concern itself with trying to increase referral rates. Research into patient outcome should be a priority and guide its future direction.
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Kidd T, Poole L, Ronaldson A, Leigh E, Jahangiri M, Steptoe A. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery. Br J Health Psychol 2016; 21:796-811. [PMID: 26999442 PMCID: PMC5082502 DOI: 10.1111/bjhp.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. DESIGN We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. METHOD One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6-8 weeks, and 12 months after surgery. RESULTS Attachment anxiety predicted symptoms of depression and anxiety at both follow-up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors. CONCLUSION These results suggest that attachment anxiety is associated with short-term and long-term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group. Depression and anxiety are associated with poor recovery following cardiac surgery. Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health. Attachment anxiety was prospectively associated with higher levels of depression and anxiety. These results add to understanding mechanisms linked to recovery following CABG.
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Affiliation(s)
- Tara Kidd
- Department of Epidemiology and Public Health, University College London, UK
| | - Lydia Poole
- Department of Epidemiology and Public Health, University College London, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, University of London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, UK
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Davydow DS, Katon JG, Rollman BL, Unützer J. Improving mental and physical health outcomes in general healthcare settings: a Gedenkschrift in honor of Wayne Katon, MD (1950-2015). Gen Hosp Psychiatry 2015; 37:375-86. [PMID: 26260404 DOI: 10.1016/j.genhosppsych.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 01/06/2023]
Abstract
This special article pays tribute to Wayne Katon, MD (1950-2015) with a Gedenkschrift, or review, of his prolific academic career. Abstracts of all of Dr. Katon's Medline citations were reviewed to develop a narrative of his seminal epidemiological and interventional research findings. Specifically, we describe: (a) how Dr. Katon's clinical work and observational epidemiology and health services research informed and guided interventional studies; (b) the evolution of multidisciplinary interventional trials from primary care-based psychiatric consultation to primary care-based collaborative care for depression to multicondition collaborative care; and (c) how Dr. Katon's research has informed the work of other leading researchers in the field of psychosomatic medicine and helped develop a new generation of researchers at the interface of psychiatry and primary care. For more than three decades, Dr. Katon led a multidisciplinary research team that conducted seminal epidemiological studies and randomized trials and that influenced the thinking and research in the field of psychiatry in a number of areas: (a) the importance and impact of mental disorders presenting in primary care settings and (b) the organization of effective multidisciplinary care for primary care patients with common mental disorders and comorbid medical conditions. Dr. Katon's work revolutionized the care of psychiatric illnesses in primary care and other medical care settings to the benefit of countless patients worldwide.
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Affiliation(s)
- Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Jodie G Katon
- U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System Health Services Research and Development, Seattle, WA, USA; VA Office of Patient Care, Women's Health Services, Washington, DC, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Relationships between coronary angiography, mood, anxiety and insomnia. Psychiatry Res 2015; 228:355-62. [PMID: 26160202 DOI: 10.1016/j.psychres.2015.05.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/06/2015] [Accepted: 05/31/2015] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to investigate and compare the anxiety, depression and insomnia levels in the pre- and post-coronary angiography in patients undergoing elective coronary angiography due to suspected coronary artery disease. This prospective cross-sectional study consisted of 120 patients consecutively underwent coronary angiogram (CAG) between January and August 2014 in Departments of Cardiology. The mean age was 57.49 (SD±9.73), and 58.3% of the sample were women. The Hospital Anxiety and Depression Scale, Profile of Mood States Scale, Spielberger's State-Trait Anxiety Inventory, and Insomnia Severity Index were used. Patients were subsumed under 2 groups as normal and critical according to the presence or the absence of visually severe stenosis in at least one coronary artery. Subjects with significant stenosis had greater mean scores on depression-dejection and anger-hostility sub-scales of the POMS in the post-angiography than pre-angiography scores. We found that older age and having a physical illness significantly contributed to the risk of having significant stenosis in coronary vasculature. Subjects with severe coronary artery stenosis scored higher on depression-dejection and anger-hostility sub-scales at the post-angiography time period relative to pre-angiography scores. Trait and state anxiety levels were found to be moderate higher in both groups.
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Cardiovascular Management Self-efficacy: Psychometric Properties of a New Scale and Its Usefulness in a Rehabilitation Context. Ann Behav Med 2015; 49:660-74. [DOI: 10.1007/s12160-015-9698-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Sin NL, Yaffe K, Whooley MA. Depressive symptoms, cardiovascular disease severity, and functional status in older adults with coronary heart disease: the heart and soul study. J Am Geriatr Soc 2015; 63:8-15. [PMID: 25597554 PMCID: PMC4299945 DOI: 10.1111/jgs.13188] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To compare the contributions of depressive symptoms and cardiovascular disease (CVD) severity to functional decline in individuals with coronary heart disease. DESIGN Longitudinal. SETTING Twelve outpatient clinics in the San Francisco Bay area. PARTICIPANTS Older adults (N = 960; mean age 67) with stable coronary heart disease recruited between September 2000 and December 2002. MEASUREMENTS At baseline, depressive symptoms and angina pectoris were assessed according to self-report, and left ventricular ejection fraction (LVEF) and exercise capacity were evaluated using echocardiography and exercise treadmill testing. Difficulty performing activities of daily living and instrumental activities of daily living was assessed at baseline and annually for the next 5 years. Covariates included demographic characteristics, comorbid conditions, cognitive function, social support, and health behaviors. Five years later, 658 participants returned for follow-up assessments. RESULTS Higher baseline depressive symptoms predicted greater risk of functional decline over 5 years, whereas higher baseline exercise capacity was associated with lower risk of functional decline. In 658 participants who returned for follow-up, 5-year changes in depressive symptoms and exercise capacity were associated with 5-year changes in functional status. Angina pectoris frequency and LVEF were not associated with functional decline or change in functional status, after adjusting for covariates and other predictors. CONCLUSION In older adults with coronary heart disease, depressive symptoms and lower exercise capacity predicted functional decline over 5 years. In contrast, other traditional measures of CVD severity (LVEF and angina pectoris) were not independently predictive of subsequent functional status. These findings suggest that efforts to ameliorate depressive symptoms may be as important as treating CVD severity to enhance functional status.
