Associations between lifestyle and comorbid anxiety and depression in pregnant women / 环境与职业医学

Background Anxiety and depression are common perinatal mental health issues that often occur together and can have serious negative effects on both maternal and infant health. Objective To examine the relationships between lifestyle factors and comorbid anxiety and depression (CAD) among pregnant women in Shanghai. Methods The study estimated the prevalence of CAD during the first, second, and third trimesters of pregnancy using the Self-rating Anxiety Scale (SAS) and Center for Epidemiological Studies-Depression (CES-D) based on data from the China National Birth Cohort (CNBC) embryonic-derived diseases with assisted reproductive technology (ART) sub-cohort. Information on demographics, sleep status, nutritional intake, and exercise during each trimester was collected through self-made questionnaires, the Pittsburgh Sleep Quality Index (PSQI), and the Food Frequency Questionnaire (FFQ). Lifestyle factors (such as sleep status, nutritional intake, and exercise during each trimester) were analyzed using logistic regression and generalized linear mixed models (GLMM) to determine their impacts on the prevalence of CAD (yes or no) among pregnant women. Results A total of 2876 pregnant women were included in this study. The prevalence of CAD was 10.6% (305), 3.6% (103), and 5.5% (159) in the first, second, and third trimesters of pregnancy, respectively. The logistic regression analysis revealed that poor sleep quality throughout the entire pregnancy were statistically associated with an increased prevalence of CAD, and the odds ratios (OR) with 95% confidence intervals (CI) were 2.817 (1.845, 4.301), 2.840 (1.855, 4.347), and 9.316 (5.835, 14.876) for the first, second, and third trimesters, respectively, when compared to good sleep quality. Additionally, compared to an intake frequency of 7 times per week, the frequency of egg intake ≤3 times per week in the first trimester (OR=2.025, 95%CI: 1.197, 3.425) and the frequency of egg intake of 4–6 times per week (OR=1.896, 95%CI: 1.117, 3.216) or ≤3 times per week (OR=1.906, 95%CI: 1.082, 3.357) in the third trimester were associated with an increased risk of CAD (P<0.05). Moreover, when compared to a frequency of exercise >3 times per week, never or almost never exercising in the second trimester (OR=2.218, 95%CI: 1.220, 4.035) was associated with an increased risk of CAD (P<0.05). The GLMM analysis also demonstrated a significant association between poor sleep quality, lower exercise frequency, or lower intake frequency of vegetables, eggs, or milk and an increased risk of CAD (P<0.05). Conclusion The prevalence of CAD among pregnant women in Shanghai follows a U-shaped distribution, with the highest rate occurring in early pregnancy and the lowest rate in mid-pregnancy. Factors such as poor sleep quality, inadequate intake of vegetables, eggs, or milk, and lack of exercise during pregnancy may increase the risk of CAD. Implementing lifestyle interventions during pregnancy could potentially reduce the risk of mental health problems and improve the overall health of both mothers and babies.

Somatización, ansiedad y depresión en mujeres víctimas de violencia de pareja íntima / Somatization, anxiety and depression in women victims of intimate partner violence

Resumen A pesar de que la violencia de pareja íntima (VPI) presenta en la mujer una variedad de síntomas evidenciables, varios de los actores involucrados en el sistema de salud no cuentan con mecanismos de evaluación temprana, ni de reconocimiento de los tipos de secuelas psicológicas, entre los que se incluye una diversa sintomatología psicofisiológica. Con el objetivo de conocer las características de somatización, ansiedad y depresión en mujeres víctimas de VPI, como parte de una investigación macro de corte transversal no experimental de campo, se realizó el presente estudio cuantitativo correlacional a través de las variables del Inventario de Evaluación de la Personalidad (PAI). Los datos obtenidos se sometieron a análisis estadístico con métodos descriptivos e inferenciales. La muestra consta de 50 mujeres de la población de víctimas de VPI de la sierra ecuatoriana. Los resultados obtenidos son bastante contradictorios en cuanto al bajo porcentaje de mujeres con afectación típica relacionada con este tipo de violencia, en comparación con los datos presentados por otros autores sobre los niveles de somatización, ansiedad y depresión en ellas. A pesar de esto, se obtuvieron tres factores independientes presentes en esta muestra: trastorno ansioso-depresivo, con elementos de estrés postraumático; trastorno obsesivo compulsivo, con elementos de ansiedad, y quejas somáticas. Al momento de finalizar este estudio, se puede concluir que el PAI, sin su validación previa en esta población, no muestra una idoneidad suficiente para evaluar mujeres víctimas de VPI en el Ecuador. Se recomiendan nuevas investigaciones en otras muestras, en las que se utilicen diversos esquemas empíricos que incluyan varios instrumentos y medios cualitativos.

