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.

No description available.

Entre 2003 et 2005, un programme de dépistage des maladies liées à l’amiante a été mis en place dans quatre régions françaises, constituant ensuite la cohorte ARDCO (Asbesto related Diseases Cohort). La cohorte ARDCO a été suivie entre 2007-2009 (étude ARDCO I) et entre 2011-2012 (étude ARDCO II). Cette thèse a été réalisée dans le cadre de l’étude ARDCO II et trois études ont été réalisées. Dans notre population d’étude, nous avons montré une amélioration de certaines connaissances sur le risque lié à l’amiante et au tabac par le biais d’une notice d’information. La prévalence globale des symptômes d’anxiété probable et de dépression probable a été respectivement estimée à 19,7% (n=435) et 9,9% (n=219). Les femmes présentaient significativement plus de symptômes anxieux et dépressifs que les hommes (respectivement 34,8% contre 19% et 18,5% contre 9,5%). Le risque de développer les symptômes anxieux et dépressifs était significativement associé à l’auto-évaluation de l’exposition à l’amiante, la perception du risque lié à l’amiante ainsi qu’à l’autoperception du risque de développer des pathologies liées à l’amiante. Une troisième étude a montré que les personnes présentant des symptômes d’anxiété probable ou de dépression probable utilisaient le plus souvent les stratégies de coping dites « maladaptatives » ; et que l’utilisation des stratégies de coping dépendait plus de la présence des symptômes anxieux ou dépressifs que de l’exposition à l’amiante. / A large-scale screening program for asbestos-related diseases was organised in four regions of France between October 2003 and December 2005. Asbestos Related Diseases Cohort was constituted and participants were followed up between 2007 and 2009 (ARDCO I study) and between 2011 and 2012 (ARDCO II study). This thesis was made from ARDCO II study and three studies have been conducted. Among the study participants, we found an improvement in knowledge about tobacco and asbestos-risk perception related to an information leaflet. The prevalence of symptoms of probable anxiety and depression was 19.7% (n=435) and 9.9% (n=219) respectively. Women had significantly more anxious and depressive symptoms than men (34.8 vs 19% and 18.5 vs 9.5, respectively). The risk of developing anxious and depressive symptoms was significantly associated to the intensity of asbestos-exposure self-evaluated and to the asbestos-risk perception. The participants with symptoms of probable anxiety or depression more frequently used “maladaptive” coping strategies and the use of the coping strategies depended specially of anxious and depressive symptoms rather than asbestos exposure.

Aims and Methods The overall aim was to evaluate methods of screening and assessment of distress, anxiety, and depression in cancer patients. Further, to evaluate effects of a psychosocial intervention and to explore changes of distress, anxiety, depression, and HRQoL during six months. Study I included 495 consecutive patients screened with the Hospital Anxiety and Depression Scale (HADS) at their first visit to an Oncology Department. Half of the patients with >7 on any of HADS subscales received standard care (SCG), and half received a psychosocial intervention (IG). To compare HADS with a thorough clinical assessment (CA), Study II included 171 identified patients representing both sexes, <65/≥65 years, and curative/palliative treatment intention. Results Screening with HADS identified anxiety or/and depression symptoms in 36% of the 495 patients. Thirty-six (43%) of 84 IG patients attended CA, resulting in support for 20 (24%) of them. There were no differences between SC and IG during follow-up, anxiety and depression decreased and HRQoL increased, although anxiety was still present and HRQoL impaired at six months. The Distress Thermometer (DT) ≥4 (sensitivity 87%, specificity 73%) is valid for screening of distress; its ability to measure changes over time is comparable to HADS. Of 319 patients screened with <8 on both HADS subscales, 196 (80%) were stable non-cases with HRQoL comparable to that of the general population and 49 (20%) patients were unstable non-cases, with deteriorated anxiety, depression, and HRQoL. >4 on HADS subscales may be useful for early detection of unstable non-cases. In Study II, HADS identified 49 (34%) and the CA 71 (49%) patients as having distress, anxiety or depression. CA identified more men and more young patients with distress than HADS did. Conclusion Screening and assessment identifies patients with persistent symptoms and increases access to CA and support. The DT may be used routinely in oncology care. When HADS is used, healthcare professionals should be aware of psychosocial problems perceived by patients but not covered by HADS. Most patients identified with distress seem to have resources to manage problems without needing additional support. Patients screened as non-cases indicate no need for re-assessment.

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.