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Affiliation(s)
- Nancy L. Sin
- Department of Medicine, University of California, San Francisco, CA
| | - Kristine Yaffe
- Departments of Psychiatry and Neurology, University of California, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
- Veterans Affairs Medical Center, San Francisco, CA
| | - Mary A. Whooley
- Department of Medicine, University of California, San Francisco, CA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
- Veterans Affairs Medical Center, San Francisco, CA
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Morgan K, Villiers-Tuthill A, Barker M, McGee H. The contribution of illness perception to psychological distress in heart failure patients. BMC Psychol 2014; 2:50. [PMID: 25520809 PMCID: PMC4266484 DOI: 10.1186/s40359-014-0050-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/11/2014] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The influences on the psychological well-being of heart failure (HF) patients have received limited attention. Illness perceptions are a specific set of cognitive representations that have been shown to predict health-related outcomes in other patient groups. This study sought to explore the role of illness perceptions in the psychological well-being of HF patients by creating a profile of illness perceptions in HF and examining their relations with anxiety and depression. METHODS Participants were 95 consecutive outpatients. Indices of psychological well-being were depression and anxiety, measured using the Hospital Anxiety and Depression Scale (HADS). Illness perceptions were measured using the Illness Perception Questionnaire - Revised (IPQ-R). Functional status was also determined using the New York Heart Association (NYHA) classification. RESULTS Illness perceptions were associated with indices of psychological well-being. Regression analyses showed that illness perceptions accounted for a significant proportion of the variance in both depression and anxiety. The contribution of illness perceptions was greater than that made by traditional covariates (socio-demographic variables and functional status). CONCLUSIONS Results highlight dynamic interrelations between perceptions of illness and mental health indices. They also suggest that in considering the role of illness perceptions in psychological well-being, the primary focus should be on the overall dynamic of an individual's illness experience rather than on specific illness dimensions. Findings highlight the potential role of illness perceptions in depression and anxiety in HF. This has implications for interventions to maximise psychological well-being in this patient group.
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Affiliation(s)
- Karen Morgan
- Department of Psychology, Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin 2, Ireland ; Perdana University, PU-RCSI School of Medicine, Block B & D Aras 1, MAEPS Building, MARDI Complex, Jalan MAEPS Perdana, 43400 Serdang Darul Ehsan, Malaysia
| | - Amanda Villiers-Tuthill
- Department of Psychology, Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin 2, Ireland ; Perdana University, PU-RCSI School of Medicine, Block B & D Aras 1, MAEPS Building, MARDI Complex, Jalan MAEPS Perdana, 43400 Serdang Darul Ehsan, Malaysia
| | - Maja Barker
- Department of Psychology, Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Hannah McGee
- Department of Psychology, Division of Population Health Science, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Allahverdipour H, Asgharijafarabadi M, Heshmati R, Hashemiparast M. Functional status, anxiety, cardiac self-efficacy, and health beliefs of patients with coronary heart disease. Health Promot Perspect 2013; 3:217-29. [PMID: 24688971 DOI: 10.5681/hpp.2013.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/19/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Beliefs and emotions could effect on functional status, quality of life, and mortality amongst patients who are suffering coronary heart disease (CHD). Current study examined the role of anxiety: trait/ state, self-efficacy, health beliefs, and functional status among patient with history of CHD. METHOD In this correlational study, 105 hospitalized and outpatients patients suffering CHD in Tehran Heart Center Hospital participated by using convenience sampling method in 2012. Cardiac self-efficacy, Seattle Angina, and research-designed health beliefs questionnaires were used to gather data. RESULTS The functional status in CHD patients showed significant relationships with gender, job, and type of medical insurance of the participants (All ps<0.05). In addition , perceived vulnerability to face again cardiac attack in the future, per-ceived severity of next cardiac attack, anxiety, state anxiety and trait anxiety (All ps<0.05) had significant and negative relationships with functional status. Con-versely, the cardiac self-efficacy had a positive and significant relationship (P<0.001) with functional status. CONCLUSION Psychological factors have important role in functional status and quality of life of patients who suffering CHD. Therefore, it is necessary to emphasize on supportive and complementary programs to promote Cardiac Reha-bilita-tion Programs.
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Affiliation(s)
- Hamid Allahverdipour
- Clinical Psychiatry Research Center, Tabriz University of Medical Sciences, Tabriz, 14711, Iran
| | | | - Rasoul Heshmati
- Department of Health Psychology, Tehran University, Tehran, 84449, Iran
| | - Mina Hashemiparast
- Department of Health Education, Tehran University of Medical Sciences, Tehran, Iran
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Suh JI, Sakong JK, Lee K, Lee YK, Park JB, Kim DJ, Seo YS, Lee JD, Ko SY, Lee BS, Kim SH, Kim BS, Kim YS, Lee HJ, Kim IH, Sohn JH, Kim TY, Ahn BM. Anxiety and depression propensities in patients with acute toxic liver injury. World J Gastroenterol 2013; 19:9069-9076. [PMID: 24379633 PMCID: PMC3870561 DOI: 10.3748/wjg.v19.i47.9069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/12/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate anxiety and depression propensities in patients with toxic liver injury.
METHODS: The subjects were divided into three groups: a healthy control group (Group 1, n = 125), an acute non-toxic liver injury group (Group 2, n = 124), and a group with acute toxic liver injury group caused by non-commercial herbal preparations (Group 3, n = 126). These three groups were compared and evaluated through questionnaire surveys and using the Hospital Anxiety-Depression Scale (HADS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the hypochondriasis scale.
RESULTS: The HADS anxiety subscale was 4.9 ± 2.7, 5.0 ± 3.0 and 5.6 ± 3.4, in Groups 1, 2, and 3, respectively. The HADS depression subscale in Group 3 showed the most significant score (5.2 ± 3.2, 6.4 ± 3.4 and 7.2 ± 3.4 in Groups 1, 2, and 3, respectively) (P < 0.01 vs Group 1, P < 0.05 vs Group 2). The BAI and BDI in Group 3 showed the most significant score (7.0 ± 6.3 and 6.9 ± 6.9, 9.5 ± 8.6 and 8.8 ± 7.3, 10.7 ± 7.2 and 11.6 ± 8.5 in Groups 1, 2, and 3, respectively) (BAI: P < 0.01 vs Group 1, P < 0.05 vs Group 2) (BDI: P < 0.01 vs Group 1 and 2). Group 3 showed a significantly higher hypochondriasis score (8.2 ± 6.0, 11.6 ± 7.5 and 13.1 ± 6.5 in Groups 1, 2, and 3, respectively) (P < 0.01 vs Group 1, P < 0.05 vs Group 2).
CONCLUSION: Psychological factors that present vulnerability to the temptation to use alternative medicines, such as herbs and plant preparations, are important for understanding toxic liver injury.
