Depression und die koronare Herzkrankheit zeigen hohe Komorbiditäten. Dabei ist das Vorliegen einer Depression nicht nur für die Lebensqualität der Patienten, sondern auch für die Prognose der koronaren Herzkrankheit bezüglich Morbidität und Mortalität relevant. Als pathophysiologische Ursache des Zusammenhangs spielen Folgen der depressiven Symptome auf der Verhaltensebene eine wichtige Rolle, die zu einem schlechteren Gesundheitsverhalten und einer geringeren Modifikation von Risikofaktoren als bei Patienten ohne depressive Symptome führen. Daneben werden aber auch gemeinsame pathophysiologische Prozesse für beide Krankheitsentitäten diskutiert, dazu gehören Veränderungen in der HPA-Achse, dem Immunsystem und einer Aktivierung des sympathischen Nervensystems, die sowohl bei der koronaren Herzkrankheit als auch bei der Depression nachgewiesen wurden. In der vorliegenden Untersuchung wurden depressive Symptome anhand der Hospital Anxiety and Depression Scale und des Patient Health Questionnaire-2 systematisch in Form einer prospektiven Beobachtungsstudie an 288 herzchirurgischen Patienten erfasst, bevor sich diese einer ACB-Operation unterzogen. Der Zusammenhang von depressiven Symptomen und präoperativem HbA1c- beziehungsweise präoperativem CRP-Wert sowie peri- und postoperative Komplikationen während des operationsbezogenen Krankenhausaufenthaltes wurde untersucht. Zwischen Patienten mit depressiven und solchen ohne depressive Symptome ließen sich keine Unterschiede bezüglich der präoperativen HbA1c-Werte im Gesamtkollektiv feststellen. Höhere HbA1c-Werte fanden sich bei depressiven Patienten nach Ausschluss der Patienten mit notfallmäßiger Koronarrevaskularisation. Präoperative CRP-Werte unterschieden sich bei Patienten mit und ohne depressive Symptome nicht. Bezüglich peri- und postoperativer Komplikationen waren auffällige Ergebnisse in der HADS-D nicht mit einem erhöhten Komplikationsrisiko während des operationsbezogenen Krankenhausaufenthaltes assoziiert. Auffällige Punktwerte im PHQ-2 waren signifikant mit verlängerter Beatmungszeit und postoperativer Revision assoziiert, für Minor Complications gesamt, therapiebedürftige Wundheilungsstörung und postoperative Mortalität zeigte sich ein Trend zu einem höheren Risiko bei Vorliegen einer Depression. Unterschiede ließen sich aber auch bereits für einzelne Items des PHQ-2 darstellen. Anhedonie war signifikant mit einem erhöhten Risiko für postoperative Mortalität, Major Complications und Revision assoziiert. Depressive Symptome stellen mit mittlerer Effektstärke einen wichtigen Risikofaktor für postoperative Komplikationen noch während des operationsbezogenen Krankenhausaufenthaltes, insbesondere bezüglich der frühen Mortalität, dar. Die systematische Erfassung depressiver Symptome sollte daher Eingang in die präoperative Vorbereitung von Patienten vor operativer Koronarrevaskularisation finden. Inwieweit sich durch spezifische Interventionen präoperativ oder in der präoperativen Vorbereitung das Depressions-assoziierte perioperative Risiko beeinflussen lässt, sollte Gegenstand zukünftiger Untersuchungen sein. / Depression and coronary artery disease show high comorbidities. The presence of depression is not only of substantial relevance for the patients’ quality of life but also for the prognosis of the coronary artery disease in terms of morbidity and mortality. On the pathophysiological side depressive symptomatology accounts for behavioral consequences, which plays a crucial role in health orientated behavior and modification of risk factors for coronary artery disease between patients with and without depressive symptoms. Moreover, common pathophysiological pathways involving both disease entities are currently under discussion, among them alterations in the hypothalamus-pituitary axis, the immune system and an activation of the sympathetic nervous system; all of them have been shown to play a role in coronary artery disease and in depression. The present study is a prospective observational study on 288 patients undergoing cardiac surgery. We systematically evaluated depressive symptoms prior to coronary artery bypass grafting (CABG) surgery with two psychometric scales: Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-2 (PHQ-2). We examined the relationship between depressive symptoms and preoperative glycated hemoglobin (hemoglobin A1c, HbA1c), depressive symptoms and preoperative C-reactive protein as well as depressive symptoms and perioperative and postoperative complications during inpatient treatment associated with CABG surgery. Overall, there were no differences in preoperative glycated hemoglobin between patients with and without depressive symptoms. After exclusion of emergency CABG procedures depressed patients showed higher preoperative glycated hemoglobin. Preoperative C-reactive protein did not differ in patients with and without depressive symptoms. Relevant depressive symptoms measured with the depression scale of the HADS were not associated with an increased risk for perioperative or postoperative complications during inpatient treatment associated with CABG surgery. Relevant depressive symptoms measured with the PHQ-2 were significantly associated with prolonged ventilation and postoperative re-exploration; depressive symptoms evaluated with the PHQ-2 were also associated with an increased risk for minor complications overall, poor wound healing or wound infection with a need for therapeutic intervention and postoperative mortality. Differences in perioperative and postoperative complications were even detectable for single items of the PHQ-2: anhedonia was independently associated with an increased risk for postoperative mortality, major complications overall and postoperative re-exploration. Depressive symptoms are an important risk factor of medium effect size for perioperative and postoperative complications even during inpatient treatment associated with CABG surgery, especially with regard to early mortality. A systematic evaluation of depressive symptoms should therefore be incorporated in preoperative assessment of patients before CABG surgery. Further research is needed to evaluate if specific interventions applied preoperatively or in the preoperative assessment are able to alter the perioperative and postoperative risk associated with depressive symptoms and depression.

