Effects of antipsychotic medications in glucose and lipid metabolism at the fasted state in drug-naïve first episode patients with psychosis after six months and three years of treatment.

Diabetes and dyslipidemia are common in patients with psychosis and may be related to adverse effects of antipsychotic medications. Metabolic disturbances in first-episode patients with psychosis are common, even prior to any antipsychotic treatment, and antipsychotic medications are implicated in the development of metabolic syndrome, at least in the long run. We therefore aimed to follow a group of drug-naïve, first-episode patients with psychosis at different time points (baseline, six months, and 36 months after the initiation of antipsychotic treatment) in order to evaluate the progression of metabolic abnormalities after antipsychotic therapy and the time-course of their onset. We assessed glucose and lipid metabolism during the fasted state in 54 drug-naïve patients with first-episode psychosis (FEP) before the initiation of any antipsychotic treatment and compared them with matched controls. The same parameters were assessed in the patient group (n=54) after six months of antipsychotic treatment and in a subgroup of patients (n=39) after three years of continuous and stable treatment in comparison to baseline. Measurements were obtained for fasting serum concentrations of total cholesterol, triglycerides, high density lipoprotein (HDL), glucose, insulin, connecting peptide (C-peptide), homeostatic model assessment index (HOMA-IR), glycated hemoglobin (HbA1c) and body mass index (BMI). Insulin, C-peptide, triglyceride levels, and HOMA-IR index were significantly higher compared to controls. Total cholesterol, triglyceride levels and BMI, increased significantly in the patient group after six months of antipsychotic treatment. After three years of continuous antipsychotic treatment, we found statistically significant increases in fasting glucose, insulin, total cholesterol, triglyceride levels, HbA1c, HOMA-IR index, and BMI compared to baseline. In conclusion, FEP patients developed significant increases in BMI and serum lipid levels as soon as six months after antipsychotic treatment. These metabolic abnormalities persisted following 36 months of treatment and in addition, increases in fasting glucose, insulin, HbA1c and HOMA-IR were observed compared to baseline.

Measuring parental stress, illness perceptions, coping and quality of life in families of children newly diagnosed with autism spectrum disorder.

BACKGROUND: A variety of psychosocial factors have been shown to affect the quality of life of families (FQoL). AIM: This study aimed to assess the impact of mother's demographic characteristics, parental stress, illness perceptions about autism spectrum disorder (ASD), coping strategies, ASD severity and time since diagnosis on FQoL during the initial period following diagnosis (≤6 months). METHOD: Fifty-three mothers of children newly diagnosed with ASD completed the Beach Center Family Quality of Life Scale, the Autism Parenting Stress Index, the Brief Illness Perception Questionnaire and the Brief Coping Orientation to Problems Experienced Inventory. A descriptive analysis was conducted on the demographic characteristics of the family. Eta coefficients and Pearson's analysis were used to determine the associations between the variables and the FQoL dimensions. Hierarchical regression was used to determine whether variables explained a statistically significant family quality of life variance. RESULTS: Pearson's analysis and eta coefficients indicated several correlations. Hierarchical regression analysis showed that higher parental stress related to core autism symptoms was associated with poorer FQoL (95% CI -0.08 to -0.02, P = 0.001), and higher perceived treatment control was associated with better FQoL (95% CI 0.04-0.16, P = 0.001). In addition, stronger perceived personal control was associated with higher physical/material well-being (95% CI 0.01-0.16, P = 0.022) and higher disability-related support (95% CI 0.30-0.61, P = 0.001). Higher family monthly income was associated with better FQoL (95% CI 0.08-0.027, P = 0.000), whereas marital status (divorced mother) was correlated with poorer FQoL (95% CI -0.68 to -0.16, P = 0.002). CONCLUSIONS: Interventions should emphasise managing the disorder's characteristics and implementing psychoeducational and supportive programmes for parents, immediately after the diagnosis, to enhance FQoL.

Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation.

INTRODUCTION: Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD). PURPOSE: To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups. METHODS: A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools. RESULTS: The majority of caregivers were females (67.2%), with a median age of 58 years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively). CONCLUSION: Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.

Adiponectin, leptin and resistin levels in first-episode, drug-naïve patients with psychosis before and after short-term antipsychotic treatment.