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de Rooij M, Steultjens MPM, Avezaat E, Häkkinen A, Klaver R, van der Leeden M, Maas T, Roorda LD, van der Velde H, Lems WF, Dekker J. Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000056] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Shanmugasegaram S, Russell KL, Kovacs AH, Stewart DE, Grace SL. Gender and sex differences in prevalence of major depression in coronary artery disease patients: a meta-analysis. Maturitas 2012; 73:305-11. [PMID: 23026020 DOI: 10.1016/j.maturitas.2012.09.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/25/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Depression is related to increased morbidity and mortality in the general population and among patients with coronary artery disease (CAD). The prevalence of major depression is two-times higher in women than men in the general population, but whether this pattern holds true in the CAD population has not been established. OBJECTIVE To test, through quantitative synthesis, whether women with CAD have a greater prevalence of major depression than men. METHOD MEDLINE, EMBASE, and PsycINFO electronic databases were searched. Authors of key articles were contacted to identify other relevant publications. The titles and abstracts were screened by the first author and the selected full-text articles were independently screened by the first and second authors based on pre-defined inclusion criteria. Major depression had to be diagnosed through structured clinical interviews during cardiac-related hospitalization or post-CAD hospitalization. Meta-analysis was undertaken using the Review Manager 5 software program. All pooled analyses were based on random-effects models. RESULTS Eight eligible cohort and cross-sectional studies reporting data for 2072 participants (509 [24.6%] women) were included. Overall, major depression was observed in 95 (18.7%) women and 187 (12.0%) men. In the pooled analysis, prevalence of major depression was significantly greater in women compared to men (odds ratio=1.77, 95% confidence interval=1.21-2.58, p<.01). Heterogeneity was considered low to moderate (I(2)=36.0%). CONCLUSION Consistent with the general population, the prevalence of major depression is two-times greater in women than men with CAD. Women with CAD may warrant greater emphasis in efforts to identify and treat depression.
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Narula N, Marshall JK. Management of inflammatory bowel disease with vitamin D: beyond bone health. J Crohns Colitis 2012; 6:397-404. [PMID: 22398052 DOI: 10.1016/j.crohns.2011.10.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 10/04/2011] [Accepted: 10/30/2011] [Indexed: 02/08/2023]
Abstract
A relationship between vitamin D and several disorders, including Crohn's disease (CD), has recently been proposed. Vitamin D appears to have several important actions beyond the maintenance of bone health, including various effects on the immune system. Vitamin D deficiency has been implicated in the development of CD, and its analogues may have a role in the treatment of CD. Current research also suggests a role for vitamin D in counteracting some IBD-specific complications, including osteopenia, colorectal neoplasia, and depression. There remains a need for prospective studies to further delineate these relationships. Given current evidence and the apparent safety of vitamin D supplementation, it appears reasonable to screen for and treat vitamin D deficiency in patients with IBD.
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Affiliation(s)
- Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease. Psychosom Med 2011; 73:803-9. [PMID: 22021458 DOI: 10.1097/psy.0b013e3182364992] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association of symptoms of persistent anxiety with the development of acute cardiac events in patients with coronary heart disease (CHD) followed for 2 years. The prevalence of symptoms of anxiety is high in patients with CHD, but their effect on cardiac events and mortality has not been well characterized. METHODS Of 3522 patients with confirmed CHD enrolled, data on symptoms of anxiety were available at two time points in 3048 patients who were then followed up for detection of the composite end point of hospitalization for myocardial infarction, unstable or stable angina, other cardiac causes, or all-cause mortality. A composite anxiety symptoms score composed of baseline and 3-month anxiety data, in which the continuous-level scores were used, was tested using Cox proportional hazards regression model. Groups (persistent anxiety [anxiety at both time points] versus nonanxious [no anxiety at either time point] versus not persistently anxious [anxiety only at one time point]) were also compared. RESULTS Symptoms of persistent anxiety, whether considered as a continuous- or categorical-level variable, were associated with shorter time to event. Persistent anxiety remained as an independent predictor of the end point after controlling for multiple variables (persistent anxiety as a summary score [hazard ratio = 1.27, 95% confidence interval = 1.067-1.514] and persistent anxiety as a categorical variable [hazard ratio = 1.52, 95% confidence interval = 1.149-2.015]). CONCLUSIONS By measuring anxiety symptoms at more than one time point and controlling for relevant sociodemographic, comorbidity, risk factor, and psychological covariates, we illustrate that symptoms of persistent anxiety are a strong, independent predictor of cardiac event-free survival.
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Prina AM, Ferri CP, Guerra M, Brayne C, Prince M. Co-occurrence of anxiety and depression amongst older adults in low- and middle-income countries: findings from the 10/66 study. Psychol Med 2011; 41:2047-2056. [PMID: 21466747 DOI: 10.1017/s0033291711000444] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is relative little information about the prevalence and risk factors of co-morbid anxiety and depression in later life. These disorders are often associated with worse response to treatment than either condition alone, and researching their epidemiology in diverse settings is vital to policy makers. We therefore investigated the co-occurrence of anxiety and depressive syndromes amongst older adults living in developing countries and measured the separate and joint effect of these two disorders on levels of associated disability. METHOD The 10/66 study carried out cross-cultural surveys of all residents aged 65 years or over (n=15021) in 11 sites in seven countries (People's Republic of China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru). Anxiety was measured by using the Geriatric Mental State Examination and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system. Depression was assessed according to International Classification of Diseases 10th revision (ICD-10) and EURO-D criteria. Disability was measured by using the World Health Organization's Disablement Assessment Scale Version II. Zero-inflated negative binomial regression models were used to investigate the association of common mental disorders and disability. RESULTS The prevalence of co-occurring anxiety and depression (with the exclusion of subthreshold disorders) ranged between 0.9% and 4.2% across sites. Gender, socio-economic status, urbanicity and physical co-morbidities were associated with the different co-morbid states. Having both disorders was linked to higher disability scores than having anxiety or depression alone. CONCLUSIONS Given the close association of co-morbid anxiety and depression with disability, new policies to improve prevention, recognition and treatment will be needed to adapt to ageing populations and their mental health needs.
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Affiliation(s)
- A M Prina
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK.