Abstract Various studies have noticed that women victims of intimate partner violence (IPV) also report having various types of health-related problems. However, health systems do not appear to have established procedures to recognize these problems (i. e., psychophysiological) in women. This study assessed somatic symptoms, anxiety, and depressive characteristics in women who have been victims of IPV. These symptoms were assessed using the scales of the Personality Assessment Inventory (PAI). The sample consisted of 50 women victims of IPV from the Ecuadorian sierra. Group participants came from two different cities: the first group included 28 women victims of IPV from Riobamba. Their ages ranged from 15 to 58. These women were receiving psychological services from a not-for-profit organization in the city. The second group included 22 women with similar characteristics between the ages of 27-63. This group of women came from the southern regions of Quito, the capital city of Ecuador. Women in this group were receiving services from two different places offering help to women experiencing IPV. Sixteen percent of women reported having a medium level of "anxiety" (some level of stress), and 14 % reported having a high level of tension and stress. Thirty-four percent of women reported medium levels of "anxiety-related disorders". These women reported having specific fears, little confidence in themselves and negative perspectives of their future. Sixteen percent of the women reported high levels of anxiety. They reported imitations in daily life (i. e., specific fears and feelings of insecurity in social situations). Thirty percent of women reported having medium levels of "depression" (sensitivity, pessimism, and feeling unhappy part of the time). Eighteen percent of women reported having high levels of "depression" (notable unhappiness and dysphoria). Forty-four percent of women in this study reported having some type of physical problem. These findings suggest that women who are victims of IPV could benefit from receiving mental health services aimed at managing their tension, stress, specific fears, and symptoms of depression. They also suggest that women victims of IPV could benefit from receiving training to increase their social competency and medical assistance to address their somatic complaints. Findings in this study are somewhat divergent from the results observed in previous investigations. Previous studies identified that most women who experienced IPV report symptoms of depression and anxiety. However, in this study, only a relatively low percentage of women reported having these symptoms. The sole utilization of the PAI as a method of evaluation may not have been sufficient to identify these symptoms. These results suggest the importance of using qualitative methods (i. e., clinical interview) or more holistic methodologies (i. e., clinical interview and tests) to better assess mental health symptoms in this group of women. It is also possible that the PAI might not be the most adequate tool to assess these symptoms in this population. The results of this investigation do reveal the importance of evaluating other mental health symptoms in women victims of IPV: post-traumatic stress, and obsessive-compulsive disorder. Future studies should focus on assessing these symptoms using other assessment methodologies (e. g. instruments designed to assess post-traumatic stress and obsessive-compulsive disorder). The efficiency of health systems evaluations and interventions depends on the methodologies used to assess problems. The sole use of one instrument such as the PAI may not provide sufficient information about symptoms experienced by women experiencing IPV. Health systems should use batteries of instruments in conjunction with the clinical interviewing processes to readily assess symptoms. However, such an alternative may not be entirely feasible taking into account that such methodology requires more time and likely financial support to acquire tests.

An analytical cross-sectional study on the association between animal companionship and anxiety among students of a private medical school in Quezon City / The Health Sciences Journal

Introduction@#Constant stress predisposes medical students to anxiety. The study aimed to determine the association between animal companionship and anxiety among medical students at UERMMMCI.@*Methods@#The study utilized an analytical cross-sectional design via an online form with the anxiety portion of the HADS questionnaire. Participants included first to third year medical students of a private medical school.@*Results@#A total of 161 responses were recorded. Sex and year-level exhibited significant association with anxiety. Those with anxiety were 2.71 times more likely to be females (p = 0.007). Stratification showed that those with anxiety were 1.72 times less likely to be females with pets (p = 0.37) while, in contrast, those with anxiety were 3.64 times more likely (p = 0.02) to be males with pets. Those with anxiety were likely to belong to first and second-years (p = 0.01 and p = 0.06), respectively and pet owners, though, not statistically significant (p = 0.357).@*Conclusion@#An association between sex and year-level with anxiety was noted. Those with anxiety were likely to be females, first-years, and males with animal companionship. Although they did not reach statistical significance.

Chaihu Longgu Mulitang in Treatment of Coronary Heart Disease Complicated with Anxiety and Depression： A Review / 中国实验方剂学杂志

Coronary heart disease （CHD） with atherosclerosis is a common chronic disease worldwide， and anxiety and depression are potential and crucial risk factors for adverse prognosis in CHD. Chaihu Longgu Mulitang （CLMT）， first mentioned in the Shang Han Lun （《伤寒论》）， is a classic prescription for treating Shaoyang diseases combined with disturbance of the mind and spirit， with the effects of harmonizing Shaoyang and calming the mind. Current research on mechanisms has shown that CLMT can play a role in CHD complicated with anxiety and depression through multiple pathways， including regulating related signaling pathways， inhibiting the expression of inflammatory factors， improving oxidative stress damage， modulating neurotransmitter levels， suppressing the hypothalamic-pituitary-adrenal axis， promoting mobilization of mesenchymal stem cells from the bone marrow， and inhibiting platelet activation. Clinical studies have demonstrated that CLMT significantly improves symptoms such as angina and insomnia caused by CHD complicated with anxiety and depression， effectively reduces negative emotions， improves traditional Chinese medicine （TCM） syndrome scores， and decreases levels of inflammatory factors. Furthermore， it has fewer adverse reactions and higher safety than conventional western medicine treatments. This article provides a review of the mechanisms and clinical studies of CLMT in the treatment of CHD complicated with anxiety and depression based on a comprehensive analysis of literature from the China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， and other databases in the past 15 years， in order to provide references for further research on the use of CLMT in the management of CHD complicated with anxiety and depression.

