Article

Anxiety and depression in Taiwanese cancer patient with and without pain

November 2000
Journal of Advanced Nursing 32(4):944-51

November 2000
32(4):944-51

Source
PubMed

Authors:

Mei-Ling Chen

Chang Gung University

Hsien-Kun Chang

Chang Gung Memorial Hospital

The purpose of this investigation was to compare anxiety and depression in Taiwanese cancer patients with and without pain. In 1998, a convenience sample of 203 hospitalized cancer patients, 77 with pain and 126 without pain, were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Disease-related factors such as performance status, disease stage and perceived treatment effect were also assessed and controlled for their effect on anxiety and depression. The prevalence of both anxiety and depression in the pain group was significantly higher than that for the pain-free group. After controlling the effect of disease-related factors, patients' pain status had a significant effect on depression, but not on anxiety. Patients with pain had more depressive symptoms than patients without pain. Cancer patients' anxiety can be predicted significantly by functional status and perceived treatment effect. In addition to pain status, cancer patients' depression can be predicted by their functional status.

The Effect of Chamomile Tea on Anxiety and Depression in Cancer Patients Treated with Chemotherapy

Article

Full-text available

Aug 2019

“Falling Hair and Drilling Bone” a Phenomenological Inquiry into the lives of Adolescents Undergoing Chemotherapy

Thesis

Feb 2010

Rudolf Cymorr Kirby Palogan Martinez

This study, employing the interpretative phenomenological approach, explored the adolescents‟ experience of undergoing chemotherapy. Five (5) coresearchers were carefully chosen based on a present criteria set upon by the researcher and are as follows: 1) They are willing to articulate, share, participate, and describe their lived experiences, 2) They have undergone at least the second chemotherapy sessions, either as an in-patient or out patient, as one of their treatment modality for their cancer regardless of its type and severity. And 3) that they are adolescents between 12-18 years of age. Moreover, the co-researchers were carefully chosen to ensure that the three (3) main phases of chemotherapy (Induction, Consolidation & Maintenance) is equally represented such that one (1) is undergoing the induction phase, another is on the consolidation phase, two (2) are in the maintenance phase while one (1) had just recently finished the treatment. Additionally, two (2) of them was diagnosed with leukemia, another two (2) with lymphoma and one (1) with bone cancer, the only one that undergo chemotherapy as an in-patient while the rest as an out-patient. Furthermore, of the five (5) co-researchers, four (4) were male while one was (female). The experiences of the co-researchers were subsequently gathered and enriched via the following methods: 1) Interview (Pakikipagusap), 2) Storytelling (Pakikipagkwentuhan), 3) Participant Observation (Pakikipamuhay), 4) Art (Sining) and 5) Group Discussion. Subsequently, three (3) levels of reflective analysis was done on the narratives of the co-researchers following the process specifically developed by the researcher, inspired by the phenomenological methods of Max van Manen and Colaizzi. Through the process of reflective analysis, three (3) themes and seven (7) subthemes were drawn and are as follows a) I am Normal More than Special (Normal na Bata, Hindi Kakaiba) with three (3) subthemes namely: (a.1) Behind the Mask: Who am I Now? (Sa Likod ng Takip, Sino na Ako?) (a.2) Forbidden but not Forgotten (Pinagbawalan pero di Kinalimutan) and (a.3) New Me: Metamorphosis of Self (Bagong Anyo: Sarili’y Pabago-bago); (B) Complex Chemo: Welcome to My Reality (Chemo Komplikado, Yan ang Totoo) with three (3) subthemes which are: (b.1) Good News and Bad News: The Amazing Twins, (Mabuti at Masamang Balita: Laging Magkasama), (b.2) Needle Here, Needle There, Poke Me Everywhere (Tusok Dito, Tusok Doon, Tusok Panapanahon) and (b.3) Chemo Condo: Are You In or Out (Parang Nasa Condo Pagnagchechemo) and (c) F4 (family, faith, friends and future): Maintains My Core. (Pamilya, Paniniwala, Kaibigan at Kinabukasan: Tagapangalaga ng Katinuan). These themes represent the constant and dynamic interaction of the co-researchers self as it maintains a feeling of normality (a) while undergoing the intricacies and complexity of the chemotherapy experience (b) and the things that serves as their source of the coping and motivation to move on (c). Further reflective analysis of the themes and subthemes reveals the essence of the phenomenon under investigation and is epitomized in the eidetic insight that: undergoing chemotherapy in the eyes of an adolescent is analogous to a tree journeying through the four seasons of change, eternally struggling to adjust, adapt, abide and assimilate the alterations brought about by the seasons, chemotherapy, while trying to maintain a normal sense of self. It is a phenomenon of conflict, of constant struggle between meeting the desire of normalcy and autonomy of the adolescents to letting oneself succumb to the dictum and demands of chemotherapy. This essence is further embodied in the Symbolic Representation entitled “Normalcy Amidst the Seasons of Change”. To download, access at http://hdl.handle.net/10755/623705

Chronic pain and anxiety in geriatric cancer patients

Article

Full-text available

Jan 2014

Introduction: This paper aims to determine the chronic pain and anxiety of geriatric cancer patients. Materials and Method: This was a descriptive study of 106 patients aged 65 or over who had been diagnosed with cancer. Study data were collected using a Personal Information Form, the McGill Pain Questionnaire to define pain characteristics, and the State-Trait Anxiety Inventory. Results: Average patient age was 70.16, 79.2% being between 65 and 74; 54.7% were male; 55.7% were literate or had finished elementary school; 63.2% lived with their spouses. Pain medication was used by 90.6%, while all patients reported that their pain did affect their activities of daily living. The pain level was found to be significantly higher in patients who experienced vomiting due to chemotherapy or radiation therapy frequently or occasionally, and in patients who reported that feeding, mobility, eating, housekeeping/gardening and sleeping among their activities of daily living were severely affected (p<0.05). State-Trait Anxiety Inventory scores were higher in patients who experienced anorexia or diarrhea/constipation frequently, those who experienced continuous pain during the day, and those who reported their feeding, mobility, housekeeping/ gardening activities of daily living to be severely affected (p<0.05). A positive correlation was found between the frequency of pain and the patients' trait anxiety levels (p<0.01). Conclusion: A negative influence of pain on the activities of daily living and anxiety level of the elderly was established; the anxiety level increased in parallel with the pain.

Disparities in the medical expenditures of patients with cancer and concomitant mental disorder: analyzing the effects of diagnosis sequence order

Article

Full-text available

Jan 2023
BMC HEALTH SERV RES

Background: Cancer is the leading cause of death in Taiwan. Medical expenditures related to cancer accounted for 44.8% of all major illness insurance claims in Taiwan. Prior research has indicated that the dual presence of cancer and mental disorder in patients led to increased medical burden. Furthermore, patients with cancer and concomitant mental disorder could incur as much as 50% more annual costs than those without. Although previous studies have investigated the utilization of patients with both diseases, the effects of morbidity sequence order on patient costs are, however, uncertain. This study explored medical expenditures linked with the comorbidity of cancer and mental disorder, with a focus on the impact of diagnosis sequence order. Methods: This population-based retrospective matched cohort study retrieved patients with cancer and mental disorder (aged ≥ 20 years) from the Ministry of Health and Welfare Data Science Center 2005-2015 database. 321,045 patients were divided based on having one or both diseases, as well as on the sequence of mental disorder and cancer diagnosis. Study subjects were paired with comparison counterparts free of both diseases using Propensity Score Matching at a 1:1 ratio. Annual Cost per Patient Linear Model (with a log-link function and gamma distribution) was used to assess the average annual cost, covarying for socio-demographic and clinical factors. Binomial Logistic Regression was used to evaluate factors associated with the risk of high-utilization. Results: The "Cancer only" group had higher adjusted mean annual costs (NT$126,198), more than 5-times that of the reference group (e^β: 5.45, p < 0.001). However, after exclusion of patients with non-cancer and inclusion of diagnosis sequence order for patients with cancer and concomitant mental disorder, the post-cancer mental disorder group had the highest expenditures at over 13% higher than those diagnosed with only cancer on per capita basis (e^β: 1.13, p < 0.001), whereas patients with cancer and any pre-existing mental disorder incurred lower expenditures than those with only cancer. The diagnosis of post-cancer mental disorder was significantly associated with high-utilization (OR = 1.24; 95% CI: 1.047-1.469). Other covariates associated with high-utilizer status included female sex, middle to old age, and late stage cancer. Conclusion: Presence of mental disorder prior to cancer had a diminishing effect on medical utilization in patients, possibly indicating low medical compliance or adherence in patients with mental disorder on initial treatments after cancer diagnosis. Patients with post-cancer mental disorder had the highest average annual cost. Similar results were found in the odds of reaching high-utilizer status. The follow-up of cancer treatment for patients with pre-existing mental disorders warrants more emphasis in an attempt to effectively allocate medical resources.

The Impact of Symptoms and Psychological Distress on Quality of Life in Early-Stage Lung Cancer Survivors

Article

Full-text available

May 2022

Background: The number of cancer survivors continues to increase worldwide. Health-related quality of life (HRQoL) is important as a health-related outcome for cancer patients and cancer survivors. Patients with early-stage non-small cell lung cancer may face the stress of symptoms and treatment side effects. However, for survivors of this type of cancer, the impact of cancer or treatment-related stress perception, symptoms, and psychological distress on HRQoL remains to be explored.Purpose: To examine the impact of stress appraisal, symptoms distress, and psychological distress (anxiety and depression) on quality of life in early-stage lung cancer survivors.Method: A cross-sectional study design using convenience sampling. Early-stage non-small cell lung cancer patients who had completed treatment of lung cancer for at least one month were recruited after obtaining informed consent. Self-administered questionnaires were used to collect demographics and information on clinical characteristics, perceived stress, symptoms distress, psychological distress (anxiety and depression), and HRQoL. Multiple regression analysis was used to identify factors affecting HRQoL.Results: The study recruited 85 (30 male and 55 female) lung cancer survivors with mean age of 63.20 years old (SD= 9.01), 85.8 % of which were diagnosed with stage I non-small cell lung cancer. Mean time since diagnosis was 3.33 years (SD = 2.05). All participants underwent surgery. We found that 52.6% of the variance (F (4, 80) =24.28, p<.001) in HRQoL was explained by the variables of anxiety (β= -.34, t= -3.36, p=.001), depression (β= -.28, t= -3.21, p=.002), perceived stress (β= -.21, t= -2.30, p=.024), and symptom distress (β= -.13, t= -1.53, p=.13).Conclusion: Our results suggest that health professionals should pay more attention to the assessment of perceived stress, psychological distress, and symptom distress for promoting HRQoL and healthy functioning of non-small cell lung cancer survivors.