OBJECTIVE: There is increasing evidence that adiponectin, resistin and leptin may be implicated in the pathophysiology of neuropsychiatric disorders, including schizophrenia. The results of the studies so far remain controversial. Our aim was to compare serum adiponectin, leptin and resistin levels between drug-naïve, first -episode patients with psychosis and healthy controls and in the same group of patients after six weeks of antipsychotic treatment. METHODS: Forty first-episode patients with psychosis and 40 matched controls were included in the study. Serum levels of adiponectin, resistin and leptin were measured by enzyme linked immunosorbent assay (ELISA) in both groups. In the patient group, the same adipokines were also measured six weeks after the initiation of antipsychotic treatment. RESULTS: Log-transformed serum levels of adiponectin (mean difference = 1.68, 95% confidence interval [CI] = 1.30 to 2.06, U = 157, p < 0.0001), resistin (0.48, 95% CI = 0.36 to 0.59, t = 8.00, p < 0.0001) and leptin (0.66, 95% CI = 0.52 to 0.80, U = 160, p < 0.0001) were significantly higher to the patient group compared to controls. Leptin levels were significantly decreased in the patient group six weeks after the initiation of antipsychotic treatment (mean change = -0.40, 95% CI = -0.59 to -0.21, W = 666; p < 0.0001) while those of adiponectin and resistin levels did not change significantly. CONCLUSION: In our study we found higher levels of adiponectin, leptin and resistin in drug-naïve, first-episode patients with normal Body Mass Index (BMI) compared to controls. After six weeks of antipsychotic treatment, there was no change in adiponectin and resistin levels, while leptin levels were reduced compared to baseline.

Chronic Pain and Its Association with Depressive Symptoms and Renal Function in Hypertensive Patients.

Chronic pain is a common concern and is considered to be one of the major problems in patients with chronic physical disorders. We studied the effect of pain in patients with hypertension with or without chronic kidney disease (CKD) and the association between pain and symptoms of depression. The study involved 158 hypertensive individuals (59.5% male, mean age 55 years), of whom 47 (29.8%) had CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2). Pain was assessed with the pain/discomfort domain of the EuroQol-5 D, while depressive symptoms were assessed with the depression module of the Patient health questionnaire (PHQ-9). The prevalence of chronic pain in our sample was 44.3%. Women exhibited chronic pain more often compared to men (57.1% vs. 42.9%, p < 0.001). The presence of CKD was not significantly associated with a higher prevalence of chronic pain among hypertensive patients. Depressive symptoms were significantly associated with the presence of chronic pain. These findings were confirmed in the logistic regression analysis. Chronic pain is common in hypertensive individuals and the association with depression warrants further investigation and may have practical implications in managing these patients.

Validation of the Greek version of the Affiliate Stigma Scale among mothers of children with autism spectrum disorder.

BACKGROUND: Caregivers of children with autism spectrum disorder (ASD) are sensitive to the internalisation of the stigma, known as affiliate stigma, resulting in reduced self-esteem, isolation and poor psychological well-being. AIMS: This study aims to validate the Greek version of the Affiliate Stigma Scale (ASS) among mothers of children with ASD. METHOD: The translated version of ASS in Greek was administered to 53 mothers of children newly diagnosed with ASD in two time periods: 1-6 months from diagnosis (time point 1) and 12 months from the initial assessment (time point 2). The control group consisted of 62 mothers of typically developing children. RESULTS: The ASS total mean score revealed a moderate level of stigma to the ASD group in both assessments. The reliability measures by item showed a satisfactory composite reliability (affective 0.828, cognitive 0.833, behaviour 0.857). Cronbach's alpha revealed that the estimated internal consistency was excellent (α = 0.888), and it found a high positive item-total correlation. Receiver operating characteristic analysis results indicated a statistically significant positive discrimination (area under the curve 0.849, P = 0.000) between the groups. The cut-off point was 31.00, with a sensitivity of 0.849 and a 1 - sensitivity of 0.258. CONCLUSIONS: The proposed version of the ASS has good psychometric properties and is valid and reliable for measuring affiliate stigma among caregivers of children with ASD in Greece. Health professionals can use it to assess and understand the stigma experienced by caregivers of children with ASD, and design appropriate interventions to reduce their affiliate stigma.

Differentiation of 2 Obsessive-Compulsive Disorder Subgroups with Regard to Demographic and Phenomenological Characteristics Combining Multiple Correspondence and Latent Class Analysis.

INTRODUCTION: Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions. OBJECTIVE AND METHODS: This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used. RESULTS: MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup. CONCLUSIONS: Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.