Linkage of blood cell division cycle 42 with T helper cells, and their correlation with anxiety, depression, and cognitive impairment in stroke patients

Cell division cycle 42 (CDC42) regulates T helper (Th) cell differentiation and is related to psychological disorders. This study aimed to assess the correlation between blood CDC42 and Th cells, and their association with mental issues in stroke patients. Peripheral blood samples were obtained from 264 stroke patients and 50 controls. Then, serum CDC42 was measured by enzyme-linked immunosorbent assay, and Th1, Th2, and Th17 cells were detected by flow cytometry. Hospital Anxiety and Depression Scale (HADS) and Mini Mental State Examination (MMSE) were applied to patients. CDC42 was decreased (P<0.001), Th1 (P=0.013) and Th17 (P<0.001) cells were elevated, while Th2 cells (P=0.108) showed no difference in stroke patients compared to controls. In addition, CDC42 was negatively associated to Th1 (P=0.013) and Th17 (P<0.001) cells in stroke patients but were not associated with Th2 cells (P=0.223). Interestingly, CDC42 was negatively associated with HADS-anxiety (P<0.001) and HADS-depression scores (P=0.034) and positively associated with MMSE score (P<0.001) in stroke patients. Lower CDC42 was associated to lower occurrence of anxiety (P=0.002), depression (P=0.001), and cognitive impairment (P=0.036) in stroke patients. Furthermore, increased Th17 cells were positively correlated with HADS-anxiety and HADS-depression scores and inversely correlated with MMSE score, which were also associated with higher occurrence of anxiety, depression, and cognitive impairment in stroke patients (all P<0.05). Blood CDC42 and Th17 cells were correlated, and both of them were linked to the risk of anxiety, depression, and cognitive impairment. However, the findings need further large-scale validation, and the implicated mechanism needs more investigation.

Anxiety and depression among medical undergraduate students and their sociodemographic correlates in Sikkim: A cross-sectional study

Background: Psychological morbidity in medical undergraduate students has always been reported from various countries across the globe. Studies which document this burden among medical students in India are very few. Aims and Objectives: The presence of depression and anxiety among medical undergraduate students was assessed using a previously validated and standardized instrument, hospital anxiety and depression scale (HADS) and the associations with their sociodemographic and comorbidities were identified. Materials and Methods: In a cross-sectional survey, a self-administered, pre-designed, pre-tested HADS was used to collect information on basic sociodemographic (age, gender, semester, and socioeconomic status) and comorbidities through a Google Forms. Informed written consent was obtained from all participants. Scores for each of the respondents over each of the subscales (depression and anxiety) were calculated as per the severity rating index. Results: The study showed that majority (77.4%) of the students did not feel that they were depressed which was found to be similar in both male and female students. However, about 50% of both male and female students were found to be suffering from either mild or moderate anxiety. The present study showed that there was no significant association between HADS score and socioeconomic and sociodemographic characteristics among medical undergraduate students. Conclusion: A substantial proportion of medical undergraduate students was found to be anxious and quite a lot of them were found to be suffering from mild to moderate depression, revealing a neglected area of the students’ psychology requiring urgent attention. Student counseling services need to be made available and accessible to curb this morbidity.

The effect of eCASH model on negative emotion and risk of related adverse events in patients with severe continuous renal replacement therapy / 中国实用护理杂志

Objective:To investigate the effects of early Comfort using Analgesics, minimal Sedatives and maximum Humane care (eCASH) patterns on the risk of negative mood and continuous renal replacement therapy (CRRT)-related adverse events in patients with severe CRRT.Methods:A total of 90 patients with severe CRRT in Shenzhen Integrated Traditional Chinese and Western Medicine Hospital from October 2018 to October 2020 were selected as the study subjects, and they were divided into observation group and control group according to random number table method, with 45 patients in each group. The control group was given routine nursing program, and the observation group was given eCASH mode on the basis of the control group.Nursing satisfaction, CRRT-related adverse events and negative mood scores before and after nursing were compared between 2 groups.Results:The nursing satisfaction degree of the observation group was 86.67% (39/45), significantly higher than that of the control group (66.67%, 30/45), and the difference was statistically significant ( χ2=5.03, P<0.05). After nursing, the Hospital Anxiety and Depression Scale-Anxiety(HADS-A) and Hospital Anxiety and Depression Scale-Depression(HADS-D) scores of the observation group were 5.18 ± 0.67 and 5.27 ± 0.61, respectively, lower than 8.14 ± 1.18, 7.94 ± 1.07 before intervention, and 6.33 ± 0.72, 5.94 ± 0.49 of the control group. Barthel Index(BI) (65.17 ± 8.67) was significantly higher than that before nursing 41.56 ± 6.46 and control group 60.48 ± 6.47, the difference was statistically significant ( t values were 5.74-20.76, all P<0.05). The scores of Visual Analogue Scale(VAS), Present Pain Intensity(PPI), sensory total score and emotional total score of observation group after nursing were 3.24 ± 0.56, 1.18 ± 0.25, 6.38 ± 0.89, 2.68 ± 0.59 significantly lower than those before nursing 6.24 ± 0.87, 3.24 ± 0.56, 11.24 ± 1.81, 6.37 ± 1.04 and 4.36 ± 0.67, 1.31 ± 0.31, 7.26 ± 0.96, 2.98 ± 0.62 of the control group. The difference was statistically significant ( t values were 2.19-20.70, P<0.05). Conclusions:eCASH model can significantly improve the negative emotions of patients with severe CRRT, improve their comfort and reduce the risk of related adverse events, which is worthy of clinical promotion.