Pain control before and after referral

Article

Full-text available

Aug 2021
BMC Palliat Care

Wafaa Mostafa Abd-El-Gawad

The pattern of change in opioid and adjuvant prescriptions for cancer pain before and after referral to a comprehensive program in the Palliative Care Center in Kuwait

Article

Full-text available

Feb 2021
BMC Palliat Care

Background: Cancer-related pain is a complicated symptom that often coincides with fatigue, depression, and anxiety. Although many safe treatments are available, inadequate control of Cancer-related pain continues to lead to suffering in cancer patients. This study's aim is to describe pain control, and the pattern of change in opioid and adjuvant medication prescriptions, before and after referral to the Palliative Care Center. Methods: We conducted a prospective cohort study in adult cancer patients the Palliative Care Center between January 1, 2016 and December 30, 2017. We measured pain intensity and other associated symptoms via the Revised Edmonton Symptom Assessment System (ESAS-r) and documented detailed analgesics and adjuvant medication history before starting any palliative care and on days 0, 3, 6, and 14. Results: The analysis included 240 patients whose cancer-related pain, anxiety, and depression scores meaningfully improved by day 6. The changes in the median (interquartile ranges) of Cancer-related pain, anxiety, and depression scores from day 0 to day 6 were: 6 (4-8) to 3 (1-4); 6 (4-9) to 2 (1-4); and 3 (2-6) to 2 (1-4), respectively, with p < 0.001 for all. Morphine was the most common opioid administered; the percentage using it increased from 20.4% (n = 49) before referral to 49.6% (n = 119) on day 6 (p < 0.001). The median morphine equivalent daily dose decreased from a median (interquartile ranges) of 60(31-93) mg/day before referral to 34(22-66) mg/day on day 6 (p < 0.001). There was also a statistically significant increase in the percentage of patients taking adjuvant medications, from 38.8% before referral to 84.2% on day 6 (p < 0.001). Comparing D0 to D6, the number of patients using Gabapentinoids significantly increased from 57(23.75%) to 79(32.9%) (p < 0.001), amitriptyline dramatically increased from 14 (5.8%) to 44 (18.3%) (p < 0.001), and other antidepressant drugs increased from 15 (6.2%) to 34 (14.1%) (p < 0.001). Conclusion: After referral to the Palliative Care Center, patients' pain and other symptoms scores decreased significantly, even with lower median morphine equivalent daily doses, arguably through more appropriately directed opioid use. This is evidence for the effectiveness of the comprehensive program at the Palliative Care Center in Kuwait.

Prevalence of Pain and its Association with Symptoms of Post-Traumatic Stress Disorder, Depression, Anxiety, and Distress in 846 Cancer Patients: a Cross Sectional Study

Article

Full-text available

Nov 2020
PSYCHO-ONCOLOGIE

Objective Pain depicts a severe physical symptom but its relationship to mental health problems is not well studied in cancer patients. The aim of this study was to investigate the prevalence of pain and its correlation with symptoms of post‐traumatic stress disorder (PTSD), depression, anxiety, and psychological distress in a large sample of cancer patients. Methods From 2010 to 2019, cancer patients who received outpatient treatment at the Medical University of Vienna, were assessed with the Post‐Traumatic Symptom Scale (PTSS‐10) and the Hospital Anxiety and Depression Scales (HADS). A visual analogue scale was used to assess pain perception. For statistical analysis, linear regression models were applied to log‐transformed data. Results Of the 846 cancer patients included in the study, 63.5% experienced pain (mild 43.5%, moderate 13.6%, severe 6.4%). About a third (31,2%) of the total sample presented with significant PTSD symptoms. Significant symptoms of depression, anxiety, and distress were present in 13.9%, 15.1%, and 25.3%, respectively. Women more often reported symptoms of PTSD, anxiety, and distress. Pain scores were significantly related to symptoms of PTSD, depression and psychological distress (all with p < .001), but not to anxiety. Conclusions Results show a high prevalence of experienced pain and indicate a clear association of elevated pain levels with psychiatric symptoms in oncological patients in a large Austrian sample. In order to decrease experienced pain and to enable better treatment of mental health problems in cancer patients, diagnostic procedures and interventions based on a biopsychosocial model need to be intensified.

Psychological distress, social support, self-management ability and utilization of social resources for female patients with cancer in Oncology Outpatient Settings in Taiwan

Article

Full-text available

Jul 2020
SUPPORT CARE CANCER

Oncology outpatient care centers generally subjugate patients’ psychosocial needs to their physical care requirements. Consequently, the patients’ self-management (SM) ability and utilization of social resources are essential in regulating their psychological distress (anxiety and depression). The study aims were (1) to examine the prevalence and severity of psychological distress in female cancer patients in outpatient settings in Taiwan and (2) to identify the major factors of psychological distress. Female cancer patients were recruited from oncology outpatient settings in Taiwan. Patients completed the questionnaires of anxiety, depression, social support, and utilization of social resources, and SM ability. In total, 116 patients were included. A total of 17.2% and 21.6% of the patients were at risk of anxiety and depression, respectively. Patients’ mean anxiety and depression scores were 4.2 (SD = 4.1) and 4.1 (SD = 4.0), respectively. The patients’ physical function, attendance of social support groups, degree of social support, and SM ability had a significant effect on their anxiety and depression. Patients’ anxiety was intensified by the presence of comorbidity. Health professionals in oncology outpatient care centers should assess the patients’ physical function, comorbidity, SM ability, and social support/engagement in order to reduce their psychological distress and devise appropriate follow-up interventions.

Investigating the risk factors for nonadherence to analgesic medications in cancer patients: Establishing a nomogram model

Article

Full-text available

Apr 2024

Objective The substantial prevalence of nonadherence to analgesic medication among individuals diagnosed with cancer imposes a significant strain on both patients and healthcare resources. The objective of this study is to develop and authenticate a nomogram model for assessing nonadherence to analgesic medication in cancer patients. Methods Clinical information, demographic data, and medication adherence records of cancer pain patients were gathered from the Affiliated Hospital of Chengde Medical University between April 2020 and March 2023. The risk factors associated with analgesic medication nonadherence in cancer patients were analyzed using the least absolute selection operator (LASSO) regression model and multivariate logistic regression. Additionally, a nomogram model was developed. The bootstrap method was employed to internally verify the model. Discrimination and accuracy of the nomogram model were evaluated using the Concordance index (C-index), area under the receiver Operating characteristic (ROC) curve (AUC), and calibration curve. The potential clinical value of the nomogram model was established through decision curve analysis (DCA) and clinical impact curve. Results The study included a total of 450 patients, with a nonadherence rate of 43.33%. The model incorporated seven factors: age, address, smoking history, number of comorbidities, use of nonsteroidal antiinflammatory drugs (NSAIDs), use of opioids, and PHQ-8. The C-index of the model was found to be 0.93 (95% CI: 0.907–0.953), and the ROC curve demonstrated an AUC of 0.929. Furthermore, the DCA and clinical impact curves indicate that the built model can accurately predict cancer pain patients' medication adherence performance. Conclusions A nomogram model based on 7 risk factors has been successfully developed and validated for long-term analgesic management of cancer patients.

The Effectiveness of Cognitive Behavioral Therapy on Coping Strategies and Depressed Women's Quality of Life

Article

Full-text available

Jan 2022

Depression is the most common psychiatric disorder. It is twice as prevalent in women as men, seriously affecting the mental health of the former group. Therefore, it is crucial to use therapeutic modalities to reduce it. For this reason, this study aimed to investigate the effectiveness of cognitive behavioral therapy on coping strategies and depressed women's quality of life. This research employed a quasi-experimental method with pre-test and post-test design studying an experimental and a control group. The population consisted of all women who were referred to counseling centers in Mashhad in 2018, scored higher than 13 on the Beck depression test. Through purposive sampling method, 30 of them were selected as a sample and then randomly divided into an experimental and a control group (15 in the experimental group-15 in the control group). The Beck Depression Inventory (II-BDI), The Coping Inventory for Stressful Situations (CISS), and The World Health Organization Quality of Life Questionnaire-Brief Version (WHOQOL-BREF) were used to collect data. The data were analyzed conducting MANCOVA. The findings indicated that there was a significant difference between the experimental and control groups in the post-test of emotion-focused and avoidance coping strategies (P<0.05). However, there was no significant difference between the two groups in the problem-focused coping strategy (P>0.05). Correspondingly, the results of the quality-of-life questionnaire indicated a significant difference between the two groups in the variables of social, psychological, physical, and environmental quality of life (P<0.05). As a result, it can be said that cognitive behavioral therapy can be used as an efficient therapeutic modality to reduce emotion-focused and avoidance coping strategies in depressed patients in the clinical environment. Similarly, using this therapeutic modality increases the level of quality of life in these patients.

Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis

Article

Full-text available

Dec 2022
J AFFECT DISORDERS

Background: Cardiovascular disease is one of the most common chronic and life-threatening diseases. Due to the changes made in the normal living conditions of people after suffering from cardiovascular diseases, the appearance of symptoms of depression, anxiety, and stress is common among these patients. The results of the studies show the different prevalence of these disorders, so this study aimed to standardize the global prevalence of depression, anxiety, and stress in Cardiac patients by a systematic review and meta-analysis approach. Methods: The present systematic review and meta-analysis were conducted from 2000 to 2022. National and international databases were considered to retrieve related studies, including SID, Magiran, Scopus, Embase, PubMed, and Web of Science (WoS). Joanna Briggs Institute (JBI) checklist was used to evaluate studies qualitatively. Heterogeneity between studies was assessed by I2 index, and data analysis was performed in Comprehensive Meta-Analysis software. Results: After reviewing the retrieved studies, finally 68 studies on the prevalence of depression with a sample size of 110,219, 36 studies on the prevalence of anxiety with a sample size of 72,374 and 5 studies on the prevalence of stress with a sample size of 533 considered for the meta-analysis. Based on the results of the Meta-Analysis, the overall estimation of the prevalence of depression was 31.3 % (95 % confidence interval: 25.4/0.38 %), anxiety prevalence; 32.9 % (95 % confidence interval: 21.9-46.6 %) and stress prevalence was 57.7 % (95 % confidence interval: 45.3-3.3 %). Conclusion: The result of the present study shows the high prevalence rate of depression, anxiety, and stress in cardiac patients. Therefore, it is recommended that health professionals and policymakers pay more attention to preventing and controlling these disorders.

