scholarly journals Cost-effectiveness of WHO Problem Management Plus for adults with mood and anxiety disorders in a post-conflict area of Pakistan: randomised controlled trial

2020 ◽  
Vol 217 (5) ◽  
pp. 623-629 ◽  
Author(s):  
Syed Usman Hamdani ◽  
Zill-e- Huma ◽  
Atif Rahman ◽  
Duolao Wang ◽  
Tao Chen ◽  
...  

BackgroundWith the development of evidence-based interventions for treatment of priority mental health conditions in humanitarian settings, it is important to establish the cost-effectiveness of such interventions to enable their scale-up.AimsTo evaluate the cost-effectiveness of the Problem Management Plus (PM+) intervention compared with enhanced usual care (EUC) for common mental disorders in primary healthcare in Peshawar, Pakistan. Trial registration ACTRN12614001235695 (anzctr.org.au).MethodWe randomly allocated 346 participants to either PM+ (n = 172) or EUC (n = 174). Effectiveness was measured using the Hospital Anxiety and Depression Scale (HADS) at 3 months post-intervention. Cost-effectiveness analysis was performed as incremental costs (measured in Pakistani rupees, PKR) per unit change in anxiety, depression and functioning scores.ResultsThe total cost of delivering PM+ per participant was estimated at PKR 16 967 (US$163.14) using an international trainer and supervisor, and PKR 3645 (US$35.04) employing a local trainer. The mean cost per unit score improvement in anxiety and depression symptoms on the HADS was PKR 2957 (95% CI 2262–4029) (US$28) with an international trainer/supervisor and PKR 588 (95% CI 434–820) (US$6) with a local trainer/supervisor. The mean incremental cost-effectiveness ratio (ICER) to successfully treat a case of depression (PHQ-9 ≥ 10) using an international supervisor was PKR 53 770 (95% CI 39 394–77 399) (US$517), compared with PKR 10 705 (95% CI 7731–15 627) (US$102.93) using a local supervisor.ConclusionsThe PM+ intervention was more effective but also more costly than EUC in reducing symptoms of anxiety, depression and improving functioning in adults impaired by psychological distress in a post-conflict setting of Pakistan.

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Mohammad Shoaib Hamrah ◽  
Mohammad Hassan Hamrah ◽  
Hideki Ishii ◽  
Susumu Suzuki ◽  
Mohammad Hussain Hamrah ◽  
...  

There is a relationship between mental and physical health. Depression and anxiety are linked with the development of several chronic diseases. The purpose of the present study was to determine the prevalence and factors associated with anxiety and depression among adult hypertensive outpatients in Afghanistan. Methods. Two hundred thirty-four consecutive hypertensive patients from December 2015 to August 2016 were recruited to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, which has scores for classifying the participants having anxiety and depression symptoms. Results. Of the total 234 patients, 81 (34.6%) were males and 153 (65.4%) were females. The mean age was 54.6±12.7 for the hypertensive patients with anxiety and 63.8±15.0 for the hypertensive patients with depression while this figure was 49.5±10.2 for the adult participants in general population in Kabul city (Saeed, 2013). The prevalence of anxiety and depression (42.3% vs. 58.1%) among hypertensive persons is compared with the same mental disorders among Afghan refugees (39.3% vs. 22.1%) in Dalakee Refugee Camp (in Iran) (Hosseini Divkolaye and Burkle, 2017). Of the total participants, 99 had anxiety (42.3%), 136 had depression (58.1%), and 66 had (28.2%) comorbid anxiety-depression. Multivariate analysis was used. For anxiety age, female gender, smoking, diabetes mellitus, and 2 or more chronic diseases had a significant association. For depression, age and diabetes mellitus had a significant association, and for comorbid anxiety, depression, age, diabetes mellitus, and 2 or more chronic diseases had a significant association. Conclusion. This study shows that anxiety and depression are highly prevalent among hypertensive patients in an outpatient clinic in Afghanistan. There was an association between some sociodemographic and clinical characteristics and anxiety and depression. More studies are needed on a national level to inform the development of strategies for the prevention and control of psychological distress among patients with chronic diseases in Afghanistan.


