Anxiety and depression are common mood disorders in cancer patients, regardless of mental state prior to diagnosis. A gap in the education of oncology nurses in an eastern Caribbean island was discovered regarding their ability to identify anxiety and depression symptoms and to help patients who suffered from these disorders. The purpose of this project was to improve oncology nurses' assessment skills by reviewing appropriate use of the Hospital Anxiety and Depression Scale (HADS) tool and familiarizing nurses with resources to help patients who score high on the HADS. The Levine conservation model was the theoretical framework for this project. The research question addressed whether a staff education module regarding the use of the HADS tool would improve staff knowledge about screening cancer patients for mood disorders in a clinic setting. This project involved a staff education module with a pretest/posttest assessment and evaluation of the responses and levels of improvement. A total of 10 oncology nurses with varying academic degrees and years of experience participated in the project. The pretest showed that many had inadequate knowledge of the HADS tool. Based on posteducation assessment scores, all participants understood how to use the tool to screen for mood disorders. The implication of this study for positive social change is that oncology nurses will be able to use a screening tool to identify undiagnosed anxiety and depression symptoms in cancer patients and provide patients with appropriate resources.

No / The factor structure of the Hospital Anxiety and Depression Scale (HADS) were investigated in 376 individuals with facial disfigurement. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. Competing one-factor, two-factor and three-factor models were evaluated to identify best model fit. The best model fit to the data was found to be consistently provided by three-factor models. However, further research into the factor structure of the HADS is suggested, particularly in terms of developing and scoring the instrument as a three-dimensional affective state screening tool.

Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

Previous research into the accuracy of referrals for glaucoma has shown that a large number of referrals to the Hospital Eye Service are false positive. Research in areas of healthcare other than ophthalmology has shown that psychological distress can be caused by false positive referrals. The present study aimed to evaluate the quality of referrals to the HES for all ocular pathologies, and also to quantify the proportion of these referrals that were false positive. Any commonality between false positive referrals was investigated. The psychological effect of being referred to the HES was also evaluated using the Hospital Anxiety and Depression Scale (HADS) and State-Trait Anxiety Inventory (STAI). Both scales were validated in this population with Rasch analysis before use. A final aim was to develop an improvement to the present referral pathway in order to reduce numbers of false positive referrals. The accuracy of referrals to the HES appears to improve as clinicians become more experienced, and greater numbers of false positive referrals are generated by female clinicians. Optometrists refer patients with a wide range of ocular diseases and in most cases include both fundus observations and visual acuity measurements in their referrals. GPs mainly refer patients with anterior segment disorders, particularly lid lesions, based on direct observation and symptoms. Illegibility and missing clinical information reduce the quality of many optometric referrals. Patients referred to the HES experience raised levels of anxiety as measured by the STAI and raised levels of depression as measured by the HADS-Depression subscale. As a method of assessing psychological distress, the questionnaires HADS-T (all items), STAI-S (State subscale) and STAI-T (Trait subscale) show good discrimination between patients when administered to a population of new ophthalmic outpatients, despite all having a floor effect. Subsequently a referral refinement service was developed which reduced numbers of unnecessary referrals and reduced costs for the NHS.