The relationship between family communication patterns and social self-efficacy in students

Article

Full-text available

Sep 2014
INT J BEHAV DEV

social self-efficacy refers to the individual capabilities in dealing with social challenges and the ability to handle interpersonal conflicts. A lot of research has demonstrated that family and the relationships among its members can pave the way to create social self-efficacy beliefs among children especially in dealing with social situations. The aim of this study is to examine the relationship between family communication patterns (Conversation and Conformity) and social self-efficacy in students. The study sample consisted of 496 fourth to sixth grade elementary school students (252 boys and 244 girls), who were administered the revised family communication patterns scale (Fitzpatrick and Ritchie, 1994) and the social selfefficacy questionnaire for students (Wheeler and Led, 1982). The reliability and validity of the instruments have been confirmed. Collected data was analyzed using the simultaneous multiple regression analysis. In addition and in order to compare social efficacy of boys and girls in different educational grades, a two-way ANOVA was used. Results showed that family Conversation orientation is a positive and significant predictor of social self-efficacy. Family Conformity orientation is, on the other hand, a significant negative predictor of social self-efficacy. There was no significant difference among different grades with regard to the total score of social self-efficacy, subscale of conflict situations, and subscale of non-conflict. In addition no significant differences were observed when comparing boys and girls in terms of their mean score of the subscale of non-conflict. However, regarding the conflict subscale, girls had significantly higher scores than the boys. Moreover the mean scores of boys and girls were significantly different with regard to the total social self-efficacy scale score and girls had higher levels of social self-efficacy than boys. As a result, the promotion of Conversation in the family is a predictor of social self-efficacy in children while emphasizing Conformity in the family diminishes the children's social self-efficacy.

Nomogram to Predict the Risk of Postoperative Anxiety and Depression in Colorectal Cancer Patients

Article

Full-text available

May 2022

Purpose To develop and validate the risk nomogram to predict the likelihood of postoperative anxiety and depression in colorectal cancer (CRC) patients. Methods A total of 602 CRC patients from the Second Affiliated Hospital of Harbin Medical University were included in the study and divided into development set and validation set with the 2:1 ratio randomly. Logistic regression model was used to determine independent factors contributing to postoperative anxiety and depression, which were subsequently applied to build the nomogram for predicting postoperative anxiety and depression. The performance of the risk nomogram was appraised by the area under the receiver operating curve (AUC), calibration curves and decision curve analyses (DCA). Results Gender, personal status, income, adjuvant therapy, the Eastern Cooperative Oncology Group Scale (ECOG) score, comorbidity, postoperative complications and stoma status were significant indicators for postoperative anxiety and depression. The AUCs for the development and validation sets were 0.792 and 0.812 for the postoperative anxiety nomogram and 0.805 and 0.825 for the postoperative depression nomogram. Additionally, calibration curves and decision curve analyses also determined the reliable clinical importance of the proposed nomogram. Conclusion The current study constructed the risk nomogram for postoperative anxiety and depression and could help clinicians determine high-risk patients to some extent.

Correlation between anxiety and depression risk and atopic dermatitis severity in Taiwan: A cross-sectional study

Article

Full-text available

Feb 2022

Background: Limited studies on atopic dermatitis (AD) have investigated the possible covariance of sociodemographic factors with the Hospital Anxiety and Depression Scale (HADS). Objective: This study aimed to examine the possible covariance between AD severity and HADS scores of patients in Taiwan. Methods: Patients with AD from a medical center and 2 regional hospitals in Taiwan were enrolled in this cross-sectional study from April 2018 to April 2019. AD severity was measured using the "scoring atopic dermatitis" index, and anxiety and depression were screened based on HADS. Results: A total of 200 patients were included. After correcting for sociodemographic variables, significantly more borderline (≥8) and abnormal (≥11) cases of anxiety/depression (P < .05) were noted in patients with moderate-to-severe AD. Limitations: First, the cross-sectional study design cannot show causality. Second, baseline data, including a history of underlying cancer or previous psychiatric disorder, were not obtained in the questionnaire and may confound the HADS scores. Finally, a standardized psychiatric clinical interviews study design should be used for higher accuracy in the assessment of psycho-comorbidities. Conclusion: Higher anxiety and depression risks were noted in patients with moderate-to-severe AD. Except for psychosomatic symptoms, all kinds of anxiety and depression symptoms occurred more frequently in patients with moderate-to-severe AD.

Risk factors for depressive disorders among patients attending outpatient clinics of Assiut University Hospitals

Article

Jan 2013

Background Depression is a common mental health problem observed frequently in general medical setting. Aim The aim of this study was to identify possible demographic and clinical risk factors for depressive disorders among patients attending outpatient clinics of Assiut University Hospitals. Methods A cross-sectional study was conducted during a 1-year period from 1 June 2006 to 31 May 2007; 2304 patients aged 15 years and above were screened for depression using the Beck Depression Inventory. Patients who scored 4 or more were further evaluated through a psychiatric sheet especially prepared for the present work. Psychiatric diagnosis of patients was based on the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.-text revision criteria. Medical/surgical diagnoses were confirmed by appropriate investigations, and information about the possible risk factors were obtained. Patients were also screened using the suicidality sheet and scored using the Sheehan Disability Scale. Results Depression was found in 202 patients, representing 8.8% of the entire sample. Depression was significantly higher among female patients, highly educated and literate individuals, nonworking male patients and among divorced/widowed/separated individuals. Patients with malignancy, disfiguring conditions, autoimmune conditions, renal diseases, and hepatic diseases were at a higher risk of developing depressive disorders. Patients with two or more medical/surgical conditions were at a high risk of developing depressive disorders (25.9 and 17.1%, respectively). Depressive disorders were significantly high among patients on dialysis (42.9%), radiotherapy (40%), chemotherapy (38.5%), steroids (28.9%), interferon (25%), and digoxin (21.9%). Depressive disorders were more prevalent among patients with a duration of medical illness of 24 months or more. The degree of impairment is significantly higher among patients with moderate and severe depression, particularly in patients having severe depression with psychotic features. Suicidality is significantly higher among patients with severe depression, particularly among patients having severe depression with psychotic features. Conclusion Patients attending outpatient clinics might be at a high risk for depressive disorders, especially those with certain medical conditions, with more than two medical diseases, and receiving specific treatment modalities. These patients need close psychiatric attention for early detection of depressive disorders and proper management.

Effect of Long-Term Diving Exposure on Sleep of Male Occupational Divers in Southern Taiwan: A Cross-Sectional Study

Article

Full-text available

Jan 2021

Objective Divers with a history of decompression sickness may be at high risk for sleep problems. However, limited studies have investigated the relationship between diving exposure and sleep problems of occupational divers. This study investigated the association between diving exposure and sleep quality and quantity among male occupational divers in southern Taiwan. Methods This descriptive, cross-sectional study included 52 occupational divers and 121 non-divers recruited from southern Taiwan in 2018. Survey data were collected using the Taiwanese version of the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and a self-report questionnaire that included demographic variables, diving exposure/protocols, and factors associated with sleep quality. Results Among all participants examined, occupational divers were significantly more likely to have both poor sleep quality (adjusted odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.48–6.06; P = 0.002) and excessive daytime sleepiness (adjusted OR = 4.49; 95% CI = 2.12–9.52; P < 0.001). The diving exposure time, depth, ascent rate, and decompression table use showed no significant associations between poor and good sleepers in the divers group. However, a history of decompression sickness was associated with poor sleep quality among divers (adjusted OR = 2.20; 95% CI = 1.07–4.54; P = 0.032). Conclusions Our results showed that occupational divers had poor sleep quality and more excessive sleepiness than non-divers. Decompression sickness likely contributes to poor sleep quality. Prevention and early detection of decompression sickness-related sleep problems should be an occupational health priority.

Visualizing Conversations in Health Care: Using Discursis to Compare Cantonese and English Data Sets

Chapter

Jun 2020

Health care is shaped by often complex communication between multiple people such as doctors, nurses, patients and carers. Research has repeatedly shown that effective communication is key to safe and high-quality care yet improving communication remains a challenge across health systems. In recent years, the field of natural language processing has developed analytic tools to supplement the study of verbal communication through visual representation of analysis. To date, these tools have primarily been used on English data. This study used the software tool Discursis to compare visual representations of Cantonese conversational data that were analysed before and after English translation. Results indicate that some linguistic features of Cantonese that carry meaning may be lost in translation into English. Specific concerns relate to the multidimensional issues of equivalence, ranging from cultural and social associations to semantic, lexical and conceptual differences. These results highlight the importance of developing visual analytic tools that can be used on Cantonese data. Generating visual representations of such data contributes to local and international understandings about communication in health care.

Prevalence of Pain and Its Characteristics in Hospitalized Patients in an Indian Teaching Hospital

Article

Jul 2019
PAIN MANAG NURS

Abstract Background Pain has a great impact on the physical and mental condition of hospitalized patients, reduces quality of life, and increases economic burden. Aims The study aimed to determine pain prevalence, its characteristics, analgesic treatment, and associated factors for severity and chronicity of pain in hospitalized patients. Methods A cross-sectional study was carried out including 847 eligible adult in-patients, aged ≥18 years, admitted to the All India Institute of Medical Sciences, Bhubaneswar, India, from June to August 2018. Pain severity was evaluated by visual analog scale (VAS) at the time of interview and after 1 week/completion of pain treatment. Results The prevalence of pain during the 24 hours preceding the interview was 70.6%. The duration of pain was ≥4 weeks in 162 (27.1%) patients and severe (VAS ≥ 7) in 144 (24.1%) patients. The mean VAS score was 6.27 ± 1.97 at the time of interview and 3.31 ± 1.89 after 1 week/completion of pain treatment (p < .001). Use of opioid analgesics (adjusted odds ratio [aOR]: 3.18; confidence interval [CI]: 2.23-4.55) was significantly related to pain severity, whereas patients ≥60 years (aOR: 1.64; CI: 0.99-2.70), patients in a nonsurgical ward (aOR: 1.78; CI: 1.21-2.60), and patients using opioid analgesics (aOR: 2.63; CI: 1.73-3.98) had prolonged pain, defined as ≥4 weeks. Conclusion Pain prevalence and intensity in this Indian hospital were high and pain treatment was adequate in many cases. Timely assessment and appropriate management of pain in hospitalized patients is needed to prevent further pain and its complications in these patients.

Depression and Quality of Life in Patients with Neurological Disorder in a Malaysian Hospital

Article

Full-text available

Jun 2019

Objective: To investigate association between major depressive disorder (MDD) and quality of life in patients with neurological disorder. Methods: This cross-sectional study was carried out at a Malaysian hospital between April 2016 and December 2016 using convenience sampling. Patients aged ≥18 years with intracranial tumour or other brain disorders were invited to participate. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life questionnaire version 3.0; diagnosis of MDD was made using Mini International Neuropsychiatric Interview. Results: Of 122 patients approached, 100 (66 women and 34 men) were included (response rate, 93.5%), with a mean age of 45.3 years. The prevalence of MDD in patients with neurological disorder was 30%. Compared with non-depressed patients, patients with MDD had poorer global health status / quality of life (p = 0.003), and reduced physical (p = 0.003), role (p = 0.021), emotional (p < 0.001), cognitive (p = 0.004), and social (p = 0.007) functioning, as well as more symptoms of fatigue (p = 0.004), pain (p < 0.001), dyspnoea (p = 0.033), insomnia (p < 0.001), appetite loss (p = 0.002), constipation (p = 0.034), diarrhoea (p = 0.021), and financial difficulties (p = 0.039). Conclusion: Patients with MDD had reduced quality of life. Fatigue, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea, and financial difficulties were prevalent among patients with MDD.