2020 ◽  
Author(s):  
Mingtai Chen ◽  
Yingnan Chen ◽  
Ling Men ◽  
Xiaoling Zhong ◽  
Shudong Yang ◽  
...  

Abstract Backgroud: It’s known that coronary heart disease (CHD) patients after percutaneous coronary intervention (PCI) was significantly associated with anxiety and depression symptoms. Several studies have showed that Xinkeshu tablet (XKS), a kind of Chinese herbal medicine (CHM) , could effectively improve post-PCI postoperative mood disorders in CHD patients. However, the intensity of evidence has been poor, limiting the further clinical application of XKS to patients above. This systematic review and meta-analysis will assess studies of the effectiveness and safety of XKS in CHD patients with anxiety and depression symptoms after PCI. Methods: A systematic literature search for articles up to July 2020 will be performed in following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM), Chinese Biomedical Literature Service System (SinoMed) and Wanfang Database. Inclusion criteria are randomized controlled trials of XKS applied on patients with CHD and depression. The primary outcome measures will be CHD-related clinical evaluation (frequency of acute attack angina, severity of angina pectoris, electrocardiographic changes, amount of nitroglycerin) and the scores or reducing fractions of depressive and anxiety measuring scales (the Hospital Anxiety / Depression Scale or other widely used anxiety / depression scale). The safety outcome measures will be adverse events, liver and kidney function. RevMan 5.3 software will be used for data synthesis, sensitivity analysis, subgroup analysis and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata 12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of evidence. Discussion: This study will provide a high-quality synthesis of the effects and safety of XKS for CHD patients with anxiety and depression symptoms after PCI. Ethics and dissemination This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal. Trial registration number PROSPERO CRD42019131346.


2003 ◽  
Vol 21 (7) ◽  
pp. 1249-1254 ◽  
Author(s):  
Sophie D. Fosså ◽  
Alv A. Dahl ◽  
Jon H. Loge

Purpose: To investigate the prevalence of chronic fatigue (CF), the levels of anxiety and depression, and the correlation between these conditions in long-term survivors of testicular cancer (TCSs). Occurrence of CF in TCSs is compared with findings in male survivors of Hodgkin’s disease (HDSs) and in males from the general population (GenPop). Methods: TCSs, HDSs, and two cohorts of the GenPop completed the Fatigue Questionnaire (FQ) and the Hospital Anxiety and Depression Scale (HADS) as part of a questionnaire survey. Cases of CF were identified according to published cut-offs, and the levels of anxiety (HADS-A) and depression (HADS-D) were calculated. Results: Among 791 TCSs, 16% displayed CF (HDSs, 24%; GenPop, 10%). In the age group younger than 30 years, the prevalence of CF was higher in TCSs than in the GenPop (P <.01). In TCSs, age, anxiety, depression, and comorbidity were independent predictors of CF. The mean HADS-A score in TCSs was significantly above the comparable figure of the GenPop and similar to that of HDSs. The mean HADS-D score in TCSs was below that of the GenPop. The highest and lowest mean scores of HADS-A and HADS-D were observed in the youngest TCSs. Conclusion: The prevalence of CF is less in TCSs than in HDSs but exceeds that of the GenPop. Together with comorbidity and age, anxiety and depression predict CF in TCSs, warranting psychiatric intervention for cases of CF among TCSs. Anxiety is a larger problem in TCSs than depression, particularly among the youngest TCSs.


2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Bing Han ◽  
Bo Yan ◽  
Jian Zhang ◽  
Na Zhao ◽  
Jinkai Sun ◽  
...  

The improvement of social support promotes the mental health and improves the health status. The study aimed to examine the influence of the social support on symptoms of anxiety and depression among patients with silicosis and provide the scientific basis to further alleviate anxiety and depression and to monitor their whole quality of life. We investigated 324 inpatients with silicosis between April 2011 and September 2011. The HADS (the Hospital Anxiety-Depression Scale) was the major methodology used to evaluate anxiety and depression, and the MSPSS (the Multidimensional Scale of Perceived Social Support) to evaluate the social support level. Among patients with silicosis, 99.1% had anxiety symptoms, and 86.1% had depression symptoms. Meanwhile, the social support significantly influenced symptoms of anxiety and depression. The study suggested that patients with silicosis presented more anxiety and depression symptoms, while the social support levels of the patients were relatively low. The influence of social support on symptoms of anxiety and depression among patients with silicosis implied that improving the level of social support and the effective symptomatic treatment might alleviate anxiety and depression symptoms and improve physical and mental status.