Using Business Process Management Notation to Model Therapeutic Prescription Protocols: The PrescIT Approach.

Clinical Decision Support Systems (CDSS) could play a prominent role in preventing Adverse Drug Reactions (ADRs) especially when integrated in larger healthcare systems (e.g. Electronic Health Record - EHR systems, Hospital Management Systems - HMS, e-Prescription systems etc.). This poster presents an approach to model Therapeutic Prescription Protocols (TPPs) via the Business Process Management Notation (BPMN), as part of the e-Prescription CDSS developed in the context of the PrescIT project.

Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.

Pharmacological and Psychotherapeutic Interventions for Management of Obsessive-compulsive Disorder in Adults: A Systematic Review and Network Meta-analysis.

Reprinted under Creative Commons CC-BY license.

Depression and Its Relationship with Coping Strategies and Illness Perceptions during the COVID-19 Lockdown in Greece: A Cross-Sectional Survey of the Population.

OBJECTIVE: The COVID-19 epidemic has shown a more benign course in Greece possibly due to the early lockdown measures. Mental health consequences of the lockdown however are unknown. In addition, illness perceptions and relevant strategies to cope with the stress of the epidemic may have played a role in complying with the restrictions. We conducted a survey of the Greek population with the aim to investigate the prevalence of anxiety and depression during the lockdown, the emotional impact of the epidemic, and the effect of coping strategies and illness perceptions in mental health. METHODS: Adult persons were invited during the peak of the lockdown period through social media. Depressive and anxiety symptoms were assessed with the PHQ-9 and GAD-2 scales, respectively. Coping strategies were assessed with selected items of the Brief COPE questionnaire, while illness beliefs were assessed with items from the revised Illness Perception Questionnaire (IPQ-R). RESULTS: A total of 3379 individuals took part. A strong emotional impact of the epidemic was more often in women and in those with severe financial difficulties. Levels of depressive and anxiety symptoms were high but similar to past assessments. Participants showed high levels of personal control and used more often positive strategies to cope with the stress of the epidemic. Depressive symptoms were higher in the younger, in students, in those with a stronger emotional impact, in those isolated due to symptoms, and those overexposed to media for COVID-19-related news. Lower levels of depression were seen in those using positive coping strategies and showing high levels of personal and treatment control. CONCLUSIONS: The study shows that certain psychological and social determinants were associated with increased depressive symptoms during the lockdown warranting the development of public health guidelines to mitigate the effects of the epidemic to the mental health of the population.

Prevalence of Alcohol Use Disorders and Their Association with Sociodemographic Determinants and Depression/Anxiety Disorders in a Representative Sample of the Greek General Population.

BACKGROUND: Country-level epidemiological data about alcohol-related problems is useful for planning prevention and treatment services. Heavy Alcohol Consumption (HAC) and Alcohol Use Disorder (AUD) are two syndromes of alcohol-related problems that have been recognized worldwide. Study of the epidemiological determinants of HAC and AUD in different sociocultural contexts could inform hypotheses about the etiology or the consequences of alcohol-related problems. OBJECTIVES: We assessed the prevalence and associations of HAC and AUD with sociodemographic variables adjusting for common mental disorders in a representative sample of the general population of Greece (N = 4894 participants). The period of data collection just preceded the emergence of the financial crisis in Greece. RESULTS: The majority of the population did not report HAC, AUD or abstinence from alcohol. HAC was reported by 12.7% (95% CI: 11.8-13.6) of the population while 3.1% (95% CI: 2.7-3.6) met criteria for AUD. Younger age, divorce, lower educational level, living in an urban area, physical health problems, and smoking were associated with a higher prevalence of both conditions. Presence of severe financial difficulties and never married family status were associated with a higher prevalence of HAC but not AUD. HAC was associated with nonspecific psychiatric morbidity while AUD was associated with more specific psychiatric disorders. Conclusion/Importance. Both alcohol-related problems are frequent in the general population and have common and distinct determinants. The comparison between the findings of our study and those of similar studies during or after the period of financial austerity in Greece, would offer the opportunity to assess the possible effects of changes in the economical context in the determinants of alcohol-related problems.

Manualized single-session behavior treatment with self-help manual for panic disorder with or without agoraphobia.