Insomnia and its associated factors in incarcerated adults: A cross‐sectional study

Article

Full-text available

Feb 2019
NURS HEALTH SCI

No evidence exists in the literature concerning the prevalence of insomnia and its associated risk factors among prison inmates in Taiwan. The aim of the present study was to determine the prevalence and factors associated with insomnia among inmates in a large prison in Taiwan. A cross‐sectional anonymous questionnaire survey was conducted at a prison. The participants were 1490 male inmates. Participants completed the self‐reported Insomnia Severity Index–Chinese version questionnaire, and the sociodemographic and psychological distress questionnaires for the study. Multivariate logistic regression was used to analyze and compare the differences between inmates with and without insomnia. The prevalence of insomnia was 26.9%. The study determined that anxiety, self‐rated health status, and religious beliefs were independent predictors of insomnia in male inmates. Given the adverse effect of insomnia and its social consequences, it is crucial to develop prevention programs to mitigate insomnia in inmates.

Depression and its Main Determinants Among Iranian Operating Room Personnel: A Systematic Review and Meta-Analysis

Article

Full-text available

Sep 2018

Background: Most nurses, especially operating room personnel, seems to be more likely to be affected by mood disorders than other social strata. The present study attempted to systematically review the prevalence of depression and its main determinants among operating room personnel in Iran. Methods: The method of this systematic review is documenting in a published protocol in the International Prospective Register of Systematic Reviews (PROSPERO) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. After this massive search, titles and abstracts of retrieved documents have screened and all irrelevant articles excluded. Two reviewers screened the documents and selected all relevant studies and assessed included articles separately. Results: Totally, 12 citations found in the initial literature search where four citations excluded, as they did not meet the inclusion criteria. The final number of studies available for analysis was 12 including a total of 373 operating room personnel (86 men and 287 women, mean the age of 27.71 years ranged from 20 to 36 years). The pooled prevalence of depression among operating room personnel was estimated to be 45.3%. In this regard, 27.0% of personnel suffered from severe depression. A significant heterogeneity found in the overall analysis of the overall prevalence of depression and its severe pattern. Conclusion: A notable number of operating room personnel in Iran suffer from depression even in its severe condition emphasizing the importance of the managerial approach to minimize its adverse effects on their performance as well as to improve their quality of life

Swallowing Ability and its Impact on Dysphagia-specific Health-related QOL in Oral Cavity Cancer Patients Post-Treatment

Article

Oct 2018
EUR J ONCOL NURS

A descriptive analysis of depression and pain complaints among patients with cancer in a low income country

Article

Full-text available

Mar 2018
PLOS ONE

Background In high income countries, cancer is one of the leading causes of death, with co-morbid depression contributing to the risk of increased mortality. However, both cancer and depression are neglected conditions in low income countries. The current study assessed the magnitude of depression and the association of pain complaints with depression among patients with cancer in a low income country. Method In this cross-sectional study participants were 390 patients with established diagnosis of cancer, who were recruited consecutively when visiting a tertiary treatment centre in Addis Ababa, Ethiopia. The occurrence of depression was determined using the nine items Patient Health Questionnaire (PHQ-9). Major depressive disorder was confirmed: (1) when five or more of the PHQ-9 symptoms were endorsed as occurring for at least ‘more than seven days’, with the exception of suicidal ideation item which counted as a positive rating if it had occurred even once in the previous fifteen days. (2) one of the symptoms has to be either depressed mood or loss of interest. Pain complaint was measured by Numeral Rating Scale (NRS) and severity of pain was assessed using Verbal Rating Scale (VRS). Results The prevalence of major depressive disorder was 16.4% (95%CI: 13.1%, 20.4%), and subthreshold depression was 17.4% (95%CI: 14.0%, 21.5%). Pain complaints occurred in 69.0% (95%CI: 64.3%, 73.4%) of the participants. The odds of having a major depressive symptom was over four times higher among participants who had pain. Limitations The study was cross sectional and liable to recall bias. Recruitment was carried out in a tertiary referral hospital, which might lead to the selection of more economically well-off and educated participants limiting generalizability of the study. Moreover, we did not control for cancer types, which may be related to pain and the experience of depression. Some of the somatic symptoms in PHQ9 may also be related to the cancer itself. Conclusions This study highlights the clinical significance of both depression and pain complaints in patients with cancer in a low income country. Exploration of the impact of depressive disorders on quality of life and outcome of cancer is an important area for further research in low income countries.

Prediction of depression symptoms based on personality traits and romantic relationships among students

Article

Full-text available

Feb 2018

Depression is one of the most common mental disorders in modern societies which also including student populations. Etiology of depression is naturally very complicated matter. Some of the effective parameters that have recently gained scholars’ attention are personality traits including romantic relationships that can affect depression. The purpose of this study was to evaluate relationship between personality traits and romantic relationships with depression. Research population was students of Payam Noor University of Tehran that 50 married students and were selected by using random sampling method. Research instruments were Beck’s depression Inventory II (BDI-II), shortened revised NEO personality Inventory (NEO-FFI-60) and sternberg's triangular love scale. Data analysis showed that neuroticism component of personality traits as well as intimacy component of Sternberg’s love theory has significant relationship with depression. Moreover, this research showed that neuroticism and intimacy could predict depression symptoms by 37 percent and 10 percent respectively. In order to prevent depression in students, interventional actions are needed to provide more clear relationships based on personality traits.

Effect of therapeutic care for treating fatigue in patients with breast cancer receiving chemotherapy

Article

Full-text available

Aug 2017

Background This study aimed to evaluate the effect of therapeutic care (TC) for fatigue in breast cancer patients receiving chemotherapy. Methods A total of 48 breast cancer patients receiving chemotherapy were randomly divided into the intervention group and the control group, with 24 patients in each group. The patients in the intervention group were treated with TC, while the participants in the control group received the sham intervention. The interventions in both groups were for 30 min/d, 3 days weekly for 12 weeks. The primary outcome of fatigue was measured by the multidimensional fatigue inventory (MFI). The secondary outcomes were measured by the Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI). All outcomes were assessed before and after 6 and 12 weeks of the intervention. Results The intervention with TC showed greater efficacy than sham TC in decreasing the MFI score after week 6 (P < .05) and week 12 (P < .01) of treatment. Significant differences were also found in the HADS and PSQI between the 2 groups after 12 weeks of treatment (P < .01). Conclusion This study demonstrated that TC might decrease fatigue and relieve the anxiety and depression of breast cancer patients receiving chemotherapy.

Alterations in Opioid Inhibition Cause Widespread Nociception but Do Not Affect Anxiety-Like Behavior in Oral Cancer Mice

Article

Full-text available

Jun 2017

Widespread pain and anxiety are commonly reported in cancer patients. We hypothesize that cancer is accompanied by attenuation of endogenous opioid-mediated inhibition, which subsequently causes widespread pain and anxiety. To test this hypothesis we used a mouse model of oral squamous cell carcinoma (SCC) in the tongue. We found that mice with tongue SCC exhibited widespread nociceptive behaviors in addition to behaviors associated with local nociception that we reported previously. Tongue SCC mice exhibited a pattern of reduced opioid receptor expression in the spinal cord; intrathecal administration of respective mu (MOR), delta (DOR), and kappa (KOR) opioid receptor agonists reduced widespread nociception in mice, except for the fail flick assay following administration of the MOR agonist. We infer from these findings that opioid receptors contribute to widespread nociception in oral cancer mice. Despite significant nociception, mice with tongue SCC did not differ from sham mice in anxiety-like behaviors as measured by the open field assay and elevated maze. No significant differences in c-Fos staining were found in anxiety-associated brain regions in cancer relative to control mice. No correlation was found between nociceptive and anxiety-like behaviors. Moreover, opioid receptor agonists did not yield a statistically significant effect on behaviors measured in the open field and elevated maze in cancer mice. Lastly, we used an acute cancer pain model (injection of cancer supernatant into the mouse tongue) to test whether adaptation to chronic pain is responsible for the absence of greater anxiety-like behavior in cancer mice. No changes in anxiety-like behavior were observed in mice with acute cancer pain.

Risk factors for depressive disorders among patients attending outpatient clinics of Assiut University Hospitals

Article

Jan 2013

Psychosocial Effects of a Skin Camouflage Program in the Female Survivors with Head and Neck Cancer: A Randomized Controlled Trial

Article

Sep 2017
PSYCHO-ONCOLOGY

Objective: The purpose of this study was to evaluate the effects of a skin camouflage program on disfigurement, self-esteem, social interaction, and body image in female head and neck cancer (HNC) survivors. Methods: A prospective, repeated measures, randomized controlled therapeutic intervention design was employed. A total 66 participants were randomly assigned to each group, with 32 in the experimental group and 34 in the control group. The experimental group received a four-session skin camouflage program, and the control group received routine care. Patients were assessed at three time points: baseline assessment (T0), and then at 1, 2, and 3-months (T1, T2, and T3) after participating in the skin camouflage program. Results: Patients in the experimental group had significantly less facial disfigurement, depression, fear of social interaction, and anxiety regarding social interaction compared to those in the control group. Participants in both groups had significantly lower levels of facial disfigurement, depression, fear of social interaction, anxiety of social interaction, and body image at the final post-test assessment than at the pretest assessment. There were no differences between the groups and within groups with respect to self-esteem. Conclusions: The 3-month skin camouflage program effectively improved facial disfigurement, fear of social interaction, anxiety of social interaction, and body image of female HNC survivors. A survival care plan should include a skin camouflage program to improve body image perception and decrease anxiety after treatment of HNC.

The Effects of Music Therapy on Anxiety and Depression of Cancer Patients

Article

Full-text available

Oct 2016
Indian J Palliat Care

Background and Purpose Cancer patients often suffer from anxiety and depression. Various methods are used to alleviate anxiety and depression, but most of them have side effects. Music therapy can be used as a noninvasive method to reduce anxiety and depression. This study aimed to examine the effect of music therapy on anxiety and depression in patients with cancer. Materials and Methods This quasi-experimental study was conducted attaching hospitals in Urmia city. A total number of sixty patients with depression and anxiety were recruited using random sampling method and divided into two groups of control and intervention. Patients in intervention group listened to light music at least 20 min per day for 3 days. The degree of patients’ anxiety and depression was assessed by Hospital Anxiety and Depression Scale at baseline and 3 days after music therapy. Data were analyzed by SPSS version 13 using t-test, Pearson, and ANOVA tests. Results The results showed no significant differences between demographic variable of intervention and control groups. Our findings indicated a significant decrease in the level of depression and anxiety among intervention group. There were significant relationships between anxiety, depression, and sex (P < 0.001, r = 0.42) as well as education (P = 0.003, r = 0.37). Conclusion This study revealed positive effects of music therapy on decreasing level of depression and anxiety in patients with cancer. Therefore, it is recommended to include music therapy in the nursing care.