Effect of kangaroo mother care on maternal anxiety and depression states at the neonatal ICU: A prospective cohort study

Objectives@#To determine the effect of kangaroo mother care (KMC) on anxiety and depression of mothers of low-birth-weight neonates during the immediate newborn period. @*Method@#Eligible participants were mothers of low-birth-weight infants (birth weight ≤2500 grams) admitted at a tertiary hospital's neonatal intensive care unit. Mothers were instructed on providing KMC daily to their infants during the study period (first seven days of life). @*Main Outcome Measure(s)@#The primary study outcome was the effect of KMC in improving maternal anxiety and depression scores in the immediate postpartum period using the locally validated Hospital Anxiety and Depression Scale-Pilipino (HADS/HADS-P). @*Results@#A total of 171 mothers were enrolled in the study. Only 79 mothers provided KMC, and the rest (92) did not provide KMC. The anxiety and depression scores improved significantly from day 1 to 7 postpartum in both groups (p<0.05). Frequency of mothers categorized as having severe anxiety significantly decreased over time whether they provided KMC or not (KMC: 40.5%, 13.9%, 7.6% at Day 1 and 7 postpartum and day of discharge; No KMC: 35.9% and 27.2% at Day 1 and Day 7 postpartum). There was a significant reduction in the percentage of mothers categorized in the depressed group from Day 1 to Day 7 postpartum, among those who rendered KMC compared with those who did not (KMC: 7.6%, 2.5%, 0% at Day 1 and 7 postpartum and at the day of discharge vs. No KMC: 7.6% and 10.9% at Day 1 and 7 postpartum). There were no significant differences in the anxiety and depression scores at any period between mothers who rendered KMC > 6 hours and KMC ≤ 6 hours/day. @*Conclusion@#Anxiety and depression scores significantly decreased over time in both mothers who rendered and did not render KMC to their infants. However, there was a significant reduction in the percentage of mothers categorized as having severe depression over time among those who rendered KMC compared to those who did not. Other factors aside from KMC may affect the maternal anxiety and depression states, such as instability of the infant.

Systematic Review and Meta-analysis of Traditional Chinese Medicine on Inflammatory Factors in Patients with Coronary Heart Disease Complicated with Anxiety and Depression / 中国实验方剂学杂志

To systematically evaluate the effect of traditional Chinese medicine（TCM） on the expression of inflammatory factors in peripheral blood of patients with coronary heart disease complicated with anxiety and depression，and explore its efficacy and safety in treatment of anxiety and depression. In this study，CNKI，VIP database，WanFang database，PubMed and Cochrane Library were searched to collect randomized controlled trials（RCTs） of TCM in the treatment of coronary heart disease complicated with anxiety and depression，and 2 researchers independently screened the literatures and extracted the data. The quality of the included literatures was evaluated with Cochrance bias risk evaluation tool and Meta analysis was conducted by Cochrane Revman 5.3 software. A total of 21 research articles were included，with a total sample size of 2 342 cases，1 175 cases in the treatment group and 1 167 cases in the control group. Meta analysis results showed that the treatment group reduced the hypersensitive C-reactive protein（hs-CRP）［standard mean difference（SMD）=-1.61，95% confidence interval（CI）（-2.14，-1.09），P<0.01］，interleukin（IL）-8［mean difference（MD）=-5.03，95% CI（-8.37，-1.70），P=0.003］，IL-17［MD=-33.27，95% CI（-40.15，-26.39），P<0.01］，tumor necrosis factor（TNF）-α［SMD=-1.18，95% CI（-1.98，-0.38），P<0.01］，and homocysteine（Hcy）［MD=-3.45，95% CI（-4.85，-2.04），P<0.01］. The treatment group was better than the control group in terms of relieving anxiety and depression，i.e. scores of Hamilton anxiety scale（HAMA） ［SMD=-1.97，95% CI（-2.48，-1.46），P<0.01］，Hamilton depression scale（HAMD） ［SMD=-1.94，95% CI（-2.50，-1.38），P<0.01］，and self-rating depression scale（SDS）［SMD=-0.72，95% CI（-0.90，-0.54），P<0.01］，so in terms of ，with statistically significant difference. 4 articles mentioned that no obvious adverse reactions occurred，4 articles mentioned that the treatment group had drowsiness，dry mouth and bitter mouth，gastrointestinal reactions，but the incidence rates were significantly lower than those of the control group. The other 13 articles did not mention the occurrence of adverse reactions.