HINTERGRUND: Die Typ-D-Persönlichkeit (von distressed personality) etablierte sich in den letzten Jahren als ein Risikofaktor für den Verlauf kardiovaskulärer Erkrankungen. Die bisherigen Studien waren in den Niederlanden oder Belgien durchgeführt worden. Das Ziel der hier vorliegenden Arbeit war eine unabhängige Überprüfung der Ergebnisse an einer Stichprobe deutscher kardiologischer Patienten. Zusätzlich sollte untersucht werden, ob die Typ-D-Persönlichkeit und ihre Dimensionen der negativen Affektivität (NA) und der sozialen Inhibition (SI) über den Untersuchungszeitraum stabil blieben. METHODEN: Hierzu wurden 1040 stationär oder ambulant kardiologisch behandelte Patienten rekrutiert. Mithilfe der Typ-D-Skala (DS14) und der Hospital Anxiety and Depression Scale (HADS) wurden die Merkmale einer Typ-D-Persönlichkeit sowie Depressivität und Ängstlichkeit erhoben. Zusätzlich wurden klinisch relevante Daten, wie z. B. Geschlecht, Alter und kardiale Vorerkrankungen, erfasst. Endpunkt der Studie war die Gesamtmortalität. Mit Cox-Regressionsanalysen wurde das relative Sterblichkeitsrisiko der Probanden ermittelt. ERGEBNISSE: Hinsichtlich der Stabilität von Typ-D, NA und SI ergaben sich über einen Zeitraum von 5,9 Jahren Re-Test Stabilitäten an der unteren Grenze des Erwarteten. Es gab also eine gewisse Stabilität der Typ-D-Persönlichkeit, diese war aber nicht wesentlich höher als beispielsweise die von Angst und Depressivität, und auf Ebene des individuellen Patienten kam es häufig zu Veränderungen. Der Überlebensstatus ließ sich für 977 Studienteilnehmer ermitteln, hiervon waren 172 im Beobachtungszeitraum verstorben. In univariater und multivariater Analyse waren weder Typ-D noch NA oder SI Prädiktionsfaktoren einer höheren Gesamtmortalität. Im Gegensatz zu anderen Studien wies unsere Stichprobe ein heterogenes kardiales Erkrankungsprofil auf. Eine hierdurch bedingte Verschleierung eines Einflusses des Typ-D-Musters konnten wir durch separate Untersuchung der KHK-Patienten ausschließen. SCHLUSSFOLGERUNG: Zusammenfassend lässt sich sagen, dass unsere Studie zu den größten zählt, die bisher zur Evaluation des Einflusses der Typ-D-Persönlichkeit auf die Gesamtmortalität kardiologischer Patienten durch-geführt worden ist. Nach mehr als 5 Jahren Beobachtungszeit, mit 5764 Menschenjahren und 172 beobachteten Todesfällen hat sie suffiziente Ausdruckskraft, relevante Effekte der Typ-D-Persönlichkeit auf die Mortalität aufzudecken. Die klare Abwesenheit dieses Effektes in univariater und multivariater Analyse legt den Schluss nahe, dass die Typ-D-Persönlichkeit und ihre Dimensionen NA und SI bei deutschen kardiologischen Patienten nicht mit einer erhöhten Mortalität assoziiert sind. Die Diskrepanz zwischen unseren Ergebnissen und den Ergebnissen von Denollet und seiner Arbeitsgruppe macht weitere Forschung an anderen Stichproben nötig. Kulturelle Unterschiede in der Verarbeitung negativer Affekte sind als mögliche Ursache unserer abweichenden Ergebnisse zu diskutieren und sollten in zukünftigen Studien weiter untersucht werden.

Magister Artium (Social Work) - MA(SW) / The burden of HIV disease is concentrated in sub-Saharan Africa and South Africa (SA) is particularly affected. Whilst there have been many studies conducted on the biomedical and socio-psychological aspects of HIV and AIDS, insufficient attention has been paid to the quality of life of those infected with the virus. The primary purpose of this study was to determine the predictors of quality of life enjoyment and satisfaction (Q-LES) of individuals living with HIV and or AIDS and those on anti-retroviral treatment or being prepared for it. Further, the study determined the relationship between psychological distress and Q-LES of HIV positive individuals because psychological distress is reported to contribute substantially to the burden of the disease in sub-Saharan Africa, including SA. This quantitative study used a battery of questionnaires administered to 121 participants in an out-patient clinic setting. The main hypothesis tested in this study is: psychological distress is a strong predictor of Q-LES. The Hospital Anxiety and Depression Scale (HADS) was used to screen for psychological distress and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) to assess the various components of QoL. A purposive sampling strategy was used to recruit participants into the study. Data analysis included descriptive and inferential statistics using SPSS to test the hypothesis. Of the total sample (N=121), 74% were females. The study found that a large proportion (49.5%) of the sample within the age group 25-49 years old had significant presence of psychological distress. Those not on ART yet were significantly affected (66%). The relationship between Q-LES subscales and psychological distress was significant (p< 0.01). The results show that psychological distress was significantly prevalent among HIV positive individuals and it was the strongest predictor of Q-LES among the study participants. Modifying the current psychological intervention programmes, in the public health clinics, for individuals vi infected with the HI virus will assist in improving the current health outcomes and also help to achieve better Quality of Life outcomes.