Prevalence, risk factors, and the desire for help of distressed newly diagnosed cancer patients: A large-sample study

Article

Full-text available

Oct 2016

Objective Beginning in 2007, all newly diagnosed cancer patients at the Koo Foundation Sun Yat-Sen Cancer Center (KF–SYSCC) were screened for psychosocial distress. Our social workers, as part of the psychosocial care team (PCT), have engaged in proactive outreach with patients identified as distressed. The goal of the present study was to assess the prevalence of psychosocial distress and the extent of contact between the PCT and distressed patients. Method Newly diagnosed patients who were treated at KF–SYSCC between 2007 and 2010 for cancer were eligible if there were at least 100 patients with the same type of cancer. Before treatment began, they were screened with the Pain Scale and the Distress Thermometer (DT) and had the option to specify a desire for help. The rates of distress were analyzed by cancer type and by probable related factors. Information regarding contact with the PCT was retrieved from computerized databases. Results Overall, some 5,335 cancer patients representing 12 major cancer types were included in our study. Of these, 1,771 (33.20%) were significantly distressed. By multivariate logistic regression, younger age, female gender, higher pain score, and disease stage, but not cancer type, were found to be associated with higher rates of distress. Among these distressed patients, 628 (36%) had some contact with the PCT. Significance of results This Taiwanese study with a large sample size revealed a prevalence rate of psychosocial distress similar to rates found in Western countries. Contact with the PCT was established in only 36% of significantly distressed patients, despite a proactive outreach program. It is very important to have screening results made available in a timely fashion to the psycho-oncology team so that appropriate care can be offered promptly.

Effective pain management for inpatients at Siriraj Hospital: A retrospective study

Article

Full-text available

May 2016

Background and Objective: The prevalence of severe cancer and non-cancer pain among in patients has been reported at rates ranging from 15% to 36%. We examined the effectiveness of the pain management provided to inpatients by the Siriraj Pain Clinic. Material and Method: A retrospective chart review was conducted among inpatients who had consulted the clinic between January 2013 and December 2014. Patients with a numeric pain rating scale (NRS) <4 on the day of consultation, those discharged within seven days, and postoperative patients were excluded. Successful pain control was defined as NRS <4 within seven days of the initial consultation. Results: We identified 352 eligible patients, of which 231 (65.4%) had cancer pain. Only 42.6% achieved successful pain control. An absence of psychological problems (odds ratio (OR) 2.1, 95% confidence interval (CI) 1.1-4.2; p = 0.010); an initial NRS <7 (OR 1.9, 95% CI 1.2-3.0; p = 0.008); the use of either a non-steroidal anti-inflammatory drugs (NSAIDs) or a Coxibs (OR 2.3, 95% CI 1.3-3.9; p = 0.017); and abdominal pain (OR 2.7, 95% CI 1.5-4.7; p = 0.008) were factors associated with successful pain control. Conclusion: Adequate pain control was achieved in less than half of the inpatients in our institution. Psychological disturbance and severe pain predicted unsatisfactory pain control.

Quality of life in metastatic breast cancer: comparing patients with major depressive episodes with patients without M.I.N.I. diagnosis

Article

Full-text available

Aug 2013

Aim To compare the quality of life indicators in patients with metastatic breast cancer diagnosed with major depressive episodes with those in patients with no psychiatric diagnosis. Patients and methods We conducted a cross-sectional, observational study at the Day Care Unit of the Oncology Institute “Ioan Chiricuţă” Cluj-Napoca in a group of 100 patients with metastatic breast cancer, during chemotherapy. General data were collected and the patients received a complete psychiatric evaluation, in conjunction with a structured interview and an oncology designed quality of life questionnaire. Results The rate of major depressive episodes in the group was 29.30%. The patients with major depressive episodes had lower adjusted mean scores for physical, emotional, social and role functioning and higher adjusted mean scores for fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss and constipation than those without diagnosis. The quality of life/global health status scores were significantly lower in the depressive patients group, and the same results were noted for sexual functioning and enjoyment mean scores, as well as for the future perspective. Conclusions These results suggest that patients with metastatic breast cancer and major depressive episodes have an impaired quality of life as compared to those without psychiatric diagnosis.

The Prediction of Quality of Life - based on Personality Traits and Spiritual Intelligence in the Elderly

Article

Full-text available

Jan 2023

Introduction: Considering the increasing trend of the elderly population in Iran, attention paid to this critical phase, both socially and psychologically, is essential in improving their quality of life. The present study aimed to investigate prediction of quality of life - based on personality traits and spiritual intelligence in the elderly. Methods: This correlational study carried out on older adults in Tehran who lived in nursing homes in 2020 and 182 of them were selected by convenience sampling. The NEO Personality Inventory (NEO-PI), The Spiritual Intelligence Self-Report Inventory (SISRI-24) and Leiden-Padua Questionnaire (LEIPAD questionnaire) were used for data collection. Descriptive statistics (mean, standard deviation) and inferential statistics (correlation and stepwise regression analysis) were used for data analysis. The correlation matrix and stepwise regression were used to predict the quality of life scores based on personality and spiritual intelligence. Results: There was a significant relationship between personality traits with spiritual intelligence and quality of life (r: 0.361, p < 0.05). Also, there was a significant relationship between spiritual intelligence and quality of life (p < 0.05). Personality traits of neuroticism, extraversion, and spiritual intelligence could predict a total of 38.5% of the variance in quality of life (p < 0.05). Conclusion: The quality of life has a significant relationship with both spiritual intelligence and personality traits, so, spiritual intelligence and personality components can predict the quality of life in the elderly.

Pain in Austrian hospitals: evaluation of 1089 in-patientsSchmerzen in österreichischen Krankenhäusern: Evaluation von 1089 stationären Patienten

Article

Nov 2022

Background: Despite the existence of internationally consistent guidelines for the management of pain, efficient regional anesthesia techniques, safe pain medications, and organizational structures, e.g., acute pain services, various studies have shown that pain is still common among both surgical and non-surgical in-patients. Objective: The primary objective of this study was to evaluate, on a multi-center basis, the point pain prevalence of surgical and non-surgical in-patients. We further analyzed pain intensities, in-hospital pain triggers, pain-related impairments, pain assessments, patient information about pain, and patient satisfaction with pain therapy. This benchmark information should lead to better implementation of pain management strategies and thus improve health care quality. Methods: We surveyed all adult in-patients in three general hospitals in Austria (general hospital Klagenfurt am Wörthersee, general hospital Villach, general hospital Wolfsberg) on the index day with two standardized questionnaires for both surgical and non-surgical patients. Results: Overall, a pain prevalence of 40.0%, with no statistically significant difference between surgical and non-surgical patients, was shown. Higher pain prevalence in female patients, high pain prevalence in the age group 18-30 years, and highest pain prevalence in the age group over 90 years old was found. Overall pain intensity was relatively low, but unacceptable maximum pain within the preceding 24 h was shown. Different in-hospital pain triggers like patient's care and mobilization were found. Our survey has shown that pain has an impact on personal hygiene, mobilization, mood, sleep, and appetite. However, patients were very satisfied with their pain therapy. Conclusion: Medical staff and nurses have to be sensitized to the urgent need to improve pain management strategies.

Nomogram to Predict the Risk of Postoperative Anxiety and Depression in Colorectal Cancer Patients

Preprint

Full-text available

Aug 2021

To develop and validate the risk nomogram to predict the likelihood of postoperative anxiety and depression in colorectal cancer (CRC) patients. A total of 602 CRC patients from the Second Affiliated Hospital of Harbin Medical University were included in the study and divided into development set and validation set with the 2: 1 ratio randomly. Logistic regression model was used to determine independent factors contributing to postoperative anxiety and depression, which were subsequently applied to build the nomogram for predicting postoperative anxiety and depression. The performance of the risk nomogram was appraised by the area under the receiver operating curve (AUC), calibration curves and decision curve analyses (DCA). Gender, marital status, income, TNM stage and ECOG score were significant indicators for postoperative anxiety and depression. The AUCs of the development and validation sets were 0.696 and 0.677 for postoperative anxiety nomogram, and 0.710 and 0.699 for postoperative depression nomogram. Additionally, calibration curves and decision curve analyses also determined the reliable clinical importance of the proposed nomogram. The current study constructed the risk nomogram for postoperative anxiety and depression, and could help clinicians perform targeted psychological intervention for high-risk patients.

Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial

Article

Apr 2021

Purpose Epilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person’s quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. Methods This was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. Results A total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups. Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. Conclusion The lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.

The Overview of Pain in Cancer Patients

Conference Paper

Full-text available

Jan 2021

What Happens to the Holistic Care of Patients in Busy Oncology Settings?

Chapter

Jun 2020

Engle Angela Chan

Cancer patients suffer from emotional issues and/or distress, for which they require appropriate care. However, effective communication that translates into recognition of patients’ cues/concerns remains an issue. Barriers to effective communication include nurse shortages, time constraints and limited healthcare communication training for cancer nurses. Exploring how nurses fare in communicating with patients by responding to their cues/concerns for emotional and/or informational needs is important. This ethnographic study examined a busy cancer ward and its nursing care as a subculture. Content analysis from patient interviews was conducted, and a statistical analysis of the nurses’ cue-responding behaviours. Findings revealed that despite no emotional counselling, nurses exhibited positive cue-responding behaviours and patients expressed appreciation for this care. This conclusion is striking at a time when nurses stated there was no time to talk to patients and Hong Kong faces a shortage of nurses, even as the emphasis on holistic care is growing. Findings challenge the cultural expectations of emotional care in oncology wards. The perception that emotional care must be addressed separately from the nurses’ everyday physical and technical care is challenged and should be re-assessed with reintegration of the physical with the emotional in the nursing care provided to patients.

Predicting Anxiety in Hospitalized Cancer Patients

Article

Apr 2020
J PAIN SYMPTOM MANAG

Context: Anxiety in patients with cancer is highly prevalent; yet it remains underestimated and inadequately assessed. Little is known about predictors for anxiety in hospitalized patients with cancer. Insight in predictors should improve recognition and enable a targeted approach. Objectives: To determine the prevalence of anxiety and predictors for anxiety in hospitalized patients with cancer at different stages of disease. Methods: A cross-sectional analysis of patients with cancer admitted to the Utrecht University Medical Center in 2015-2018 was conducted. The Utrecht Symptom Diary, an adapted Dutch version of the Edmonton Symptom Assessment System, was used to assess symptom burden on a numeric rating scale (0 = no symptom and 10 = worst possible symptom). Scores ≥4 were considered clinically relevant. All patients completed the Utrecht Symptom Diary as part of routine care. The first questionnaire after admission was selected. Using multivariable linear regression, the predictive value of potential predictors on anxiety was analyzed. Results: In total, 2144 patients were included, of which 22% reported clinically relevant anxiety. The prevalence of anxiety was highest (36%) in patients receiving symptom-directed palliation only. In the total group, female gender, younger age, depressed mood, sleeping problems, dyspnea, and cancer of the head and neck were predictive of anxiety. Throughout all stages of disease, depressed mood was consistently the strongest predictor. Conclusion: We found a high prevalence of anxiety in hospitalized patients with cancer. It is recommended to explore anxiety in hospitalized patients with cancer, in particular when they experience depressed mood. Structural use of a symptom diary during hospitalization facilitates the recognition of anxiety and concurrent symptoms.