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Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21485743 PMCID: PMC3181964 DOI: 10.31887/dcns.2011.13.1/wkaton] [Citation(s) in RCA: 434] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
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Affiliation(s)
- Wayne J Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
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Langlieb AM, Guico-Pabia CJ. Beyond symptomatic improvement:assessing real-world outcomes in patients with major depressive disorder. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2010; 12. [PMID: 20694113 DOI: 10.4088/pcc.09r00826blu] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To quantify the negative impact that major depressive disorder (MDD) has on quality of life, disability, and work, family, and overall psychosocial functioning. Available scales that assess these areas of impairment as they relate to patients with MDD are described. DATA SOURCES PUBMED SEARCHES WERE CONDUCTED USING THE FOLLOWING TERMS: (MDD OR major depressive disorder) AND (absenteeism OR absente*); AND (quality of life OR QOL); AND (psychosocial function*); AND (presente* OR presenteeism); AND (health care cost* OR [health care] cost*); AND (health outcome*); AND (functional outcome*); AND (family life); AND (disabil* OR disability); AND (work function*); AND (unemployment OR unemploy*). The literature search was conducted in July 2008 and was restricted to English language articles. There were no limits set on the dates of the search. STUDY SELECTION Two hundred twenty potential articles were identified. Among these studies, 48 presented primary data directly demonstrating the effect of MDD on quality of life, disability, and work, family, and overall psychosocial functioning. DATA EXTRACTION Primary data were compiled from these studies and are summarily described. Available scales that assess quality of life, disability, and work, family, and overall psychosocial functioning are also described. DATA SYNTHESIS MDD was found to be associated with significant disability and declines in functioning and quality of life. The Sheehan Disability Scale, the 36-item Short-Form Health Survey, and the Work Limitations Questionnaire were the most commonly used scales according to this review of the literature, but the majority of studies used direct and indirect disability measures, such as health care and other disability-related costs. CONCLUSIONS In addition to assessing symptomatic outcomes, physicians should routinely assess their depressed patients on "real-world" outcomes. The development of a concise functional outcome measure specific to MDD is necessary for busy clinical practices.
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Affiliation(s)
- Alan M Langlieb
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland and Pfizer Inc, formerly Wyeth Research, Collegeville, Pennsylvania.
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Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med 2010; 72:563-9. [PMID: 20410247 DOI: 10.1097/psy.0b013e3181dbff97] [Citation(s) in RCA: 318] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the association of anxiety after myocardial infarction (MI) with cardiac prognosis. METHODS A meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO (1975-March 2009) was performed without language restrictions. End point was cardiac outcome defined as all-cause mortality, cardiac mortality, and cardiac events. The authors selected prospective studies with at least 6 months follow-up, and anxiety had to be assessed within 3 months after MI with reliable and valid instruments. RESULTS Twelve papers met selection criteria. These studies described follow-up (on average, 2.6 years) of 5750 patients with MI. Anxious patients were at risk of adverse events (odds ratio (OR) fixed, 1.36; 95% confidence interval (CI), 1.18-1.56; p < .001). Anxiety was also specifically associated with all-cause mortality (OR fixed, 1.47; 95% CI, 1.02-2.13; p = .04), cardiac mortality (OR fixed, 1.23; 95% CI, 1.03-1.47; p = .02), and new cardiac events (OR fixed, 1.71; 95% CI, 1.31-2.23; p < .001). CONCLUSIONS Post-MI anxiety is associated with a 36% increased risk of adverse cardiac outcomes in bivariate analyses. Because the existing literature is small and contains several limitations, more research is needed to evaluate the association of anxiety and prognosis in patients with MI and to assess the extent to which this association is independent of clinical variables, such as disease severity, and other psychological variables, especially depression.
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Wagenaar TC, Rohling WJ, Klomp M, Meesterman MG, Henriques JPS. Sedative treatment regimes in all Dutch centers carrying out percutaneous coronary interventions, a comprehensive nationwide survey. Eur J Cardiovasc Nurs 2010; 9:195-6. [PMID: 20071236 DOI: 10.1016/j.ejcnurse.2009.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/04/2009] [Accepted: 12/02/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Tineke C Wagenaar
- Department of Cardiology, Academic Medical Center-University of Amsterdam, The Netherlands.
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Abstract
BACKGROUND The objective of this study was to examine the prevalence and short-term course of depression and anxiety in a sample of hospitalized, medically unwell older adults, using both a symptom measure and a diagnostic instrument. METHODS One hundred participants were recruited from in-patients in a geriatric hospital in Melbourne, Australia. Anxiety and depression were assessed shortly after admission, and again two months later, using the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Mental Status Schedule/ AGECAT diagnostic system. RESULTS At Time 1, 60% of the sample exhibited anxiety symptoms at a sub-case level, while 16% had anxiety symptoms at a syndrome case level, whereas 48% of the participants had depression at syndrome level. The HADS and AGECAT were concordant with respect to anxiety for 78% of participants, but agreement was lower for depression; AGECAT identified a further 36 syndrome cases of depression not deemed depressed by the HADS. There was a significant decrease in overall rates of both depression and anxiety symptoms and syndromes from Time 1 to Time 2. CONCLUSION This study confirms the findings of previous research with respect to the high prevalence of depression in physically unwell older adults, and extends knowledge about anxiety in this group. Symptoms of anxiety are even more common than symptoms of depression in this group, especially around the time of admission to hospital. Over a relatively short time period, there is a marked reduction in symptoms, but levels of anxiety and depression remain high.
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Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis 2009; 15:1105-18. [PMID: 19161177 DOI: 10.1002/ibd.20873] [Citation(s) in RCA: 385] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship. This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset. There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease. The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions. There is evidence, however, that the course of the disease is worse in depressed patients. Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms. The second part of the review focuses on patient management issues for those with comorbid anxiety or depression. Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease. We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient.
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Affiliation(s)
- Lesley A Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
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Bellelli G, Frisoni GB, Turco R, Trabucchi M. Depressive symptoms combined with dementia affect 12-months survival in elderly patients after rehabilitation post-hip fracture surgery. Int J Geriatr Psychiatry 2008; 23:1073-7. [PMID: 18489008 DOI: 10.1002/gps.2035] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To assess whether the association of depression and dementia affects 12-month survival of elderly patients after rehabilitation post-hip fracture (HF) surgery. METHODS Two hundred eleven inpatients admitted to a Rehabilitation and Aged Care Unit (RACU) following surgery for HF were screened for depression with the 15-item Geriatric Depression Scale (GDS) and stratified into four groups according to dementia (n = 40), depressive symptoms (n = 54, GDS score > 7/15), both (n = 27), and neither conditions (n = 90). The 12-months survival after discharge was assessed among groups with Kaplan Meyer analysis and compared with Cox proportional hazard regression models adjusted for covariates. Subjects with neither depression nor dementia were the reference group. RESULTS Survival of patients with depression and dementia was significantly lower than the other 3 groups: after adjustment for age, gender, comorbidity (Charlson Index), use of antidepressants, and Barthel Index at discharge, their Hazard Ratio (HR) was 8.7 (95% CI 1.5-48.5; p = 0.01); in the same Cox regression model, the HR of patients with dementia alone was 3.4 (95% CI 0.5-24.0; p = 0.20) while the HR of patients with depressive symptoms but no dementia was 5.0 (95% CI 0.8-28.3; p = 0.07). CONCLUSIONS The co-occurrence of depression and dementia significantly increases the 12-months risk of dying in elderly patients after rehabilitation post-HF surgery.