Measurement of anxiety and depression among cancer patients seen in an outpatient clinic of a tertiary hospital using the validated Hospital Anxiety and Depression Scale – Pilipino Version (HADS-P)

Background@#Anxiety and depression, two of the most common affective disorders in cancer patients can affect one’s compliance to treatment leading to poorer outcomes. Therefore, means of determining the psychological wellness of cancer patients through screening tools for anxiety and depression are an integral part of their management.@*Objectives@#1) To measure the prevalence of anxiety and depression among cancer patients seen in an outpatient clinic of a tertiary hospital using the HADS-P. 2) To assess the impact of the following variables on symptoms of anxiety and depression: demographic, socio-economic, biological and health/clinical parameters.@*Methodology@#This is a cross-sectional analytic study involving 381 cancer patients seen in the outpatient clinic. Symptoms of anxiety and depression were measured using the HADS-P with an 11+ cut-off to identify possible cases of anxiety and depression. Univariate analysis, using STATA Version 13, was performed to identify correlates of anxiety and depression.@*Results@#The prevalence of anxiety, depression and mixed diagnosis (anxiety and depression) amongst this study population were 9.45%,4.72% & 2.89%, respectively. The multivariate analysis described non-college graduates (OR=1.82, CI 0.80-4.14), poor performance status (ECOG 2-3) (OR=5.34, CI 2.44-11.71) and the newly diagnosed and with ongoing treatment patients (OR= 12.02, CI 2.67-54.04 and OR=4.04, CI 0.88-18.58, respectively) as possible correlates of anxiety. Patients with poor performance status and have moderate-severe pain were likely to experience depression (OR= 6.14, CI 2.14-17.62; OR= 2.78, CI 0.92-8.46, respectively).@*Conclusions@#There are several factors that can affect one’s predisposition to having affective disorders. Clearly, there is a necessity to allocate resources for screening and treating affective disorders among cancer patients to improve their compliance, to achieve a more holistic approach in their management and ultimately, to improve their quality of life.

Affective relationships as predictors of TMD symptoms in young adults / Relações afetivas como preditoras de sintomas de DTM em adultos jovens

Abstract Introduction Orofacial pain is a critical TMD symptom that can influence physical and social capacity. Objective To evaluate the association of temporomandibular disorders (TMD) symptoms with affective relationships and demographic variables in young adults. Material and method A cross-sectional study involving 395 young adults was developed. Diagnostic Criteria for TMD, anxiety, and depression were collected from questionnaires. The Dental Health Component of the Index of Orthodontic Treatment Need measures the orthodontic treatment need. Questionnaires also contained questions related to the previous orthodontic treatment. Logistic regression models were adjusted, estimating crude odds ratio with the 95% confidence intervals. The variables with p<0.20 in the analyses were assessed in a multiple logistic regression model, remaining with p≤0.10. Result There was no significant association of TMD symptoms with sex, age, medication use for pain, previous orthodontic treatment, orthodontic treatment need, anxiety, and depression (p>0.05). Individuals without an affective relationship are 1.78 (95%CI: 0.99-3.17) times more likely to report TMD symptoms. Conclusion Affective relationships showed an association with TMD symptoms in young adults.

Resumo Introdução A dor orofacial é um sintoma crítico da DTM que pode influenciar a capacidade física e social. Objetivo Avaliar a associação dos sintomas das desordens têmporomandibulares (DTM) com as relações afetivas e variáveis demográficas em adultos jovens. Material e método Estudo transversal envolvendo 395 adultos jovens foi realizado. Os critérios diagnósticos para DTM, ansiedade e depressão foram coletados a partir de questionários. O Componente de Saúde Bucal do Índice de Necessidade de Tratamento Ortodôntico mensurou a necessidade de tratamento ortodôntico. Os questionários também continham questões relacionadas ao tratamento ortodôntico anterior. Modelos de regressão logística foram ajustados, estimando odds ratio bruto com os intervalos de confiança de 95%. As variáveis com p<0.20 nas análises foram avaliadas em modelo de regressão logística múltipla, permanecendo as variáveis com p≤0.10. Resultado Não houve associação significativa dos sintomas de DTM com sexo, idade, uso de medicamentos para dor, tratamento ortodôntico prévio, necessidade de tratamento ortodôntico, ansiedade e depressão (p>0.05). Indivíduos sem relacionamento afetivo têm 1.78 (IC95%:0.99-3.17) vezes mais chance de relatar sintomas de DTM. Conclusão Os relacionamentos afetivos mostraram associação com os sintomas de DTM em adultos jovens.

WeChat-based education and rehabilitation program in unprotected left main coronary artery disease patients after coronary artery bypass grafting: an effective approach in reducing anxiety, depression, loss to follow-up, and improving quality of life

This study aimed to investigate the effect of WeChat-based education and rehabilitation program (WERP) on anxiety, depression, health-related quality of life (HRQoL), major adverse cardiac/cerebrovascular events (MACCE)-free survival, and loss to follow-up rate in unprotected left main coronary artery disease (ULMCAD) patients after coronary artery bypass grafting (CABG). In this randomized controlled study, 140 ULMCAD patients who underwent CABG were randomly assigned to WERP group (n=70) or control care (CC) group (n=70). During the 12-month intervention period, anxiety and depression (using hospital anxiety and depression scale (HADS)) and HRQoL (using 12-Item Short-Form Health Survey (SF-12)) were assessed longitudinally. During the total 36-month follow-up period (12-month intervention and 24-month non-intervention periods), MACCE and loss to follow-up were recorded. During the intervention period, HADS-anxiety score at month 9 (M9) (P=0.047) and month 12 (M12) (P=0.034), anxiety rate at M12 (P=0.028), and HADS-D score at M12 (P=0.048) were all reduced in WERP group compared with CC group. As for HRQoL, SF-12 physical component summary score at M9 (P=0.020) and M12 (P=0.010) and SF-12 mental component summary score at M9 (P=0.040) and M12 (P=0.028) were all increased in WERP group compared with CC group. During the total follow-up period, WERP group displayed a trend of longer MACCE-free survival than that in CC group but without statistical significance (P=0.195). Additionally, loss to follow-up rate was attenuated in WERP group compared with CC group (P=0.033). WERP serves as an effective approach in optimizing mental health care and promoting life quality in ULMCAD patients after CABG.