Author(s):  
Isabela Gonzales Carvalho ◽  
Eduarda dos Santos Bertolli ◽  
Luciana Paiva ◽  
Lidia Aparecida Rossi ◽  
Rosana Aparecida Spadoti Dantas ◽  
...  

ABSTRACT Objectives: to analyze the relationship between anxiety and depression symptoms, resilience and self-esteem with sociodemographic and clinical characteristics; correlate resilience and self-esteem with age and duration of the disease; check associations between anxiety and depression with measures of resilience and self-esteem among individuals with cardiovascular diseases. Method: correlational study conducted in a large university hospital in the interior of the state of São Paulo, Brazil. The population was composed of adult inpatients with cardiovascular diseases. A non-probabilistic consecutive sample was composed of 120 patients. Variables of interest were assessed using the Hospital Anxiety and Depression Scale, Resilience Scale, and Rosenberg Self-Esteem Scale. Results: anxiety and depression symptoms were present in 32.5% and 17.5% of the patients, respectively, and were associated with the female sex (p = 0.002; p = 0.022). Manifestations of depression were associated with the presence of comorbidities (p = 0.020). More resilient patients did not present depression symptoms (p < 0.001) and anxious women were more resilient (p = 0.042). The highest scores regarding self-esteem were present in patients with anxiety and depression. Men presented higher resilience and lower self-esteem compared to women. Conclusion: patients with anxiety and depression were less resilient but presented higher self-esteem.


Medicina ◽  
2019 ◽  
Vol 55 (5) ◽  
pp. 168 ◽  
Author(s):  
Georgia Gerogianni ◽  
Maria Polikandrioti ◽  
Fotoula Babatsikou ◽  
Sofia Zyga ◽  
Victoria Alikari ◽  
...  

Background and Objectives: Anxiety–depression of patients undergoing hemodialysis has a strong relation with the levels of anxiety–depression of their caregivers. The aim of this study was to evaluate anxiety–depression of dialysis patients and their caregivers. Materials and Methods: In this cross-sectional study, 414 pairs of patients and caregivers from 24 hemodialysis centers of Greece completed the Hospital Anxiety and Depression Scale (HADS). The statistical analysis of the data was performed through the Statistical Program SPSS version 20.0. The statistical significance level was set up at 5%. Results: The mean age of patients was 64 (54.06–72.41) years old and the mean duration of hemodialysis was 36 (16–72) months. The mean age of caregivers was 54 (44–66) years old. Of the total sample, 17.1% (n = 71) of patients had high levels of anxiety and 12.3% (n = 51) had high levels of depression. Additionally, 27.8% (n = 115) of caregivers had high levels of anxiety and 11.4% (n = 47) had high levels of depression. Caregivers had higher levels of anxiety when their patients had high levels of anxiety as well (42.3%). Additionally, they had higher levels of depression when their patients had high levels of depression as well (17.6%). Conclusions: The results of this study showed a significant association between the levels of anxiety and depression among patients and caregivers. There is a necessity for individualized assessment of dialysis patients and their caregivers and the implementation of specific interventions for reducing the levels of anxiety and depression among them.


2020 ◽  
Author(s):  
Rajan Shrestha ◽  
Bijay Khatri ◽  
Suman Ranjitkar ◽  
Santoshi Adhikari