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Affiliation(s)
- Giuseppe Bellelli
- Rehabilitation and Aged Care Unit, Ancelle della Carità Hospital Cremona, Brescia, Italy.
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Schillerstrom JE, Royall DR, Palmer RF. Depression, disability and intermediate pathways: a review of longitudinal studies in elders. J Geriatr Psychiatry Neurol 2008; 21:183-97. [PMID: 18838741 DOI: 10.1177/0891988708320971] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cross-sectional studies demonstrate depression is associated with disability in elders. These studies also report that disability in depressed elders is associated with greater medical illness burden, cognitive impairment, and behavioral changes. Only longitudinal studies, however, can determine the impact of depression and its comorbidities on functional decline. This review summarizes the findings of 20 longitudinal studies examining the relationship between baseline or incident depression and functional decline. However, the mediational effects of potential risk factors identified by cross-sectional studies cannot be derived from the current literature. We propose a mediational effects model for future longitudinal studies, incorporating measures sensitive to both mood symptoms and the medical, cognitive, and behavioral comorbidities of depression to better understand the impact of each on functional decline and to focus future clinical interventions.
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Affiliation(s)
- Jason E Schillerstrom
- Department of Psychiatry The University of Texas Health Seience Center, San Antonio, TX 78229, USA.
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Bryant C, Jackson H, Ames D. The prevalence of anxiety in older adults: methodological issues and a review of the literature. J Affect Disord 2008; 109:233-50. [PMID: 18155775 DOI: 10.1016/j.jad.2007.11.008] [Citation(s) in RCA: 277] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 11/21/2007] [Accepted: 11/21/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the relative neglect of anxiety in older adults, the growing literature on its prevalence suggests that anxiety is highly prevalent and associated with considerable distress and morbidity in this age group. This review provides a comprehensive overview of this literature and discusses some unresolved controversies in the field. METHODS A systematic search of articles published from 1980-2007 was performed. Articles were included for review if they reported the prevalence of anxiety symptoms, anxiety disorder or specified anxiety disorders in adults aged >60 in either community or clinical settings. RESULTS The prevalence of anxiety in community samples ranges from 1.2% to 15%, and in clinical settings from 1% to 28%. The prevalence of anxiety symptoms is much higher, ranging from 15% to 52.3% in community samples, and 15% to 56% in clinical samples. These discrepancies are partly attributable to the conceptual and methodological inconsistencies that characterise this literature. Generalised Anxiety Disorder is the commonest anxiety disorder in older adults. LIMITATIONS The methodologies used in the studies are so variable as to make comparisons difficult. CONCLUSIONS Although anxiety disorder, particularly Generalised Anxiety Disorder is common, issues in relation to comorbidity and the nature of anxiety in old age remain unresolved. This hampers the design of intervention programmes, and highlights the need for further research with a primary focus on anxiety.
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Affiliation(s)
- Christina Bryant
- School of Behavioural Science, University of Melbourne, Victoria, Australia.
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Scott K, McGee MA, Schaaf D, Baxter J. Mental–physical comorbidity in an ethnically diverse population. Soc Sci Med 2008; 66:1165-73. [DOI: 10.1016/j.socscimed.2007.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Indexed: 11/26/2022]
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Scott KM, Bruffaerts R, Tsang A, Ormel J, Alonso J, Angermeyer MC, Benjet C, Bromet E, de Girolamo G, de Graaf R, Gasquet I, Gureje O, Haro JM, He Y, Kessler RC, Levinson D, Mneimneh ZN, Oakley Browne MA, Posada-Villa J, Stein DJ, Takeshima T, Von Korff M. Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. J Affect Disord 2007; 103:113-20. [PMID: 17292480 DOI: 10.1016/j.jad.2007.01.015] [Citation(s) in RCA: 304] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 01/05/2007] [Accepted: 01/09/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prior research on the association between affective disorders and physical conditions has been carried out in developed countries, usually in clinical populations, on a limited range of mental disorders and physical conditions, and has seldom taken into account the comorbidity between depressive and anxiety disorders. METHODS Eighteen general population surveys were carried out among adults in 17 countries as part of the World Mental Health Surveys initiative (N=42, 249). DSM-IV depressive and anxiety disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). Chronic physical conditions were ascertained via a standard checklist. The relationship between mental disorders and physical conditions was assessed by considering depressive and anxiety disorders independently (depression without anxiety; anxiety without depression) and conjointly (depression plus anxiety). RESULTS All physical conditions were significantly associated with depressive and/or anxiety disorders but there was variation in the strength of association (ORs 1.2-4.5). Non-comorbid depressive and anxiety disorders were associated in equal degree with physical conditions. Comorbid depressive-anxiety disorder was more strongly associated with several physical conditions than were single mental disorders. LIMITATIONS Physical conditions were ascertained via self report, though for a number of conditions this was self-report of diagnosis by a physician. CONCLUSIONS Given the prevalence and clinical consequences of the co-occurrence of mental and physical disorders, attention to their comorbidity should remain a clinical and research priority.
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Affiliation(s)
- K M Scott
- Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, PO Box 7343 Wellington South, New Zealand.