Objective: We examined the clinical feasibility and utility of a single behavior treatment session, with 11 patients with Panic Disorder with or without Agoraphobia (PD+/-AG). Patients used an individualized, exposure based, homework manual, derived from their behavioral analysis. Treatment was implemented in an outpatient behavior treatment unit. Method: Patients presented with moderate to severe anxiety, avoidance behavior, functional impairment and depressive symptoms. Treatment was evaluated with a double-baseline case series/pre-post design with four follow-ups. Results: There was a significant and steady improvement in all self-rated outcome measures and participants were satisfied with the services provided. Nine out of 11 patients (82%) were free of PD+/-AG at 3 months and all patients at 1-year follow-up. The absence of a control group, the small sample and lack of blind assessments, limit the validity of the study. Conclusions: These case studies provide empirical evidence in support of both the feasibility and utility of a single-session behavior treatment (SSBT) plus self-help implemented in a public mental health unit. Further research with a control group is needed to assess the efficacy of the intervention in routine clinical practice.

Sex hormone levels in drug-naïve, first-episode patients with psychosis.

Aim: Sex differences have long been reported in schizophrenia leading to the hypothesis that sex hormones may be implicated in the pathophysiology of the disorder. We assessed gonadal hormones during the fasted state in drug-naïve patients with psychosis.Method: Fasting serum concentrations of follicular-stimulating hormone (FSH) and luteinizing hormone (LH), testosterone, free-testosterone, Sex Hormone Binding Globulin (SHBG) and oestradiol (E2) were compared between a group of 55 newly diagnosed, drug-naïve, first-episode men with psychosis and a group of 55 healthy controls, matched for age, smoking status and BMI. Testosterone, free-testosterone and SHBG were compared between a group of 32 drug-naïve, first-episode females with psychosis and a group of 32 healthy controls matched for age, smoking status and BMI.Results: Testosterone and free-testosterone levels were significantly lower in the patients' group and SHBG levels significantly higher in the patients' group compared to those in healthy controls. The two female groups had similar values in the hormones which were measured.Conclusion: Our findings provide evidence of lower testosterone and free-testosterone levels and increased SHBG levels in drug-naïve, first-episode males with psychosis.KEY POINTSReduced testosterone and free-testosterone levels in drug-naive, first-episode males with psychosis.Increased SHBG levels in drug-naive first-episode males with psychosis.No difference in FSH, LH and E2 levels between drug-naive first episode males with psychosis and controls.No difference in testosterone, free-testosterone and SHBG levels between drug-naive, first-episode women with psychosis and controls.

Epidemiology of Alcohol Use in Late Adolescence in Greece and Comorbidity with Depression and Other Common Mental Disorders.

BACKGROUND: The aim of the current study was to examine the prevalence and associations of hazardous alcohol use with sociodemographic variables and its comorbidity with depression and other common mental disorders in a sample of Greek adolescents between 16 and 18 year old. METHODS: We recruited 2431 adolescents attending 25 senior high schools in Greece. We assessed depressive and anxiety disorders using the computerized version of a fully-structured psychiatric interview (the revised Clinical Interview Schedule / CIS-R). Alcohol use was assessed using questions taken from a previous WHO school survey. RESULTS: Approximately one-third of adolescents (overall: 30.7%, boys: 39.2%, girls: 21.9%, p < 0.001) consumed alcohol on a weekly basis. The experience of excessive consumption, leading to drunkenness at least two or more times in their lifetime, was reported by 15.39% of the adolescents (19.42% for the boys and 11.24% for the girls, p < 0.001). Frequent alcohol consumption and drunkenness were strongly associated with the presence of depression, all other anxiety disorders except panic disorder, current smoking, and lifetime cannabis use, lower school performance, bad or fair relationship with parents, and increased health services use. CONCLUSION: Alcohol use is highly prevalent among Greek adolescents. Special attention for the development of more focused preventive strategies should be paid to adolescents suffering from depression or other common mental disorders.

Prevalence, comorbidity, quality of life and use of services of obsessive-compulsive disorder and subthreshold obsessive-compulsive symptoms in the general adult population of Greece.