The Use of Distress Thermometer in Advanced Cancer Inpatients with Pain

Article

Feb 2019

Objective This study was aimed to provide support for the extensive application of Distress Thermometer in advanced cancer inpatients with pain and explore the risk factors of DT among this population. Methods Advanced cancer patients with pain were recruited from Department of Pain Relief in Tianjin Cancer Hospital & Institute, China. They completed the DT with problems list and HADS within 48h after admission. The cutoff score of DT was evaluated against HADS for its sensitivity and specificity by using ROC curves. Multiple logistic regression model analysis was performed to investigate the main factors. Results 441 inpatients with mixed diagnoses were recruited. Referring to the cutoff of 15 on HADS, DT cutoff score of 5 yielded AUC of 0.757 with an optimal sensitivity (0.861) and specificity (0.531). Using the cutoff scores of ≥5, 70.5% patients were distressed. Logistic regression analysis of DT found that the breakthrough pain, poorer KPS, higher pain degree and emotional problems were the predictive factor for current distress. Conclusion DT is efficacious for screening psychological distress in advanced cancer inpatients with pain. With the cutoff score of 5, the psychological distress is prevalent. To better identify the distressed cancer patients with pain, the pain, performance status and emotional problems should be considered together.

Swallowing ability and its impact on dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment

Article

Oct 2018
EUR J ONCOL NURS

Shu-Ching Chen

Purpose The purpose of this study was to identify the characteristics of swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL), and the predictors of dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment. Methods A cross-sectional study of 151 oral cavity cancer patients was performed at a medical center. Patients were assessed for swallowing ability, depression, and dysphagia-specific health-related QOL. Multiple stepwise regression was used to identify factors related to dysphagia-specific health-related QOL. Results Of the 151 patients surveyed, the top swallowing impairments were difficulty swallowing dry foods, difficulty swallowing hard food, and swallowing problems interfering with enjoyment or QOL. Patients with tumors of the tongue had worse functional dysphagia QOL than those with cancers in other locations. Patients with buccal cancer had worse overall dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL than patients with cancers in other locations. Patients with poor swallowing ability were more likely to have worse global dysphagia QOL. Emotional dysphagia QOL was associated with poor swallowing ability and depression. Poor swallowing ability, higher level of depression, and tumors of the tongue were associated with the worst functional dysphagia QOL. Patients with poor swallowing ability, higher level of depression, and less functional oral intake were more likely to have worse physical dysphagia QOL. Conclusion Swallowing ability and depression were the most important factors associated with dysphagia-specific health-related QOL. Patient-centered swallowing rehabilitation programs are recommended to help cope with swallowing impairment.

Comparison of group vs self-directed music interventions to reduce chemotherapy-related distress and cognitive appraisal: an exploratory study

Article

Full-text available

Feb 2018
SUPPORT CARE CANCER

PurposeThe purpose of this study was to determine effects of group music intervention and self-directed music intervention on anxiety, depression, and cognitive appraisal among women with breast cancer. MethodsA quasi-experimental design randomly assigned 60 women undergoing chemotherapy to 3 groups: group music intervention, self-directed music intervention, or a control group. The Hospital Anxiety and Depression Scale and the Mini-Mental Adjustment to Cancer Scale were administered before, after the 8-week interventions, and at 3-month follow-up. ResultsOf the 52 women completing the study, results indicated that group music intervention had a significant (p < .01) immediate effect to decrease helplessness/hopelessness and anxious preoccupation and significant effects for reducing anxiety, depression, helplessness/hopelessness, and cognitive avoidance compared to the other two groups at 3-month follow-up. Conclusions Group music intervention can be considered an effective supportive care in alleviating the chemotherapy-related distress and enhancing cognition modification of women with breast cancer. Further research is needed to determine the role of cognitive appraisal in the illness trajectory.

Psychological distress and cancer pain: Results from a controlled cross-sectional survey in China

Article

Full-text available

Jan 2017

We evaluated the pain associated with cancer and its impact on pain management, anxiety, and depression in Chinese patients using a controlled cross-sectional study. One hundred and twenty-six cancer outpatients were evaluated from January 2012 to June 2014; 64 reported pain and 62 did not. Patients with cancer eligible for this study were older than 18 years and able to effectively communicate with medical personnel. Patients were administered a questionnaire regarding their medical status. The information collected was used along with patient charts to complete a socio-demographic and clinical characteristic summary for each patient. Results showed that patients who reported pain had mean State-Trait Anxiety Inventory (STAI) scores of 46.38 for state anxiety and 44.64 for trait anxiety, as well as a mean BDI (Beck Depression Inventory) score of 19.17. The pain-free patient group had mean STAI scores of 40.73 for state anxiety and 42.87 for trait anxiety, and a mean BDI score of 15.35. In conclusion, patients who reported pain were more prone to anxiety and depression, with pain severity being a strong predictor of anxiety. Adequate pain assessment and adjustment proved necessary for pain management.

Factors Predicting Emotional Cue-Responding Behaviors of Nurses in Taiwan: An Observational Study: Emotional cue-responding behaviors

Article

Nov 2016
PSYCHO-ONCOLOGY

Objective: Responding to emotional cues is an essential element of therapeutic communication. The purpose of this study is to examine nurses' competence of responding to emotional cues (CRE) and related factors while interacting with standardized patients with cancer. Methods: This is an exploratory and predictive correlational study. A convenience sample of registered nurses who have passed the probationary period in southern Taiwan was recruited to participate in 15-minute videotaped interviews with standardized patients. The Medical Interview Aural Rating Scale was used to describe standardized patients' emotional cues and to measure nurses' CRE. The State-Trait Anxiety Inventory was used to evaluate nurses' anxiety level before the conversation. We used descriptive statistics to describe the data and stepwise regression to examine the predictors of nurses' CRE. Results: A total of 110 nurses participated in the study. Regardless of the emotional cue level, participants predominately responded to cues with inappropriate distancing strategies. Prior formal communication training, practice unit, length of nursing practice, and educational level together explain 36.3% variances of the nurses' CRE. Conclusions: This study is the first to explore factors related to Taiwanese nurses' CRE. Compared to nurses in other countries, Taiwanese nurses tended to respond to patients' emotional cues with more inappropriate strategies. We also identified significant predictors of CRE that show the importance of communication training. Future research and education programs are needed to enhance nurses' CRE and to advocate for emotion-focused communication.

Opioid-taking self-efficacy as influencing emotional status in patients with cancer pain

Article

Dec 2016

Purpose: The purpose of this study was to evaluate how much of the variance in emotional status amongst Taiwanese cancer patients could be accounted for by opioid-taking self-efficacy. Methods: This cross-sectional study included 109 cancer patients who had taken prescribed opioid analgesics for cancer related pain in the past week and completed the Opioid-Taking Self-Efficacy Scale-CA (OTSES-CA) and Hospital Anxiety and Depression Scale. Results: There was a significant and negative correlation between scores on anxiety and self-efficacy total scale (r = -0.29, p < 0.01), self-efficacy communication subscale (r = -0.37, p < 0.01), self-efficacy acquiring help subscale (r = -0.22, p < 0.05) and self-efficacy managing treatment related concerns subscale (r = -0.32, p < 0.01). However, the correlation between scores on depression and the self-efficacy total scale was not significant (r = -0.18, p > 0.05); only the self-efficacy communication subscale was significantly and negatively associated with depression (r = -0.27, p < 0.01). The opioid-taking self-efficacy total scale accounted for 8% of predicting the patients' anxiety. Opioid-taking self-efficacy subscales accounted for 20% (R(2) = 0.20, p = 0.000) of the variance in predicting anxiety and 10% (R(2) = 0.10, p = 0.02) of the variance in predicting depression. Conclusions: This study highlights the potential importance of a patient's opioid-taking self-efficacy beliefs in their emotional status, which is relevant to cancer pain.

Depression in unstable angina inpatients in Iran: a case-control study

Article

Full-text available

Jan 2009

Ali Talaei

Abstract Depression can be a risk factor for coronary heart diseases and/or a consequence of that. This may eventually worsen prognosis, elongation of the treatment and increase the costs. It seemed necessary to perform a study that can distinguish the degree and intensity of depression signs in patients with unstable angina in comparison with non-angina patients in Qaem general hospital in Mashhad, Iran. Materials and Methods: One hundred unstable angina patients in heart emergency ward of Qaem hospital were assessed for depression signs and were compared with non-angina patients in 2006. Demographic data forms and Beck depression inventory (BDI) were filled out for all cases in both groups. Data was statistically analyzed using SPSS and appropriate descriptive and analytic statistical tests such as chi square or t-test were conducted. Results:The mean age was 59.4±11.7 years. Females were 64% of participants. Depression rate was significantly more in the case group (81%) than the control group (P=0.01). There was no relationship between depression rate and age, sex, marital status, education, familial history of depression, occupation, consumption of cardiac or psychological drugs, and duration of cardiac or psychological diseases. Patients with low satisfaction on their income significantly showed more depression rate (P=0.006). Conclusion: Depression sign rates are significantly higher in patients with unstable angina than the non-angina patients.

Factors affecting quality of life in adults with epilepsy in Taiwan: A cross-sectional, correlational study

Article

May 2016
EPILEPSY BEHAV

Purpose: The purpose of this study was to assess eight factors considered important for quality of life in persons with epilepsy in order to determine which of these components affect quality of life in adults with epilepsy in Taiwan. Methods: A cross-sectional, correlational study using structured questionnaires assessed 260 patients with epilepsy purposively sampled from a medical center in Northern Taiwan. Health-related quality of life (HRQoL) was evaluated with the Quality of Life in Epilepsy-31 (QOLIE-31) questionnaire. Data also included personal and health-related characteristics, knowledge of epilepsy, efficacy in the self-management of epilepsy, and social support. Results: Scores for the QOLIE-31 were correlated with the following factors: (1) demographic characteristics of age, gender, and income; (2) sleep quality; (3) symptoms of anxiety and depression; (4) epilepsy-specific variables: seizure frequency; types, number, and frequency of antiepileptic drugs (AEDs); and adverse events of AEDs; and (5) social support. Stepwise regression analysis showed that seven factors were predictive for quality of life: anxiety, depression, adverse events of AEDs, social support, seizure frequency of at least once in three months, household income of NT$ 40,001-100,000, and male gender. These factors accounted for 58.2% of the variance of quality of life. Significance: Our study assessed multiple factors in an examination of relationships and predictive factors for quality of life in adults with epilepsy in Taiwan. Knowledge of these contributing factors can assist health-care providers when evaluating patients with epilepsy to help target interventions for improving quality of life.