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Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 2007; 29:417-24. [PMID: 17888808 DOI: 10.1016/j.genhosppsych.2007.06.005] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 06/17/2007] [Accepted: 06/19/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD. METHOD Three months post-discharge for a cardiac admission, 193 CAD patients completed the HADS and PHQ-9. The Mini International Neuropsychiatric Interview (MINI) was the criterion standard. Scale reliability was calculated using Cronbach's alpha. Convergent validity was computed using Pearson's intercorrelations. Sensitivity and specificity for various cut-off scores for both measures and for the PHQ-9 categorical algorithm were calculated using receiver operating characteristics (ROC). For analyses, participants were assigned to two groups, 'major depressive disorder' or 'any depressive disorder'. RESULTS For all calculations, alpha was 0.05 and tests were two-tailed. Internal consistencies for the two measures were excellent. Criterion validity for the PHQ-9 and HADS was good. We found no statistical differences between the PHQ-9 and HADS for detecting either group; however, the categorical algorithm of the PHQ-9 for diagnosing major depression had a superior LR+ when compared with the summed HADS or PHQ-9. The operating characteristics of the screening instruments for 'any depressive disorder' were slightly lower than for 'major depressive disorder'. Some optimum cut-off scores were lower than the generally recommended cut-off scores, particularly when screening for major depression (e.g., > or = 5/6 vs. > or = 10 and > or = 8 for PHQ-9 and HADS, respectively). Lowering the cut off scores substantially improved the sensitivity of these instruments while retaining specificity, thereby improving their usefulness to screen for CAD patients with depression. CONCLUSIONS Both instruments have acceptable properties for detecting depression in recently hospitalized cardiac patients, and neither scale is statistically superior when summed scores are used. The categorical algorithm of the PHQ-9 for diagnosing major depression has a superior LR+ compared to the summed PHQ-9 and HADS scores. Use of the generally recommended cut-off scores should be cautious. In light of the aversive outcomes associated with depression in CAD, screening for depression is a clinical priority.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, University of Melbourne, Victoria 3010, Australia.
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Abstract
Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers’ knowledge of anxiety assessment and providers’ practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients’ outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.
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Affiliation(s)
- Debra K. Moser
- Debra K. Moser is a professor and holds the Gill Endowed Chair of Nursing at the University of Kentucky College of Nursing in Lexington
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Krupa T. Interventions to improve employment outcomes for workers who experience mental illness. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2007; 52:339-45. [PMID: 17696019 DOI: 10.1177/070674370705200602] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review employment interventions for individuals who experience mental illness. METHOD I reviewed employment interventions described in the mental health, disability, and rehabilitation literature for the period 1990 to 2005 and organized these interventions into a framework. RESULTS The framework develops 7 distinct individual-level employment interventions as well as interventions directed at the employer and at workplace organization. It also considers factors that will affect access to these interventions. Although there is a sense of optimism about the potential of these interventions, research in the area is limited. CONCLUSION Physicians who are knowledgeable about the nature and scope of employment interventions for individuals with mental illness are in a good position to effect positive change in the work lives of the individuals they serve.
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Affiliation(s)
- Terry Krupa
- School of Rehabilitation Therapy, Queen's Univeristy, Kingston, Ontario.
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McCauley E, Katon W, Russo J, Richardson L, Lozano P. Impact of anxiety and depression on functional impairment in adolescents with asthma. Gen Hosp Psychiatry 2007; 29:214-22. [PMID: 17484938 PMCID: PMC2770903 DOI: 10.1016/j.genhosppsych.2007.02.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 02/20/2007] [Accepted: 02/26/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to assess the association of anxiety and depression with psychosocial and asthma-related functional impairment in a large-population-based sample of adolescents with asthma. METHOD The sample consisted of 767 youths ages 11 to 17 with a documented diagnosis of, and active treatment for, asthma. Telephone interviews were completed with each youth and one parent to assess asthma-related symptoms and self-report of psychosocial and asthma-related functional status. Structured diagnostic interviews (Computerized Diagnostic Interview Schedule for Children) were administered to determine psychiatric diagnoses. Weighted multiple linear regression models were employed to identify variables that were independently and significantly associated with levels of functioning. RESULTS One hundred twenty-five youths (16.2%) met DSM-IV criteria for one or more anxiety and depressive disorders in the last 12 months. After controlling for demographic variables, greater severity of self-reported depressive and anxiety symptoms and presence of one or more DSM-IV anxiety or depressive diagnosis were associated with psychosocial and asthma-related functional status. The mental health factors were more strongly associated with measures of asthma and psychological functional outcomes than the modified Health Plan Employer Data and Information Set asthma risk measure. CONCLUSIONS Increased awareness of the need to assess and effectively treat psychiatric symptoms in youth with asthma may reduce the functional burden associated with asthma.
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Affiliation(s)
- Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
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Bergh CD, Bäckström M, Axelsson K, Jönsson H, Johnsson P. Protein S100B after cardiac surgery: an indicator of long-term anxiety? SCAND CARDIOVASC J 2007; 41:109-13. [PMID: 17454836 DOI: 10.1080/14017430601024269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of the study was to assess long-term state and trait anxiety in cardiac surgical risk patients. DESIGN Thirty two patients with serum S100B>0.3 microg/l 48 hours after cardiac surgery with cardiopulmonary bypass were matched according to age, gender, type, date and length of surgery with 35 operated patients without elevated S100B. They completed Spielberger's Anxiety Inventory (STAI). RESULTS Patients with elevated S100B reported more state anxiety and trait anxiety. S100B was an independent predictor of both state and trait anxiety when controlling for perioperative variables. CONCLUSIONS Patients with elevated S100B reported more anxiety 3-6 years after cardiac surgery. A postoperative blood sample can identify risk patients and facilitate appropriate follow-up.
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Stafford L, Berk M, Reddy P, Jackson HJ. Comorbid depression and health-related quality of life in patients with coronary artery disease. J Psychosom Res 2007; 62:401-10. [PMID: 17383491 DOI: 10.1016/j.jpsychores.2006.12.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD). METHODS Articles for the primary review were identified via MEDLINE and PsycINFO (1995-2006). RESULTS Evidence suggests that depression has an aversive impact on the HRQOL of patients with stable CAD as well as on patients hospitalized for acute myocardial infarction and coronary artery bypass graft surgery. Unfortunately, there are few depression treatment studies in patients with CAD that make use of standardized HRQOL measures, but the limited evidence suggests that successful treatment has positive implications for HRQOL in these patients. The mechanisms through which depression impacts on HRQOL require further study but are likely to be behavioral. CONCLUSIONS Depressive symptoms significantly undermine HRQOL in patients with CAD despite successful medical and surgical management. Although successful treatment of depression has not been shown to reduce mortality rates in patients with CAD, further study may find that the HRQOL benefits of such treatment are equally valuable.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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Ozkan M, Corapçioglu A, Balcioglu I, Ertekin E, Khan S, Ozdemir S, Karayün D, Unsalver BO, Kocaman N, Kaymakglu S, Köroglu G. Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C. Int J Psychiatry Med 2007; 36:283-97. [PMID: 17236696 DOI: 10.2190/d37y-x0jy-39mj-pvxq] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE The primary aim of our study was to determine the prevalence of psychiatric morbidity in a cohort of consecutive chronic hepatitis patients not receiving antiviral therapy. The secondary aim of our study was to determine if psychiatric morbidity, type of hepatitis, and the level of depression correlated with health-related quality of life (HRQL). METHODS The study was conducted in collaboration with Hepatology and Infectious Disease Clinics at three-major university hospitals. One hundred seven patients who met the criteria for being diagnosed with either chronic hepatitis B or C, had non-cirrhotic compensated liver disease, had not received antiviral treatment in the preceding 6 months, and had no accompanying physical illness were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Short Form--36 for measuring HRQL, and semi-structured interviews for assessing psychosocial variables were used. Sixty-seven healthy adults formed the control group. RESULTS 43.9% of the patients had hepatitis B, 56.1% hepatitis C. A psychiatric diagnosis was made in 48.6%, of which 15% was depression. No significant difference was found in the rate of psychiatric diagnosis between hepatitis B and hepatitis C patients. Hepatitis B and C patients were found to vary significantly (p < 0.001) from the control group on all subcategories of quality of life criteria. Psychiatric morbidity (mainly depression) was the major variable on lowering HRQL (p = 0.000). CONCLUSIONS Chronic hepatitis B and C patients presented a high rate of psychiatric disorder. HRQL was significantly decreased in patients with psychiatric morbidity.