Abstract BackgroundCOVID-19 is an infectious disease caused by a newly discovered coronavirus that is pandemic, with more than 338 thousand cases worldwide. Geometrically increasing numbers of cases and deaths from COVID 19 in the world, both medical staff and the public have been experiencing psychological problems, including anxiety, depression, and stress, which can cause disability and functional impairment of the individual. One of the most stressful situations is the unpredictability of the situation and the uncertainty of when to control the disease and the seriousness of the risk. These challenges and stress can trigger a common mental disorder. This study aimed to determine the burden of stress anxiety and depression among all employees of Eye and ENT hospitals.MethodologyA hospital-based cross-sectional study was carried out among all the employees of Hospital for Children Eye ENT and Rehabilitation Services Bhaktapur during the COVID-19 pandemic lockdown using an online self-administered questionnaire through Google forms. The tools were adopted from Hospital Anxiety and Depression scale (HADS) Nepali version on a Likert's scale of 0 to 3 validated by Risal A. et al. and WHO Disability Assessment Schedule (WHODAS S2.0) on a Likert's scale of 1 to 5 to assess functional impairment.ResultsThe mean age (SD) of the participants (n=86) was 32.53 (7.92) years. Male and female participants was equal in number. The point prevalence of anxiety and depression was 25.6% and 14.0%, respectively. Females had a higher prevalence of both anxiety (39.5% vs 11.6%, p<0.01) and depression (18.6% vs 9.3%, p=0.351). The mean (SD) anxiety, depression and functional impairment scores were 7.27 (4.621), 5.13 (4.023) and 19.47 (6.228), respectively. Females had a very strong association with both anxiety (AOR=5.008 (95% CI; 1.593-15.741)) and depression (AOR=2.173 (95% CI; 0.599-7.882)). Married participants had a positive association with anxiety (AOR 4.379 (95% CI; 1.121-17.106)) and depression (AOR 1.542 (95% CI; 0.379-6.276)). Clinical and supporting staff both had a higher prevalence of both anxiety (31.0% and 20.5%, p=0.265) and depression (16.7% and 11.4%, p=0.478). The mean 12-item WHO disability assessment schedule score (WHODAS 2.0) among all participants and participants with anxiety and depression was 19.47 (95% CI: 18.13-20.80), 21.27 (95% CI: 18.08-24.46) and 19.92 (15.28-24.56), respectively. The life activities domain of WHODAS 2.0 was significantly higher in participants with anxiety (1.91 vs 1.56, p<0.01) and depression (1.75 vs 1.63, p<0.001) than in those without anxiety.ConclusionAnxiety and depression during COVID-19 pandemic lockdown were highly prevalent both in clinical and non-clinical employees, causing mild to moderate functional impairment.


2021 ◽  
Vol 12 ◽  
Author(s):  
Rodrigo Rocamora ◽  
Beatriz Chavarría ◽  
Eva Pérez ◽  
Carmen Pérez-Enríquez ◽  
Ainara Barguilla ◽  
...  

Introduction: The overall combined prevalence of anxiety and depression in patients with epilepsy has been estimated at 20.2 and 22.9%, respectively, and is considered more severe in drug-refractory epilepsy. Patients admitted to epilepsy monitoring units constitute a particular group. Also, patients with psychogenic non-epileptic seizures can reach more than 20% of all admissions. This study aims to characterize these symptoms in a large cohort of patients admitted for evaluation in a tertiary epilepsy center.Materials and Methods: The study was conducted among 493 consecutive patients (age: 38.78 ± 12.7, 57% females) admitted for long-term video EEG from January 2013 to February 2021. Demographic, clinical, and mood disorder patients' data were collected. Anxiety and depression symptoms were assessed through the Hospital Anxiety Depression Scale (HADS-A and HADS-D), the State Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Quality of life was determined using the QOLIE-10. Patients were divided into three groups: patients with epilepsy (n = 395), psychogenic non-epileptic seizures (PNES) (n = 56), and combined (n = 33). A univariate and multivariate regression analysis was performed for variables associated with quality of life.Results: Of 493 patients, 45.0% had structural etiology, and considering epilepsy classification, 43.6% were of temporal lobe origin. In addition, 32.45% of patients had a previous psychiatric history, 49.9% of patients had depressive symptoms in BDI, and 30.9% according to HADS-D; 56.42 and 52.63% of patients presented pathological anxiety scores in STAI-T and STAI-S, respectively; and 44.78% according to HADS-A. PNES and combined groups revealed a higher incidence of pathologic BDI scores (64.29 and 78.79%, p &lt; 0.001) as well as pathologic HADS-A scores (p = 0.001). Anxiety and depression pathologic results are more prevalent in females, HADS-A (females = 50.7%, males = 36.8%; p = 0.0027) and BDI &gt; 13 (females = 56.6%, males = 41.0%; p = 0.0006). QOLIE-10 showed that 71% of the patients had their quality of life affected with significantly higher scores in the combined group than in the epilepsy and PNES groups (p = 0.0015).Conclusions: Subjective anxiety, depression, and reduced quality of life are highly prevalent in patients with refractory epilepsy. These symptoms are more evident when PNES are associated with epilepsy and more severe among female patients. Most of the cases were not previously diagnosed. These factors should be considered in everyday clinical practice, and specific approaches might be adapted depending on the patient's profile.