Assessment of depression, anxiety and stress among Indian infertile couples in a tertiary health care centre in Bihar

Background: Infertility rate is on rising trend. It is often associated with a chronic state of stress which may manifest itself in anxiety-related and depressive symptoms. Also, the affected family faces social discrimination, ostracism and stigma which leads to increased anxiety or depression among infertile couples. The motive of this study was to assess the quality of life among infertile couples; to determine the relationship between various domains of quality of life of infertile couples i.e. emotional, mind/body, relational, social, environmental and tolerability and to determine the association of levels of quality of life of infertile couples with the selected variables visiting  IGIMS.Methods: This was a cross-sectional based study; carried out in the department of reproductive medicine, IGIMS, Patna, Bihar for one-year duration (January 2017 to December 2017), on 122 infertile patients attending outpatient department for treatment. Data was collected by using self-administered questionnaire i.e. Ferti QoL questionnaire and HADS.Results: Among all these 96 cases was found to be suffering from primary infertility and 26 cases from secondary infertility. In primary infertile patient social domain was the most affected domain having the greatest impact on their quality of life. In secondary infertile patients the tolerability domain was the most affected domain having the greatest impact on their quality of life. The total fertility quality of life score in primary infertility patients showed a lesser quality of life (55.41) than secondary infertility patients (66.29).Conclusions: This study points at the necessity of specific psychological interventions, presently absent from the public healthcare routine, for women struggling with infertility, to help them manage potential mental health problems and meet their reproductive goals.

Focus on Effects of Chinese Medicine on Improving Anxiety-Depression and Quality of Life of Patients with Primary Sjögren's Syndrome / 中国结合医学杂志

Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease with a long duration of illness, for which there is no cure. Patients often suffer from anxiety and depression due to various reasons, exhibiting a decline in their quality of life. Chinese medicine (CM) has certain advantages in the treatment of pSS, which not only helps relieve clinical symptoms and improve treatment outcomes, but also reduces anxiety and depression and improves the quality of life. Therefore, CM should be considered as early as possible given its effectiveness and synergistic effects in treating pSS.

Prevalence and risk factors of restless legs syndrome in patients of migraine without aura

Background: An association between migraine and Restless Legs Syndrome (RLS) has been proposed due to shared dopaminergic dysfunction. Both have substantial effects on the quality of life. Identifying co morbidities of migraine helps in optimizing patient management. Objectives To study the prevalence of RLS in patients of migraine without aura, and associated co morbidities of RLS.Methods: This was a hospital based prospective observational study. All patients diagnosed as Migraine without aura as per ICHD-3 criteria completed the questions regarding migraine headache, Migraine Disability Assessment (MIDAS) questionnaire, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and International RLS Study Group (IRLSSG) Rating Scale. RLS was diagnosed using the IRLSSG criteria. Serological investigations were done to look for secondary causes of RLS.Results: Out of 200 consecutive patients of migraine without aura were included in the study over a period of 18 months. Frequency of RLS was 13.5% (n=27). All patients had primary RLS. Mean PSQI score was higher in the patients of migraine without aura with RLS than in non RLS patients of migraine without aura (3.30±2.66 vs 2.24±2.03 p≤0.0168). Poor sleep quality, anxiety, depression was found in 9%, 8% and 2.5% respectively in patients of migraine without aura.Conclusions: An association between migraine without aura and RLS was demonstrated. Migraine without aura was associated with increased frequency of poor sleep quality, anxiety and depression.

Assessment of psychiatric illness and other comorbidities associated with patients attending obesity clinic in Ahmedabad

Background: Psychosocial impact of obesity is of concern in the present world but remains less studied compared to its physical consequences. People who take treatment for obesity are reported to be positively associated with psychiatric illnesses and also personality characteristics or psychological conditions influence the obesity treatment. Objective: The objective of this study was to study the prevalence of psychiatric illness and comorbid conditions among people with overweight and obesity and to find out factors associated with psychiatric illness. Materials and Methods: A cross-sectional study was conducted in private obesity clinic, Ahmedabad. A total of 103 people attending obesity clinic were studied. Self-structured questionnaire and Hospital Anxiety and Depression Scale (HADS) were used. Results: Of 103, 87.5% (91) were female. Mean age of people attending obesity clinic was 35 ± 9.2 years. About 67.3% were housewife and 92.2% were educated up to secondary or above. Thirty-eight (38.8%) and 59 (57.2%) of 103 were found to be having overweight and obesity, respectively. About 69% of people with obesity belong to Grade 1 and 31% belong to Grade 2 and 3. Psychiatric illness was observed among 38.8% (40) of the obesity clinic attendees. Of 40, 32.5% were found to have abnormal level of HADS score and needed intervention. Of 103, 45.6% had comorbid conditions such as joint associated problems (25%), hypertension (16.5%), and hypothyroidism (14%). Among overweight and obese with comorbidities, 48.9% had psychiatric illness. Psychiatric illness was observed among 37% of people with duration of obesity >5 years. The study did not find any significant association between overweight and obese having comorbid conditions (z = 0.63, P > 0.05) and duration of obesity (z = 0.44, P > 0.05) with psychiatric illness. Conclusion: Both comorbidity and psychiatric illness are highly prevalent among obese people. This indicates early detection and intervention for both to decrease the morbidity and mortality among obese and overweight.

