Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men.

UNLABELLED: A cross-sectional study of 120 subjects was performed with the purpose of evaluating stress hormones and emotional stress (anxiety) in outpatient and hospitalized subjects. The aims were to determine the degree of objective stress, as well as to correlate this finding with subjective findings, estimated using Beck's Anxiety Inventory. METHOD: Three populations were investigated, namely outpatient clinical cases (Group I, n = 30), hospitalized clinical individuals (Group II, n = 30), and hospitalized surgical candidates (Group III, n = 30). Controls (Group IV, n = 30) were healthy volunteers who were health-care professionals and students. To avoid hormone interactions, only men were enrolled in all groups. All hospitalized subjects were tested on admission and before therapeutic interventions. Fasting epinephrine, norepinephrine, and cortisol were measured in the morning, and Beck's Anxiety Inventory was adminstered by a trained psychologist. RESULTS: The 3 patient groups displayed higher anxiety levels than the controls. Hormone concentrations did not present remarkable changes and did not correlate with subjective stress (anxiety). CONCLUSIONS: 1) Subjective disorders (as determined with Beck's Anxiety Inventory ) were a common finding in both outpatient and hospitalized populations, without differences between the various groups; 2) Objective stress (as determined by elevated hormone levels) was more difficult to confirm--findings rarely exceeded the reference range; 3) Correlation between the two variables could not be demonstrated; 4) Further studies are necessary to define stress quantification and interpretation in patient populations, especially in relationship with nutritional diagnosis and dietetic prescription.

Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

Um estudo transversal de 120 indivíduos foi executado visando avaliar hormônios do estresse e estresse subjetivo (ansiedade) em casos ambulatoriais e hospitalizados. O objetivo era determinar o grau de estresse objetivo, bem como correlacionar este achado com queixas subjetivas, estimadas pelo Inventário de Ansiedade de Beck. MÉTODO: Três populações foram investigadas, nominalmente doentes clínicos ambulatoriais (Grupo I, n= 30), enfermos clínicos hospitalizados (Grupo II, n=30), e pacientes cirúrgicos hospitalizados (Grupo III, n= 30). Os controles (Grupo IV, n= 30) eram voluntários sadios recrutados entre profissionais da saúde e estudantes. Todos casos hospitalizados foram documentados na admissão, antes de quaisquer procedimentos terapêuticos, e somente homens foram selecionados em todos os grupos, a fim de contornar interações hormonais. A adrenalina, noradrenalina e cortisol foram mensurados pela manhã, e o Inventário de Ansiedade de Beck foi aplicado por uma psicóloga especializada. RESULTADOS: Os três grupos de doentes exibiram níveis de ansiedade superiores aos dos controles. As taxas hormonais não estavam apreciavelmente alteradas, e não se corelacionaram com os achados de estresse subjetivo (ansiedade). CONCLUSÕES: 1) Anormalidades subjetivas (Inventário de Ansiedade de Beck ) foram comuns tanto em populações internadas quanto ambulatoriais, sem diferenças entre os grupos; 2) Estresse objetivo (hormonal) foi mais difícil de confirmar e os valores raramente ultrapassaram a faixa de referência; 3) Não se conseguiu demonstrar correlação entre as duas órdens de variáveis; 4) Estudos adicionais são necessários para definir a quantificação e a interpretação de estresse em populações enfermas, especialmente para fins de diagnóstico nutricional e prescrição dietética;

A randomized controlled trial of the effect of psychotherapy on anxiety and depression in chronic obstructive pulmonary disease.

OBJECTIVE: To assess the effect of psychotherapy on the anxiety and depression levels of patients with chronic obstructive pulmonary disease (COPD). DESIGN: A blind, randomized, controlled trial. SETTING: Outpatient university pulmonary rehabilitation program in Brazil. PARTICIPANTS: Thirty patients with COPD (mean age, 60.33y; 22 men) attending a pulmonary rehabilitation program were randomized into 2 groups: experimental group (G1) and control group (G2). Both groups underwent a 12-week treatment program. INTERVENTIONS: Group 1 (n=14) participated in 24 sessions of physical exercise, 24 sessions of physiotherapy, 12 psychologic sessions, and 3 educational sessions. Group 2 did not participate in psychotherapy sessions. MAIN OUTCOME MEASURES: All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program by using 3 instruments: the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and 6-minute walk distance (6MWD). RESULTS: Both groups showed statistically significant improvements on the 6MWD (G1, P<.001; G2, P=.03). Only G1 had a significant reduction in anxiety and depression levels (G1: BAI, P<.001; BDI, P<.001; G2: BAI, P=.156; BDI, P=.142). Statistically significant differences existed between G1 and G2 for BAI (P<.001) and BDI (P=.02). CONCLUSIONS: Including psychotherapy in a pulmonary rehabilitation program for COPD reduced patients' anxiety and depression levels but did not modify 6MWD performance.