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Affiliation(s)
- Mine Ozkan
- Istanbul Faculty of Medicine, Istanbul Universitesi, Turkey.
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Katon W, Lin EHB, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007; 29:147-55. [PMID: 17336664 DOI: 10.1016/j.genhosppsych.2006.11.005] [Citation(s) in RCA: 602] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 11/27/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses. METHODS MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes. RESULTS Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures. CONCLUSIONS Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.
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Affiliation(s)
- Wayne Katon
- Department of Psychiatry, University of Washington School of Medicine, Seattle, WA 98195-6560, USA.
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Pedersen SS, Denollet J, Spindler H, Ong ATL, Serruys PW, Erdman RAM, van Domburg RT. Anxiety enhances the detrimental effect of depressive symptoms on health status following percutaneous coronary intervention. J Psychosom Res 2006; 61:783-9. [PMID: 17141666 DOI: 10.1016/j.jpsychores.2006.06.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Revised: 05/23/2006] [Accepted: 06/27/2006] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Susanne S Pedersen
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, The Netherlands.
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Scott KM, Oakley Browne MA, McGee MA, Wells JE. Mental-physical comorbidity in Te Rau Hinengaro: the New Zealand Mental Health Survey. Aust N Z J Psychiatry 2006; 40:882-8. [PMID: 16959014 DOI: 10.1080/j.1440-1614.2006.01907.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of chronic physical conditions, and the risk factors for those conditions, among those with 12 month mental disorder; to estimate the prevalence of 12 month mental disorder among those with chronic physical conditions. METHOD A nationally representative face-to-face household survey was carried out in October 2003 to December 2004 with 12,992 participants aged 16 years and over, achieving a response rate of 73.3%. Mental disorders were measured with the World Mental Health version of the Composite International Diagnostic Interview (CIDI 3.0). Physical conditions were self-reported. All associations are reported adjusted for age and sex. RESULTS People with (any) mental disorder, relative to those without mental disorder, had higher prevalences of several chronic physical conditions (chronic pain, cardiovascular disease, high blood pressure and respiratory conditions) and chronic condition risk factors (smoking, overweight/obesity, hazardous alcohol use). Around a quarter of people with chronic physical conditions had a comorbid mental disorder compared with 15% of the population without chronic conditions. Significant relationships occurred between some mental disorders and obesity, cardiovascular disease and diabetes for females, but not for males. CONCLUSIONS This paper provides evidence of substantial comorbidity between mental disorders and chronic physical conditions in New Zealand. This should be borne in mind by clinicians working in both mental health and medical services.
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Affiliation(s)
- Kate M Scott
- Department of Psychological Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Welliington South, New Zealand.
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Pedersen SS, Ong ATL, Lemos PA, Erdman RAM, Serruys PW, van Domburg RT. Risk factors for impaired health status differ in women and men treated with percutaneous coronary intervention in the drug-eluting stent era. J Psychosom Res 2006; 61:11-7. [PMID: 16813840 DOI: 10.1016/j.jpsychores.2006.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 10/10/2005] [Accepted: 01/10/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In patients treated with percutaneous coronary intervention (PCI) in the drug-eluting stent era, we compared women's and men's health status 6 and 12 months post-PCI and investigated whether predictors of poor health status at 12 months are similar for women and men. METHODS Consecutive patients (n=692; 28% women) treated with PCI completed the 36-item Short-Form Health Survey (SF-36) 6 and 12 months post-PCI. RESULTS There was a significant improvement in health status over time (P<.001), but women experienced a significantly poorer health status compared with men (P<.001) at 6 and 12 months, adjusting for differences in baseline characteristics and health status at 6 months. Predictors of impaired health status were generally different for women and men. In women, the predominant predictors were previous coronary artery bypass graft (CABG) surgery, renal impairment, and older age; in contrast, in men, older age was associated with better functioning. In women, previous CABG was associated with a 4-15 fold increased risk of impaired health status. Health status at 6 months was a predictor of all SF-36 domains at 12 months in both women and men. CONCLUSIONS Women reported poorer health status compared with men 6 and 12 months post-PCI, and predictors of impaired health status generally differed for women and men. Further studies examining risk factors for adverse outcomes for women and men separately, which will lead to better risk stratification in research and clinical practice, are warranted.
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Affiliation(s)
- Susanne S Pedersen
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
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Furlanetto LM, Brasil MA. Diagnosticando e tratando depressão no paciente com doença clínica. JORNAL BRASILEIRO DE PSIQUIATRIA 2006. [DOI: 10.1590/s0047-20852006000100002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diagnosticar depressão em um doente clínico é uma tarefa difícil por vários motivos. Muito embora tristeza e humor depressivo possam indicar síndrome depressiva subjacente, eles também podem fazer parte da adaptação normal a uma doença que ameace a vida. Os sintomas somáticos e vegetativos incluídos nos critérios diagnósticos das classificações atuais não são específicos e podem de fato ser atribuíveis à hospitalização, aos tratamentos ou à própria doença clínica. Tratar a depressão no paciente clínico é também difícil devido à preocupação com a interação de drogas, assim como questões de eficácia e segurança nesse grupo. Nesta conferência clínica os autores discutem questões como que diagnósticos podem ser feitos em pacientes clínicos com sintomas depressivos; prevalência de depressão em diferentes ambientes; mecanismos de co-morbidade (fatores fisiológicos e comportamentais) que relacionam a depressão às doenças clínicas e o manuseio da depressão nesse grupo.