Im Zentrum des forschungsleitenden Interesses stand die Fragestellung, ob es Unterschiede bezüglich des Auftretens und der Intensität von Angst bzw. Depression sowie körperlichen Beschwerden zwischen den Patientengruppen mit unterschiedlichen chronischen Lebererkrankungen (HBV, HCV, AIH) gibt. Die Bestimmung der Korrelation zwischen dem Fortschreiten der Lebererkrankung (von Hepatitis über Fibrose zu Zirrhose) und dem Ausmaß depressiver und ängstlicher Symptomatik stand hierbei für alle drei Patientengruppen im Fokus des Interesses. Alle Patienten waren zum Erhebungszeitpunkt ohne spezifische medikamentöse Behandlung aufgrund ihrer Lebererkrankung. Als sekundäres Studienziel sollte die Forschungsfrage beantwortet werden, ob die vier angewendeten verschiedenen psychometrischen Erhebungsinstrumente (HADS-D, SCL-90-R, IIP-C und SF-36) hier zu unterschiedlichen Ergebnissen führen oder ob die Verfahren größtenteils in ihren Ergebnissen übereinstimmen. Auf der Grundlage der histologischen Daten konnte in der Subgruppe der Hepatitis-C-Patienten ein Zusammenhang zwischen Progression der Leberfibrose, depressiver Symptomatik und verminderter körperlicher Gesundheit dargestellt werden. Nur bei Patienten mit chronischer Hepatitis-C-Infektion konnte ein signifikant positiver Zusammenhang (r = 0,205) zwischen der Zeitdauer seit Mitteilung der Primärdiagnose und dem Ausmaß der depressiven Symptomatik festgestellt werden. Alle drei chronischen Lebererkrankungen waren dagegen mit erhöhten Angstwerten assoziiert: bei der Autoimmunhepatitis kam es in 21,4 % der analysierten Fälle, bei der Hepatitis B in 13,9 % und bei der Hepatitis C in 11,8 % zu einer Überschreitung des Cutoff-Wertes mit klinisch relevanter Symptomausprägung. Dieser Prozentsatz fällt in der Allgemeinbevölkerung mit 5,7 % deutlich geringer aus. Es fiel auf, dass die Angst mit zunehmend besseren Therapiemöglichkeiten der Grunderkrankung abnimmt. Lediglich in der Subgruppe der HBV-Infizierten war eine signifikant positive Korrelation der Variablen Angst bzw. Ängstlichkeit und Zeitraum seit Mitteilung der Diagnose zu verzeichnen (r = 0,388). Das eingesetzte psychiatrische Screeningverfahren (SCL-90-R) vermochte nicht zwischen den drei chronischen Lebererkrankungen zu differenzieren, zeigte jedoch eine deutlich erhöhte psychische Gesamtbelastung im Vergleich zur Allgemeinbevölkerung. Die Gesamtbelastung war größer als beispielsweise bei Patienten nach Myokardinfarkt. Dagegen scheinen interpersonale Probleme gemäß den vorgestellten Studienergebnissen bei keiner der drei hepatologischen Erkrankungen eine Rolle im Sinne einer Belastung mit Krankheitswert zu spielen. Bezüglich der erhobenen Lebensqualitätsparamter (SF-36) zeigte sich ein deutlich messbarer Unterschied zwischen der psychischen und der physischen Gesamtbelastung. Hierbei war die psychische Belastung eindeutig im Vordergrund. Alle drei Patienten-Subgruppen zeigten in diesem Zusammenhang durchaus vergleichbare Resultate. Die Hepatitis-B-Gruppe gab insgesamt die größte mentale Belastung an, bei gleichzeitig größten körperlichen Schmerzen innerhalb der drei Gruppen. Zusammenfassend kann man sagen, dass die gemessene psychische Gesamtbelastung der drei Erkrankungen deutlich über der der Allgemeinbevölkerung liegt und vergleichbare Muster aufweist. Bei der chronischen HCV-Infektion zeigte sich ein signifikanter Zusammenhang von Fibroseprogression, länger dauerndem Krankheitsbewusstsein und erhöhten Depressionswerten. Alle drei Erkrankungen führten zu psychischen Auffälligkeiten (z.B. bezüglich der erhobenen HADS-Scores): Während die Depression bei den HCV-Patienten überwog, war die Angst das dominierende Problem der AIH- und der HBV-Patienten. Bei letzteren wären mit Blick auf den weiterführenden Forschungsbedarf erneute Studien anzustreben, die die Angst in den Fokus der Betrachtung stellen, da deren Auswirkung auf die Therapie nicht zu unterschätzen ist. Für die Klinik bedeutet dies, dass es wünschenswert wäre, den neu erworbenen Wissensbestand bezüglich Depression und Angst der Patienten in Schulungen des klinischen Fachpersonals handlungsleitend zu integrieren und auf diesem Wege unter anderem einen Beitrag zu leisten, den Stigmatisierungstendenzen im Umgang mit den Erkrankungen entgegenzuwirken und die klinischen Betreuung weiter zu optimieren. / In the center of the research-leading interest the question was located whether there is a difference in the occurrence and the intensity of fear and/or depression as well as physical complaints between the groups of patients with different chronic liver illnesses (HBV, HCV, AIH). The focus of the interest stood here in the determination of the correlation between the progressing of the liver illness (hepatitis over fibrosis to cirrhosis) and the extent of depressive and fearful symptomatology. At the collection time all patients were without specific medicamentous treatment due to their liver illness. As a secondary study goal the research question should be answered whether here the four applied different collection instruments (HADS-D, SCL-90-R, IIP-C and SF-36) to lead to different results. On the basis of the histological data a connection between progression of the fibrosis, depressive symptomatology and decreased physical health could be represented in the group of the hepatitis C patients. Only the patients with chronic hepatitis C infection showed a correlation (r = 0.205) between the length of time since report of the primary diagnosis and the extent of the depressive symptoms. All three chronic liver illnesses were associated with increased fear values. The SCL-90-R showed similar results for the psychological stress by all three chronic liver illnesses. Who was larger than by patients after myocardial infarction. In summary one can say that the measured psychological total cost of the three illnesses is higher as in the general population. With the chronic HCV infection a significant connection showed up of fibrosisprogression, longer lasting disease consciousness and higher depression values. While the depression outweighed with the HCV patients, the fear was the dominating problem of the AIH and the HBV patients.