Objective: We aimed to describe the epidemiology of obsessive-compulsive disorder (OCD) and related subthreshold symptoms in the general population of Greece and to assess the comorbidity, use of health services and impact on quality of life of these syndromes in the general population. Methods: This was a secondary analysis of the 2009-2010 general population Greek psychiatric morbidity survey (4902 participants living in private households, response rate 54%). Psychiatric disorders were assessed with the revised Clinical Interview Schedule (CIS-R). Quality of life was assessed with the EuroQoL EQ-5D. Results: 1.69% of the participants (95% confidence interval [CI]: 1.33%-2.05%) met criteria for current OCD while 2.79% met criteria for subthreshold obsessive-compulsive symptoms (95%CI: 2.33%-3.26%). In the adjusted analysis few sociodemographic associations remained statistically significant. Although the full-blown syndrome was more severe in terms of comorbidity and quality of life our results showed that even subthreshold obsessive-compulsive symptoms were associated with significant comorbidity and reductions in quality of life. Use of mental health services was small. Conclusions: OCD is an under-treated public health problem that needs more attention in Greece and elsewhere. Provision of specialised mental health services should be a priority for publicly funded national health systems. Keypoints OCD is common in the general population of Greece with few sociodemographic associations apart from subjective financial difficulties. The comorbidity pattern of the full-blown syndrome versus the subthreshold obsessive-compulsive symptoms is similar and differs in magnitude in the expected way. Quality of life in OCD is greatly reduced especially when there is chronicity and/or comorbidity with depression. Use of services is limited but comorbidity with depression may increase the chances of consultation with a mental health professional.

Does maternal somatic anxiety in pregnancy predispose children to hyperactivity?

The objective of this study is to explore the association between maternal somatic anxiety in pregnancy and hyperactivity symptoms and ADHD diagnosis in children. Data from the Avon Longitudinal Study of Parents and Children cohort were used to examine the association between somatic anxiety symptoms in pregnancy measured with five items of the Crown-Crisp Experiential Index, ADHD diagnosis in children at 7.5 and 15 years (obtained with the Development and Well-Being Assessment-DAWBA) and hyperactivity at 4 and 16 years (measured with the Strengths and Difficulties Questionnaire hyperactivity subscale-SDQ). Maternal somatic anxiety was associated with ADHD diagnosis at age 7.5 [crude OR = 1.87 (95% CI = 1.21-2.91)], adjusted model [OR = 1.57 (95% CI = 0.99-2.48)]. There was no evidence of association with ADHD at 15: crude OR = 2.27 (95% CI = 0.90-5.71), adjusted OR = 1.65 (95% CI = 0.63-4.35). An association was found at 4 and 16 with the SDQ hyperactivity subscale: crude OR at 4: 1.70 (95% CI =1.37-2.11), adjusted OR = 1.34 (95% CI = 1.07-1.69); crude OR at 16: 1.95 (95% CI = 1.47-2.58), adjusted OR = 1.62 (95% CI = 1.21-2.17).Thus, there was evidence for an association between maternal somatic anxiety in pregnancy and increased hyperactivity symptoms (SDQ) at 4 and 16. There was no association with ADHD diagnosis.

Surgery, Complications, and Quality of Life: A Longitudinal Cohort Study Exploring the Role of Psychosocial Factors.

OBJECTIVE: To determine whether psychosocial factors moderate the relationship between surgical complications and quality of life (QoL). BACKGROUND: Patients who experience surgical complications have significantly worse postoperative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear whether they affect QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients postoperatively. METHODS: This is a longitudinal cohort study; data were collected pre-op, 1 month post-op, 4 months post-op, and 12 months post-op. A total of 785 patients undergoing major elective gastrointestinal, vascular, or cardiothoracic surgery who were recruited from 28 National Health Service sites in England and Scotland took part in the study. RESULTS: Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (P < 0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL. CONCLUSIONS: Surgical complications alongside other sociodemographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies before surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow-up procedures.

The Relationship between Burden and Depression in Spouses of Chronic Kidney Disease Patients.

The purpose of the present study was to investigate the burden and depression in spouses of patients with chronic kidney disease (CKD). The interrelation between burden and depression in family caregivers has been pointed out by previous researches in several chronic diseases and researchers agree that they clearly go together and one cannot talk about one without considering the other. More particularly, in the present study, the caregiver burden, the depression, anxiety, and also health-related quality of life and demographic factors of spouses of patients with CKD were examined, using self-report questionnaires. Participants were 50 spouses of patients with CKD, 29 of whom were dialysis dependent and 21 were not dialysis dependent. Group differences were examined for participants. Results confirm the interrelation between caregiver burden and depression in spouses. The increased perceived burden related to higher levels of depression. Low levels of caregiver burden, depression, anxiety, and satisfactory quality of life were found in spouses, with no differences between them relevant to whether the patients were dialysis dependent or not. All the above parameters interrelated. Implications for the findings and future research directions are discussed.