2018 ◽  
Vol 9 (2) ◽  
pp. 63
Author(s):  
Anil Kumar Roy ◽  
Nilesh Maruti Gujar ◽  
Arif Ali ◽  
Utpal Borah

Background: Studies have shown that caregivers of the persons with the neurological illness have high levels of psychological distress, depression and caregiver’s burden. The aim of the study was to find out anxiety, depression and caregiver’s burden among the caregivers of persons with neurological illness (PWNI). Method: Thirty caregivers of PWNI attending the Centre of Rehabilitation Sciences, LGB Regional Institute of Mental Health, Tezpur, Assam were selected using purposive sampling technique for the present study. Socio-demographic and clinical data sheet, Zarit Burden Interview Scale and The Hospital Anxiety and Depression Scale were used. Results: The results shown that in Hospital Anxiety and Depression Scale, 26.6% of the caregivers' scores were in the abnormal range in the domain of depression. While in the domain of anxiety, 16.6% scored in the abnormal range. In Zarit Burden of Scale, 13.3% of the caregivers were having little or no burden, 26.6% of the caregivers were having mild to moderate level of burden, 20% were having moderate to severe burden and 30% were having a severe burden of care. Care burden has significant positive correlation with depression (r= .124, p≤ 0.01 and anxiety (r= .124, p≤ 0.05). Conclusion: Caregivers of PWNI have been found to be at higher risk of mental health problems and care burden. The importance of addressing the burden of caregivers involved in the care of PWNI need to be taken into consideration while providing treatment and rehabilitation of PWNI.     Keywords: Anxiety, depression, burden, neurological illness


Author(s):  
Beata Dziedzic ◽  
Paulina Sarwa ◽  
Ewa Kobos ◽  
Zofia Sienkiewicz ◽  
Anna Idzik ◽  
...  

Introduction: Having impaired relations and limited interpersonal contact is associated with a sense of loneliness, and can result in a number of mental disorders, including the development of depression. Approximately one in five adolescents in the world suffers from depression, and first episodes of such are occurring at increasingly young ages. Due to a lack of appropriate support from parents, teachers and the healthcare system, the young person feels alone when dealing with their problem. Aims: The aims of this study are to determine the prevalence of anxiety, depression, aggression and sense of loneliness among high school students, and to analyze a correlation between loneliness and depression. Materials and methods: The study was conducted on 300 high school students in Poland. The study material was collected using the Hospital Anxiety and Depression Scale (HADS-M) and De Jong Gierveld Loneliness Scale (DJGLS). Results: A feeling of loneliness correlated significantly with depressive disorders (p < 0.005), with the strongest effect between the total HADS-M score and the total loneliness scale score (r = 0.61). The overall presence of disorders as per HADS-M was found to be 23%, and borderline conditions were found in 19.3%. In 24% of the students, disorders were revealed on the anxiety subscale and in 46.3% on the aggression subscale. On DJGLS, a very severe sense of loneliness was observed in 6.67% of the subjects, and in 42.3% of them, a moderate feeling of loneliness was indicated. On the social loneliness subscale, a severe sense of loneliness was found in 22.7%, while on the emotional loneliness subscale, it was found in 16.7% of the subjects. Conclusions: In this study, a quarter of the student participants experienced anxiety and depression disorders. Students showing higher levels of anxiety, depression, and aggression also showed enhanced loneliness. Girls showed higher levels of anxiety, depression and aggression, as well as emotional loneliness.


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