Risk Factors for Depression and Anxiety among Breast Cancer Survivors in Their 40s

Article

Feb 2015

Sook Yeon Hwang

This study was performed to examine the prevalence of and risk factors for depression and anxiety among breast cancer survivors in their 40s. Completed questionnaires were collected from 609 breast cancer survivors in their 40s who agreed to participate the study. The mean scores of CES-D and GAD-7 were 16.35(SD

Effect of Music Therapy as Intervention on Peripheral Neuropathic Pain and Anxiety of Gynecologic Cancer Patients Undergoing Paclitaxel Chemotherapy

Article

Full-text available

Sep 2011

Purpose: This study was to investigate the effect of music therapy as intervention on peripheral neuropathic pain and anxiety of gynecologic cancer patients who were undergoing paclitaxel chemotherapy. Methods: Hospitalized 62 patients were assigned to an experimental group (n=30) and a control group (n=33) in this quasi-experimental study. The experimental group participated in music therapy that includes listening, singing and song writing during 1 hour. The peripheral neuropathic pain, anxiety and depression were examined as pre-intervention evaluation by using pain scale, anxiety scale (20 questions) and depression scale (20 questions) in both groups. There were no further treatments for the control group while the experimental group involved in music therapy. The peripheral neuropathic pain and anxiety were evaluated in both groups as post-intervention evaluation. Results: Outcomes were verified through hypothesis testing. The level of peripheral neuropathic pain and anxiety in the experimental group was decreased, compared to the control group. Conclusion: According to the study, music therapy is a beneficial intervention that reduces peripheral neuropathic pain and anxiety in gynecologic cancer patients. These findings are encouraging and suggest that music therapy can be applied as an effective intervention for minimizing chemotherapy related symptoms.

Depressive Phenomena, Physical Symptom Distress, and Functional Status Among Women With Breast Cancer

Article

Full-text available

Jul 1997

Jeannie Pasacreta

The nature and scope of depression and its relationship to physical symptom distress and functional status were examined in 79 women 3 to 7 months after breast cancer diagnosis. Psychiatric diagnostic criteria for depressive disorders and a depression rating scale were used to measure depression. Nine percent of the sample had depressive disorder, and 24% had elevated depressive symptoms. Women with elevated depressive symptoms had more physical symptom distress (p < .0001) and more impaired functioning (p < .0001) than subjects with depressive disorders and without depression. Multiple regression was used to examine the contribution of key variables to functional status. Two variables accounted for 35% of the variance in functional status: symptom distress (28%) and depressive symptoms (7%).

Psychological factors in pain

Article

Jan 1976
Adv Pain Res Ther

R. Sternbach

The Prevalence of Psychiatric Disorders Among Cancer Patients

Article

Feb 1983

Leonard R. Derogatis

Two hundred fifteen randomly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder. Each patient was assessed in a common protocol via a psychiatric interview and standardized psychological tests. The American Psychiatric Association's DSM-III diagnostic system was used in making the diagnoses. Results indicated that 47% of the patients received a DSM-III diagnosis, with 44% being diagnosed as manifesting a clinical syndrome and 3% with personality disorders. Approximately 68% of the psychiatric diagnoses consisted of adjustment disorders, with 13% representing major affective disorders (depression). The remaining diagnoses were split among organic mental disorders (8%), personality disorders (7%), and anxiety disorders (4%). Approximately 85% of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom. The large majority of conditions were judged to represent highly treatable disorders. (JAMA 1983;249:751-757)

The Hospital Anxiety And Depression Scale

Article

Jun 1983
ACTA PSYCHIAT SCAND

ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

Carroll BT, Kathol RG, Noyes Jr R, Wald TG, Clamon GHScreening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. Gen Hosp Psychiatry 15: 69-74

Article

Apr 1993
GEN HOSP PSYCHIAT

Nine hundred and thirty inpatients and outpatients with cancer were approached to complete the Hospital Anxiety and Depression Scale (HADS). Eight hundred and nine (86.9%) of those approached participated in this screening. Using the suggested cutoff score of 8 for the anxiety and depression subscales, we found that 47.6% of this population would warrant further psychiatric evaluation. Twenty-three percent (23.1%) had scores 11 or greater and would be the most likely to have had anxiety (17.7%) or depressive (9.9%) disorders based on DSM-III-R criteria. Patients with active malignant disease and inpatient status were more likely to have higher depression scores. The HADS was an easily administered tool that identified a large proportion of cancer patients as having high levels of anxiety or depression. However, clinical psychiatric interviews were not performed, so it is not possible to determine what proportion of patients would benefit from treatment.

Depression, stress, mastery, and social resources in four ethnocultural women's groups

Article

Oct 1990

This descriptive study was designed to examine the interrelationships of depression, stress, mastery, and social resources in four ethnocultural women's groups. The random sample (N = 212) was comprised of Chinese (n = 60), Vietnamese (n = 46), Portuguese (n = 56), and Latin American (n = 50) immigrant women. Using the CES-D, high depressive symptoms were reported by all groups. Collectively, the major correlates and predictors of depression were perceived stress and mastery. Group-specific analyses revealed different models for predicting depression in each ethnic group. The findings underscore the need for observation of the indicators of depression in immigrant women--regardless of their phase of resettlement--and a flexible, individualized approach to ethnic women's psychological health care.

Razavi D, Delvaux N, Farvacques C, Robaye EScreening for adjustment disorders and major depressive disorders in cancer patients. Br J Psychiatry 156(Suppl): 79-83

Article

Feb 1990

The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1-specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.

Psychiatric Management of Cancer Pain

Article

Jul 1989

William Breitbart

Appropriate management of cancer pain is essential and requires a multidisciplinary approach that includes a major role for a psychologist and/or psychiatrist. An increased incidence of psychiatric disturbance, in particular, anxiety and depression, is found in patients with pain. Psychiatric symptoms in patients with cancer pain must be initially viewed as a consequence of uncontrolled pain. Personality factors may be quite distorted by the presence of pain, and its relief often results in the disappearance of a perceived psychiatric disorder. Reassessment after pain control is imperative. Optimal treatment of cancer pain includes pharmacologic, psychologic, behavioral, anesthetic, stimulatory, and rehabilitative approaches, often in combination. Cognitive and behavioral interventions, such as relaxation, imagery, hypnosis, distraction, and biofeedback, are effective as part of a comprehensive multimodal approach and must never be used as a substitute for appropriate analgesic management of cancer pain. Psychotropic drugs, particularly the tricyclic antidepressants, are useful as adjuvant analgesic agents in the pharmacologic management of cancer pain.

The Cancer Patient with Pain: Psychiatric Complications and Their Management

Article

Apr 1987
MED CLIN N AM

The most common psychiatric complications in the cancer population are depression, anxiety, and delirium. All are more likely to occur in the cancer patient who has pain. This review outlines the normal responses to cancer and the psychiatric disorders frequently encountered in clinical practice. The influence of pain on the incidence and presentation of these disorders is described. Multimodal treatment, which includes pharmacologic, psychotherapeutic, and behavioral interventions, is outlined.

An exploration of somatization among Asian refugees and immigrants in primary care

Article

Oct 1985

The clinical records of Chinese, Filipino, Vietnamese, Laotian, and Mien patients in primary care were reviewed to determine the prevalence of somatization, its associated patient characteristics, and the manifested illness behavior. Patients in this study were generally poor, unemployed, and spoke little English. Somatization accounted for 35 per cent of illness visits. These visits were also more costly. Refugees had a higher rate of somatization (42.7 per cent) than immigrants (27.1 per cent). Although sociodemographic characteristics did not strongly differentiate patients with somatization from others, ethnicity and indicators of decreased resources such as large households with low income, households headed by single women, or a limited English proficiency were associated with somatization in certain ethnic groups. Somatization is thus an important health problem among Asian refugees and immigrants.

Absence of major depressive disorder in female cancer patients

Article

Dec 1985

This investigation evaluated the prevalence of depression in female patients who had cancer in any of five predesignated sites. Five hundred five women aged 17 to 80 (190 with breast cancer, 143 with gynecologic malignancies, 111 with melanoma, 37 with bowel cancer, and 24 with lymphoma) were randomly screened. Assessment included the Hamilton rating scale for depression, the Zung self-rating depression scale, the Karnofsky performance scale, and a 10-cm visual pain analogue line. The results revealed a mean Hamilton of 10.2 (range, 0 to 41; SD, 7.5), a mean Zung score of 35.3 (range, 11 to 68; SD, 9.6), a Karnofsky median score of 80, and a median pain score of 0. Scores on the Zung scale were highly correlated with those of the Hamilton scale (r = .75). Based on cutoff scores accepted as indicating depression (Hamilton greater than or equal to 20 and Zung greater than or equal to 50), patients were depressed. The depressed subgroup was in significantly more pain, experienced greater physical disability, and was more likely to have had prior episodes of depression as compared to the non-depressed women. The two best predictors of current depression were performance status (Karnofsky) and history of depression. No relationship was found between depression and other demographic variables or disease parameters (diagnosis, time since diagnosis, stage or phase of illness, and current treatment). Our findings indicate that the prevalence of major depression in cancer patients is lower than many previous studies have indicated and falls within the range seen in the general population.

The multidimensional nature of pain

Article

Dec 1983

A critical review of the literature examining the assessment of cancer-related pain revealed a lack of systematic research. In the present study, 40 patients with cancer-related pain were compared to 37 pain-free cancer patients matched on diagnosis, stage of disease, age, sex, and inpatient vs. outpatient status. The results supported a multidimensional conceptualization of cancer-related pain consisting of sensory, affective, cognitive, and behavioral components.

Depression in Hospitalized Cancer Patients

Article

May 1984

The study of depression in cancer patients has been hampered by difficulty in establishing diagnostic criteria, since neurovegetative signs and symptoms may be attributable either to depression or physical illness. Confusion has also arisen in defining the boundary between "normal" grieving with illness, and "abnormal" clinical depression. We studied 62 oncology inpatients applying DSM-III diagnostic criteria, patient self-report, and interview report rating scales. Forty-two percent met criteria for nonbipolar major depression: 24% with severe and 18% with moderately severe symptoms. Fourteen percent of the sample had depressive symptoms that did not meet criteria for a major depression. Forty-four percent had no depressed affect. Medical and demographic variables were evaluated for relationship to depression; only greater degree of physical disability was clearly associated. Other negative life events and poor quality of social supports were additionally associated with depression in the less disabled patients. The use of clearly defined criteria for diagnosis of depression in cancer patients provides a basis for the study and implementation of specific therapeutic interventions.