Anxiety and depression among nurses working in a tertiary care hospital in South India

Background: Nursing binds human society with a bond of care and affection. Nurses are often the first healthcare professional that patients meet. Quality of care for patients is strongly linked to the performance of the nursing staff. If the mental health status of these nurses is troubled, then they will not be able to give their full attention to this demanding task. Nowadays, all efforts to fight health workers’ illnesses are extremely important. This descriptive cross-sectional study will give us knowledge regarding the anxiety and depression status among nurses and give the nursing staff an opportunity to express their difficulty in professional life working in a tertiary care hospital in South India. Objective of this study was conducted to assess the prevalence of anxiety and depression among nurses working in a tertiary care hospital and to assess the correlation between various factors influencing the level of anxiety and depression among nurses.Methods: Nurses were selected by simple random sampling till the sample size was obtained. A standardised questionnaire was handed over to the participants to collect relevant data and was assessed by Hospital Anxiety and Depression Score (HADS) and analysed using SPSS software.Results: The participants consist of 120 nurses. The study gives frequencies of nurses with anxiety as 48(40%) and depression as 43(35.8%). There does not exist any significant correlation of anxiety and depression with various factors influencing them.Conclusions: Anxiety and depression levels are increased in the younger and less experienced nurses. Thereafter, interventions can be planned to improve the quality of work-life of nurses that can improve patient care and in turn benefit the society.

La estructura factorial de la Escala hospitalaria de Ansiedad y Depresión en pacientes adolescentes con enfermedad crónica / Factor structure of the Hospital Anxiety and Depression Scale in adolescent patients with chronic disease

Introducción. La Escala hospitalaria de Ansiedad y Depresión (Hospital Anxiety and Depression Scale, HADS) es un instrumento de pesquisa, utilizado para evaluar sintomatología emocional en diferentes poblacionesy patologías médicas. Este estudio analiza las propiedades psicométricas y la estructura factorial de la HADS en adolescentes con enfermedad crónica y las diferencias en función de la patología médica. Método. La HADS fue administrada a una muestra de 302 adolescentes con enfermedad crónica. Se realizaron análisis factoriales exploratorios con una submuestra de 100 adolescentes y análisis factoriales confirmatorios con el resto de los participantes (202) para analizar la validez y fiabilidad de la HADS (14 ítems); además se calculó el análisis de la varianza de un factor para analizar las diferencias entre patologías. Resultados. Pacientes de 12 a 16 años de edad, con una distribución similar por género; el 43 % padecía enfermedades respiratorias, y el 47 %, endocrinológicas. La estructura original de dos factores (ansiedad y depresión) fue la que mostró buenos índices de ajuste e incorporó un factor de 2° orden (malestar emocional). Tres de los ítems originales de la escala fueron eliminados; se obtuvo, finalmente, una nueva versión de 11 ítems. Esta mostró adecuadas propiedades psicométricas y se observaron diferencias entre pacientes con diabetes mellitus 1 y con patología respiratoria, pero no en talla baja, en el factor de depresión. Conclusiones. Esta escala presenta una adecuada fiabilidad y validez en pacientes con enfermedad crónica pediátrica y resulta útil para la detección temprana de clínica ansioso-depresiva en el ámbito sanitario.

Introduction. The Hospital Anxiety and Depression Scale (HADS) is a screening instrument that assesses emotional symptoms in different populations and medical conditions.This study analyzes the psychometric properties and factor structure of the HADS in adolescents with chronic disease and the differences based on their medical condition. Method. The HADS was administered to a sample of 302 adolescents with chronic disease. Exploratory factor analyses were done in a sub-sample of 100 adolescents, while confirmatory factor analyses were performed in the rest of participants (202) to examine the validity and reliability of the HADS (14 items); an analysis of variance for a single factor was also done to study differences among diseases.Results. Patients were aged 12-16 years, with a similar sex ratio; 43 % had respiratory diseases and 47 %, endocrine disorders. The original two-factor structure (anxiety and depression) showed adequate fit indices and incorporated a second-order factor (emotional distress). Three of the original items were removed, thus obtaining a new 11-item version. This showed adequate psychometric properties, and differences were observed between patients with type 1 diabetes mellitus and those with respiratory disease, but not in terms of short stature, in the depression factor.Conclusions. The HADS displays an adequate reliability and validity in pediatric patients with chronic disease and is useful for the early detection of anxiety and depression in the health care setting

