The Hospital Anxiety and Depression Scale: a pilot study to examine its latent structure and the link between psychological state and symptom severity in transient ischaemic attack patients

The effect of depressive disorder on the clinical presentation of coronary artery disease and five-year survival of patients after myocardial infarction

Aim. To assess the effect of depressive disorder (DD) on the clinical presentation of coronary artery disease (CAD) and five-year survival rate of patients with chronic CAD.

Materials and methods. The study included 79 patients with functional class II–III exertional angina who experienced myocardial infarction more than 6 months before. The patients were divided into two groups: group 1 (n = 45) consisted of patients with CAD and depression and group 2 (n = 34) encompassed patients with CAD without depression. The clinical presentation of CAD was assessed by the results of filling out the angina pectoris self-control diary and exertion tests. The presence and severity of DD were determined using psychometric scales, such as Hospital Anxiety and Depression Scale (HADS) and Beck Depression Inventory (BDI), and verified by the psychiatrist. Information about five-year survival was obtained via telephone interviews with the patients and their relatives.

Results. Patients with CAD and DD were characterized by more frequent episodes of angina pectoris during a week (10 [8; 14] vs 6 [4; 7], p = 0.000004), an increased demand for nitroglycerin (4 [0; 10] tablets vs 0 [0; 4] tablets, p = 0.001), and lower exercise tolerance (50 [25; 75] W vs 75 [50; 75] W (p = 0.06), 350 [250; 400] meters vs 435 [350; 500] meters (p = 0.01) than CAD patients without DD. The five-year survival rate was significantly lower in group 1 than in group 2 (69 [62; 72] vs 71 [68; 72] months (p = 0.04)), 35 (77.8%) vs 32 (94.1%) patients survived. In group 1, a greater number of deaths from cardiovascular accidents (10 (22.2%) vs 2 (5.9%)) was noted (log-rank test, p = 0.03).

Conclusion. In patients with CAD, associated depression results in aggravation of the clinical course of CAD and poor disease prognosis, which requires timely diagnosis and treatment of DD.

[Psychosocial factors and coronary heart disease]

Article is devoted to a research of interrelation of psychosocial factors and courses of coronary heart disease (CHD). The anxiety, a depression, social isolation of patients with CHD is considered. Need of identification of psychosocial factors at patients with CHD for the purpose of their correction and improvement of the forecast of sick CHD and quality of their life is shown.

Problems of medical rehabilitation in patients after a transient ischemic attack

The efficacy of rehabilitation in post-TIA patients still remains a clinical challenge, considering the combined burden of the primary disease and comorbidities. The aim of this study was to provide a rationale for introducing psychological counseling into post-TIA rehabilitation programs after studying the presentations of cognitive and emotional impairments developed after this cerebrovascular event. We analyzed in- and outpatient medical records of 351 participants (the mean age was 58.6 ± 2.2 years) who had experienced a TIA. Data was collected from forms 0.25/y and 003/y, medical/social questionnaires and also included MMSE and HADS scores. We found that CI and MD ranked second after cardiovascular diseases among the comorbidities in post-TIA patients (186.8 cases per 100 patients). We conclude that rehabilitation of post-TIA patients should involve a multidisciplinary team of experts including a psychotherapist or a clinical psychologist who will provide psychological counselling.

The General Health Questionnaire-28 (GHQ-28) as an outcome measurement in a randomized controlled trial in a Norwegian stroke population

BACKGROUND

Several studies have documented the variety of post-stroke psychosocial challenges, which are complex, multifaceted, and affect a patient's rehabilitation and recovery. Due to the consequences of these challenges, psychosocial well-being should be considered an important outcome of the stroke rehabilitation. Thus, a valid and reliable instrument that is appropriate for the stroke population is required. The factor structure of the Norwegian version of GHQ-28 has not previously been examined when applied to a stroke population. The purpose of this study was to explore the psychometric properties of the GHQ-28 when applied in the stroke population included in the randomized controlled trial; "Psychosocial well-being following stroke", by evaluating the internal consistency, exploring the factor structure, construct validity and measurement invariance.

METHODS

Data were obtained from 322 individuals with a stroke onset within the past month. The Kaiser-Meyer-Olkin (KMO) test was used to test the sampling adequacy for exploratory factor analysis, and the Bartlett's test of sphericity was used to test equal variances. Internal consistency was analysed using Cronbach's alpha. The factor structure of the GHQ-28 was evaluated by exploratory factor analysis (EFA), and a confirmatory factor analysis (CFA) was used to determine the goodness of fit to the original structure of the outcome measurement. Measurement invariance for two time points was evaluated by configural, metric and scalar invariance.

RESULTS

The results from the EFA supported the four-factor dimensionality, but some of the items were loaded on different factors compared to those of the original structure. The differences resulted in a reduced goodness of fit in the CFA. Measurement invariance at two time points was confirmed.

CONCLUSIONS

The change in mean score from one to six months on the GHQ-28 and the factor composition are assumed to be affected by characteristics in the stroke population. The results, when applying the GHQ-28 in a stroke population, and sub-factor analysis based on the original factor structure should be interpreted with caution.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02338869 , registered 10/04/2014.