No description available.

Magister Psychologiae - MPsych / This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 – 49 years of age being most affected. As previously mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The primary aim of this study was to compare the Beck’s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale –(the Depression component) (HADS-D) as a screening tool for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach’s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish the sociodemographic and disease profiles of the participants under study. / South Africa

<p>This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 &ndash / 49 years of age being most affected. As previously&nbsp / mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the&nbsp / progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it&nbsp / difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that&nbsp / females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on&nbsp / gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will&nbsp / only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those&nbsp / living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this&nbsp / disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The&nbsp / primary aim of this study was to compare the Beck&rsquo / s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale &ndash / (the Depression component) (HADS-D) as a screening tool&nbsp / &nbsp / for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach&rsquo / s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish&nbsp / the sociodemographic and disease profiles of the participants under study. </p>

<p>This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 &ndash / 49 years of age being most affected. As previously&nbsp / mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the&nbsp / progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it&nbsp / difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that&nbsp / females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on&nbsp / gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will&nbsp / only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those&nbsp / living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this&nbsp / disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The&nbsp / primary aim of this study was to compare the Beck&rsquo / s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale &ndash / (the Depression component) (HADS-D) as a screening tool&nbsp / &nbsp / for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach&rsquo / s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish&nbsp / the sociodemographic and disease profiles of the participants under study. </p>

This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 – 49 years of age being most affected. As previously mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The primary aim of this study was to compare the Beck’s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale –(the Depression component) (HADS-D) as a screening tool for depression.Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach’s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish the sociodemographic and disease profiles of the participants under study. / Magister Psychologiae - MPsych