Evaluación de ansiedad y depresión en pacientes con lumbalgia crónica en la unidad de dolor de un hospital universitario / Evaluation of anxiety and depression in patients with chronic low back pain of a university hospital pain unit

La ansiedad y la depresión son las formas más frecuentes de alteraciones psicológicas que se ven en pacientes con dolor crónico, en general; y lumbalgia crónica, en particular. No existen, en nuestro medio, reportes sobre estos trastornos psicológicos en pacientes con lumbalgia crónica, siendo pocos los estudios en latinoamérica. El objetivo del presente estudio piloto fue evaluar la presencia de ansiedad y depresión en pacientes con lumbalgia crónica, acompañada o no de dolor radicular, que consultaron en el servicio de tratamiento del dolor de nuestro hospital universitario. La escala de ansiedad y depresión Hospitalaria (EADH, versión en español de la hospital anxiety and depression scale, HADS) fue el instrumento utilizado para la valoración de ansiedad y depresión. La muestra fue de 25 pacientes. De éstos, 16 (64 por ciento) presentaron diagnóstico de ansiedad y 7 (28 por ciento) de depresión. La frecuencia de ansiedad en esta muestra fue más alta que la de depresión que, sin contar los casos probables, fue de 28 por ciento. Se registraron 3 casos de diagnóstico probable de ansiedad y 7 de depresión. Los pacientes estudiados presentaban dolor intenso e incapacitante, evaluado por el Inventario abreviado de dolor. Se observó una correlación lineal positiva moderada a débil, pero estadísticamente significativa entre ansiedad y depresión, y la intensidad del dolor medido el Índice de Intensidad. Se encontró una correlación positiva débil, aunque estadísticamente significativa entre ansiedad y depresión y el Índice de Interferencia. En conclusión, en este estudio piloto en pacientes con lumbalgia crónica se detectaron, utilizando la escala de ansiedad y depresión hospitalaria, niveles elevados de ansiedad, con niveles menores de depresión, trastornos que se correlacionan con la intensidad del dolor y la incapacidad derivada de éste de manera moderada a débil. Este es el primer estudio en nuestro medio que evalúa ansiedad y depresión en pacientes con lumbalgia crónica, utilizando la escala de ansiedad y depresión hospitalaria validada en español. Los hallazgos obtenidos exigen un abordaje interdisciplinario de la lumbalgia crónica, que podrá incluir el uso de antidepresivos con acción ansiolítica como la duloxetina.

Anxiety and depression are frequent disorders in patients with chronic pain, in particular in the spine. No studies evaluating these psychological disorders have been performed in our country in chronic low back pain patients, and a few were found in latin America. The goal of the present pilot study was to evaluate the presence of anxiety and depression in chronic back pain patients with or without radicular pain, utilizing the hospital anxiety and depression scale, in the Spanish validated version. 25 patients were chosen of the ambulatory consultation of the chronic pain treatment unit of the university hospital. 16 (64 percent) presented anxiety and 7 depression (28 percent). The probable cases were 3 for anxiety and 7 for depression. All the patients had intense pain and functional impairment, evaluated by the brief pain Inventory instrument. A moderate to weak, statistically significant, positive correlation, were observed between anxiety and depression and pain intensity and interference, measured by the Intensity and interference scores. In conclusion, in the present pilot study in chronic low back pain patients, high levels of anxiety was observed, with lower frequency of depression, utilizing, for first time in our country, the hospital anxiety and depression scale in Spanish. Weak to moderate positive correlations were observed between anxiety and depression and pain intensity and interference in patient daily activities. Under the light of these findings, an interdisciplinary approach of chronic low back pain patients is mandatory, including the use of antidepressants with a tranquilizer profile, as it is duloxetine.

Anxiety and depression in heart failure patients: A prospective, cross-sectional study

Introduction@#Anxiety and depression are the two most common mental disorders among medically ill patients with prevalence of 10%-50%. Anxiety and depression are prevalent in patient with heart disease and are associated with high morbidity and mortality. This study aims to determine the prevalence of anxiety and depression and its correlation with clinical profile in heart failure patients using the Hospital Anxiety and Depression Scale Filipino Version (HADS-P). @*Methods@#A prospective cross-sectional study was conducted. HADS-P questionnaire was administered to heart failure patients admitted at the University of Santo Tomas Hospital from December 2013 to November 2014. After securing consent from the attending physicians and patients, the HADS-P questionnaires were then administered to the patients at the end of hospitalization by the investigator/s. The recommended cut-off score for HADS-P is score of 11. Chi-square and Independent T-tests were used in this study.@*Results@#144 heart failure patients were enrolled in this study. The prevalence of depression and anxiety among heart failure patients is 13.2% and 25.7%, respectively. Having prior coronary angiography, coronary angioplasty, EF < 40%, and multiple co-morbidity diseases/s are significant factors for depression. While among patients with anxiety, the significant factor is the length of hospital stay.@*Conclusion@#This study shows that depression and anxiety are common among heart failure patients. Heart failure patients should be screened for depression and anxiety especially among those having above mentioned clinical profile. The HADS-P questionnaire is an easily applied screening method. A formal psychiatric referral can be taken and should be a part of the comprehensive management among heart failure patients with depression and anxiety.