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de Jonge P, Spijkerman TA, van den Brink RHS, Ormel J. Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months. Heart 2006; 92:32-9. [PMID: 15890765 PMCID: PMC1860990 DOI: 10.1136/hrt.2004.059451] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2005] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To study the prospective effects of post-myocardial infarction (MI) depressive disorder on health status, including self reported cardiac symptoms, disability, and health related quality of life, at 12 months after MI while controlling for cardiac condition and health status at three months after MI. METHODS Longitudinal study of a cohort of 468 adults with MI recruited from four hospitals in the north of The Netherlands between September 1997 and September 2000. Assessment of depressive disorder in the year after MI according to International classification of disease, 10th revision criteria. Assessment of health status at three and 12 months by the RAND 36 item health survey, the health complaints scale, self rated cardiac complaints, and disability. RESULTS Patients with post-MI depressive disorder were more likely than those without to have poor quality of life, more health complaints, more cardiac complaints, and more disability at 12 months' follow up. In multivariate analyses adjusted for cardiac condition, health status at three months, age, sex, and pre-MI depression, the prospective association of post-MI depression with poor health status remained for most of the indicators. Severity of the post-MI depression further contributed to aspects of poor health status. CONCLUSIONS In a prospective study design, post-MI depression had strong effects on poor health status exceeding the effects of cardiac condition and its short term consequences. Efforts to improve health status after MI should therefore include standard assessment and guideline based treatment of post-MI depressive disorder.
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Affiliation(s)
- P de Jonge
- Department of Psychiatry, University of Groningen, Groningen, The Netherlands.
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Abstract
OBJECTIVE Employers provide most American mental health benefits and are increasingly cost conscious. However, commonplace anxiety and depressive disorders have enormous economic and workplace performance costs. METHODS We performed multiple literature searches on several areas of pertinent research (and on key articles) covering the past 5 years. RESULTS Substantial research exists about anxiety and depression costs, such as performance and productivity, absenteeism, presenteeism, disability, physical disability exacerbation, mental health treatment, increased medical care costs, exacerbating of physical illness, and studies of mental health care limitations and cost-offset. Research addressing the potential value of higher quality mental health care is limited. CONCLUSIONS Commonplace anxiety and depressive disorders are costly in the workplace. Employers and researchers remain largely unaware of the value of quality care and psychiatric skills. Effective solutions involve the increased use of psychiatric skills and appropriate treatment.
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Affiliation(s)
- Alan M Langlieb
- Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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St-Jean K, D'Antono B, Dupuis G. Psychological distress and exertional angina in men and women undergoing thallium scintigraphy. J Behav Med 2005; 28:527-36. [PMID: 16228694 DOI: 10.1007/s10865-005-9024-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED The relation between psychological factors and angina has mostly been studied in male patients with confirmed CAD and few have evaluated this relation during actual provocation of ischemia. This study evaluated gender differences in the association between psychological distress and angina pain experience in 907 Caucasian patients (479 women, mean age = 60 years) undergoing exercise stress testing with thallium scintigraphy. Data were analyzed separately for patients with and without exercise related ischemia using a series of 2 (low/high distress) x 2 (gender) ANOVAs as well as binary logistic regressions. Among all patients, distress and gender were associated with greater risk and intensity of angina pain during testing (p < 0.05) and more angina following exertion (p < 0.05) or stress (p < 0.05) at home. CONCLUSION angina pain was more severe in women and individuals with high levels of distress, regardless of their ischemic status. A generalized hypersensitivity to pain/symptoms may be indicated in these patients.
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Affiliation(s)
- Karine St-Jean
- Montreal Heart Institute, Belanger Street East, Montreal, Quebec, H1T 1C8, Canada
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Jeste DV, Blazer DG, First M. Aging-related diagnostic variations: need for diagnostic criteria appropriate for elderly psychiatric patients. Biol Psychiatry 2005; 58:265-71. [PMID: 16102544 DOI: 10.1016/j.biopsych.2005.02.004] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Revised: 01/27/2005] [Accepted: 02/02/2005] [Indexed: 11/17/2022]
Abstract
It is commonly thought and taught that most psychiatric disorders other than dementia are much less prevalent among the elderly than among younger adults. This perception is based on a relatively small number of published epidemiologic investigations of the incidence and prevalence of mental illnesses in elderly populations. Most of these studies have had a number of methodologic problems, including improper definitions and diagnostic criteria for older persons. A likely consequence of these misconceptions is that clinically significant and potentially treatable mental illnesses might be overlooked, misdiagnosed, and mistreated in elderly patients. Studies in community samples suggest that many older adults who experience clinically significant psychopathology do not fit easily into our existing nomenclature, and yet are disabled. There is a need to develop aging-appropriate diagnostic criteria for major psychiatric disorders. In this article, we discuss the potential causes of this diagnostic confusion. Four specific classes of disorders-mood (specifically depressive) disorders, schizophrenia (and related psychotic disorders), anxiety disorders, and substance use disorders-are discussed as examples. Finally, we suggest some future steps for clarifying this diagnostic confusion.
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Affiliation(s)
- Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, California 92161, USA.
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Affiliation(s)
- Trey Sunderland
- National Institute of Mental Health 9000 Rockville Pike Building 10, Room 3N228 Bethesda, Maryland 20892, USA.
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Fauerbach JA, Bush DE, Thombs BD, McCann UD, Fogel J, Ziegelstein RC. Depression Following Acute Myocardial Infarction: A Prospective Relationship With Ongoing Health and Function. PSYCHOSOMATICS 2005; 46:355-61. [PMID: 16000679 DOI: 10.1176/appi.psy.46.4.355] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relationship between baseline depression and health-related quality of life were examined in a cohort of patients after hospitalization due to acute myocardial infarction (N=196). Patients were assessed for presence of mood disturbance, anxiety, and quality of life at the time of hospitalization and again 4 months later. Baseline assessment was used to assign subjects to a depressed or a nondepressed group. Adjusting for preinfarction quality of life, in-hospital anxiety, and demographic variables, depression was prospectively and independently related to reduced global health at 4 months as well as reduced overall mental health-including vitality, psychological health, and social function-and increased role interference from psychological problems.
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Affiliation(s)
- James A Fauerbach
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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