The Prevalence of Psychiatric Disorders Among Cancer Patients

Article

Mar 1983

The Hospital Anxiety and Depression Scale

Article

Jul 1983

A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

The Relationship of Cancer Pain to Anxiety

Article

Feb 1995

The interaction between pain and anxiety in the setting of somatic illness is a widely recognised association. More accurate knowledge about the association and also about the means of assessing anxiety in a clinical setting are of use to the clinician. The present study used the Hospital Anxiety and Depression Scale for assessment of anxiety, and the set of linear analogue scales for detecting the presence and severity of anxiety and pain in an oncology clinic, where patients were undergoing active treatment for cancer. The relationship between pain and anxiety was found to be significant, even when the possible mediating effect of the variables of illness severity and age were removed. The need for detecting anxiety in order to plan treatment strategy is emphasised.

Psychological distress in cancer patients with advanced disease

Article

Jul 1993
RADIOTHER ONCOL

The objective of this study is to explore the nature and extent of the cognitive behavioral response to treatment, and the accompanying anxiety and/or depression in cancer patients with advanced disease. In a multicenter study, 247 patients treated with palliative radiotherapy filled out a questionnaire before start of treatment. The questionnaire consisted of Impact of Event Scale (IES), General Health Questionnaire (GHQ-20), and two questions assessing pain intensity. Seventy percent of the patients reported a high level of psychological distress. The mean score of the patient population on the IES was 14.4 (IES intrusion) and 15.3 (IES avoidance). The mean Likert score on the GHQ-20 was 27.3. Patients with poor performance status and pain were most distressed. In order to improve patients' care and support, cases at risk must be identified. In the present population, psychological distress is related to pain and reduced performance status.

Depression in patients with cancer: Diagnosis, biology, and treatment

Article

Mar 1995
ARCH GEN PSYCHIAT

This article reviews the challenge of diagnosing depression in patients with cancer. Major depression and depressive symptoms, although commonly encountered in medical populations, are frequently underdiagnosed and undertreated. This is especially true for patients with cancer in whom the diagnosis of major depression is clouded by neurovegetative symptoms that may be secondary to either cancer or depression. Well-established biological markers for major depression are proposed as diagnostic adjuncts in patients with cancer. Studies using biological markers in depressed patients with and without cancer are reviewed, and the implications of diminished immune function in depressed patients with cancer are discussed. The limited database on treatment of depression in patients with cancer also is reviewed. Treatment of depression in these patients improves their dysphoria and other signs and symptoms of depression, improves quality of life, and may improve immune function and survival time. Guidelines for future research are proposed.

Pain and depression in patients with cancer

Article

Dec 1994

Although the existence of a relationship between depression and pain in patients with cancer has been known for many years, the influence of one upon the other is still poorly understood. It has been thought that depressed individuals complain of pain more because of their psychiatric illness. Evidence from two studies indicate that pain may induce clinical depression. In the first study, the authors examined both current and lifetime psychiatric diagnoses among patients with cancer who had high and low pain symptoms to examine the strength of the relationship between depression and cancer pain. The sample consisted of 72 women and 24 men, with 39 women and 9 men in the high pain group, and 33 women and 15 men in the low pain group. In the second study, 35 patients with metastatic carcinoma of the breast were examined for pain intensity and frequency and mood disturbance. The prevalence of depressive disorders of all types was found to be significantly higher in the high pain than in the low pain group across measures, 33 versus 13% (chi-square [degrees of freedom = 1] = 5.90, P < 0.05). Furthermore, there was a significantly higher history of major depression in the low pain group than in the high pain group (chi-square [degrees of freedom = 1] = 3.86, P < 0.05). Also, in comparison with patients in the low pain group, patients in the high pain group were significantly more anxious and emotionally distressed. In the second study, pain intensity correlated significantly with fatigue, vigor, and total mood disturbance, and pain frequency correlated significantly with fatigue, vigor, and depression. This study confirms the high concomitant occurrence of pain and psychiatric morbidity and suggests that pain may play a causal role in producing depression.

Psychological Adjustment in Adults With Cancer: The Self as Mediator

Article

Aug 1994

The role of the self in adjustment to cancer has been noted but is not well understood. Research and theory on the self suggest that discrepancies between actual and ideal self-conceptions influence adjustment and mediate the effects of disease-related health problems on psychological well-being. This relationship was investigated in a cross-sectional study of 108 persons with cancer. Cancer patients who had more symptoms and worse functional health and perceived their cancer as a chronic rather than an acute disease had higher levels of self-discrepancies and poorer adjustment. Self-discrepancy was a significant mediator of the effects of perceived health status on purpose in life, positive relations with others, and depression.

Ibbotson T, Maguire P, Selby P, Priestman T, Wallace LScreening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 30A(1): 37-40

Article

Feb 1994
EUR J CANCER

The General Health Questionnaire 28 (GHQ 28), Hospital Anxiety and Depression Scale (HADS), and Rotterdam Symptom Checklist (RSCL) seemed promising in their ability to detect anxiety and depression in cancer patients. To compare their screening performance, 513 patients were recruited from four cancer centres, and visited at home by a trained interviewer. Paired combinations of questionnaires (GHQ 28 + HADS, GHQ 28 + RSCL or RSCL+HADS) were used, and then the Psychiatric Assessment Schedule was administered to enable a psychiatric diagnosis to be made using DSM III diagnostic criteria. A receiver operating characteristics curve was drawn by plotting the true positive rate (sensitivity) against the false positive rate (1-specificity) for each possible score on each questionnaire. In the overall sample, the HADS and RSCL performed well comparably. The HADS did best in those free of disease and when the disease was judged to be stable. Only the RSCL performed well in those with progressive disease. Both the HADS and RSCL were effective in those on treatment. The GHQ was superior to the RSCL in those off treatment. The choice of questionnaire and threshold score should take disease and treatment status into account, but all three questionnaires have a definite role in screening out anxiety and depression.

Emotional distress in men with life-threatening illness

Article

Nov 1996
INT J NURS STUD

This descriptive survey explored the relationship of health status, functional status, stressful life events, stress resistance resources and emotional distress in 60 men with life-threatening illness (N = 30 with cancer and N = 30 with AIDS). Sixty-two percent met CES-D criteria for clinical depression. This study's results supported the hypotheses that poorer functional status and greater negative stressors are associated with both higher levels of hopelessness and depression. Twenty-four patients constituted a group with severe emotional distress. This group was significantly different from the less vulnerable group with poorer functional status (KPS), a greater number and severity of negative stressors, less satisfaction with social support, and less hopefulness.

Psychological variables and cancer

Article

Feb 1996

Pain can cause both physical and psychological distress that has a negative impact on a patient's quality of life. The purpose of this descriptive study was to determine whether cancer patients (N = 60) with pain (n = 30) had higher scores of depression, anxiety, somatization, and hostility than did cancer patients without pain (n = 30). The study was conducted in a midwestern medical center hospital during a 9-month period. Psychological variables were measured using subscales of the Brief Symptom Inventory (BSI). Patients who reported pain completed the McGill Pain Questionnaire (MPQ) and Visual Analogue Scale. Significant positive correlations were found between total MPQ scores and all four subscales of the BSI (r = 0.60-0.78, p < 0.05). Patients with pain scored higher on all four subscales of the BSI, with significant differences occurring in somatization (t = 2.05, p < 0.05) and hostility (t = 1.93, p < 0.05). The findings suggest a relationship between pain intensity and psychological status. Nursing interventions aimed at reducing these factors may help to decrease the pain, in addition to then decreasing the psychological distress experienced by patients with cancer.

Family and Cultural Correlates of Depression Among Chinese Elderly

Article

Feb 1997
INT J SOC PSYCHIATR

This study hypothesized that depressive experiences of the elderly could be aggravated by universal factors such as low social status, poor health, financial strain, and unhealthy lifestyle, as well as by factors specific to an indigenous socio-cultural environment (stressful family dynamics) of a given population. Three hundred and fifty Chinese subjects aged 65 or older were interviewed either at their homes or in the geriatric out-patient clinic of Beijing Hospital. Hierarchical logistic regression was used to examine significant predictors of depression. Results showed that certain social status, poor physical health, financial strain, unhealthy lifestyle, and stressful family situation explained 47 percent of the variance in depression. However, stressful family situation alone explained 13 percent of the variance in depression, indicating that family factors were important predictors of depression for Chinese elderly. Furthermore, this study demonstrated for the first time that verbal abuse within Chinese families is a significant correlate of depression among the elderly. Cultural implications of these findings are discussed.

Prevalence of Anxiety and Depression in Cancer Patients Seen at the Norwegian Radium Hospital

Article

Oct 1997
EUR J CANCER

The aim of this study was to investigate the prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital, using the Hospital Anxiety and Depression Scale (HADS), the EORTC QLQ-C33 and an ad hoc designed questionnaire. In addition, information about the patients' malignant disease and treatment was obtained. The prevalence of anxiety and depression among 716 evaluable patients was 13% and 9% respectively, as assessed with HADS. In hospitalised patients, the risk of psychiatric distress was approximately twice that of patients in the outpatient clinic. Female patients reported significantly more anxiety than men. Patients < 30 or > 70 years old expressed less anxiety than all other patients. Age or gender had no influence on the occurrence of depression. Impaired ability to continue professional work and/or daily life activities, impaired social life and previous psychiatric problems were significantly correlated with anxiety and depression as were impaired physical function, fatigue and pain. The prevalence of depression, but not anxiety, increased in the presence of distant metastases, with less than a month since diagnosis, and with relapse or progression. In the logistic regression analysis, a history of previous psychiatric problems and impaired social life were correlated with both anxiety and depression. Female gender, impaired physical activity and impaired social role function were additional predictive parameters for anxiety, whereas fatigue predicted depression. Careful attention should be paid to cancer patients displaying these problems in order to diagnose and treat depression and anxiety disorders.

Screening for anxiety and depression in women with breast cancer. Psychiatry and medical oncology gear up for managed care

Article

Jan 1999
PSYCHOSOMATICS

In this study, 275 women with breast cancer attending ambulatory breast cancer clinics in two sites were evaluated for psychological distress by using three self-report instruments: a visual analogue scale for psychological distress, the Hospital Anxiety and Depression Scale, and the Brief Symptom Inventory. Results suggest that significant psychological distress exists in ambulatory women with breast cancer; all three instruments effectively measured that level of distress. Implications for the use of these instruments in educating oncological staff members, documenting need for psychiatric services in a period of capitation, and providing quality assurance evaluations of psychiatric services are discussed.

Anxiety and depression in Taiwanese cancer patient with and without pain

Abstract

No full-text available

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