The influence of anxiety on the progression of disability.

Brenes GA, Guralnik JM, Williamson JD, Fried LP, Simpson C, Simonsick EM, Penninx BW.

Department of Psychiatry and Behavioral Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina 25157, USA. gbrenes wfubmc.edu <gbrenes wfubmc.edu>

OBJECTIVES: To determine the influence of anxiety on the progression of disability and examine possible mediators of the relationship. DESIGN: Community-based observational study. SETTING: Women's Health and Aging Study I, a prospective observational study with assessments every 6 months for 3 years. PARTICIPANTS: One thousand two functionally limited women aged 65 and older. MEASUREMENTS: Anxiety symptoms were assessed using four questions from the Hopkins Symptom Checklist (nervous or shaky, avoidance of certain things, tense or keyed up, fearful). Participants who reported experiencing two or more of these symptoms at baseline were considered anxious. Anxiety as a predictor of the onset of four types of disability was examined using Cox proportional hazards models. Three models were tested: an unadjusted model, a model adjusted for confounding variables (age, race, vision, number of diseases, physical performance, depressive symptoms), and a mediational model (benzodiazepine and psychotropic medication use, physical activity, emotional support). RESULTS: Nineteen percent of women reported two or more symptoms of anxiety at baseline. Unadjusted models indicate that anxiety was associated with a greater risk of worsening disability: activity of daily living (ADL) disability (relative risk (RR)=1.40, 95% confidence interval (CI)=1.10-1.79), mobility disability (RR=1.41, 95% CI=1.06-1.86), lifting disability (RR=1.54, 95% CI=1.20-1.97), and light housework disability (RR=1.77, 95% CI=1.32-2.37). After adjusting for confounding variables, anxiety continued to predict the development of two types of disability: ADL disability (RR=1.41, 95% CI=1.08-1.84) and light housework disability (RR=1.56, 95% CI=1.14-2.14). Finally, benzodiazepine and psychotropic medication use, physical activity, and emotional support were not significant mediators of the effect of anxiety on the development of a disability. CONCLUSION: Anxiety is a significant risk factor for the progression of disability in older women. Studies are needed to determine whether treatment of anxiety delays or prevents disability.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15667373&dopt=Abstract anxiety medicine




Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn's and Colitis Foundation of America.

Shepanski MA, Hurd LB, Culton K, Markowitz JE, Mamula P, Baldassano RN.

Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. shepanski email.chop.edu

PURPOSE: To describe the reported health-related quality of life (HRQOL) in children and adolescents with inflammatory bowel disease (IBD) after attending an IBD summer camp. METHODS: A prospective analysis of quality of life was completed at an overnight camp that was exclusively for patients with IBD, which was sponsored by the Crohn's and Colitis Foundation of America. The IMPACT-II questionnaire (Canada and United States) and the State-Trait Anxiety Inventory for Children were administered to the campers at the beginning and at the end of a 1-week camp to assess HRQOL and anxiety. The IMPACT-II questionnaire consists of 35 questions measuring 6 quality-of-life domains (i.e., bowel domain, systemic symptoms, emotional functioning, social functioning, body image, and treatment/interventions). The State-Trait Anxiety Inventory for Children consists of 2 different 20-item sets of questions. One set assesses state anxiety, and the other, trait anxiety. A repeated-measures multivariate analysis of variance was performed to determine the differences between scores attained before and after camp on the IMPACT-II questionnaire and in each of its domains. Paired sample t tests were performed on state and trait anxiety before and after camp. RESULTS: A total of 125 individuals consented to participate, but 61 patients (50 girls and 11 boys; age range, 9 to 16 y) completed the IMPACT-II questionnaire in full. Of those 61 patients, 47 had Crohn's disease and 14 had ulcerative colitis. There was statistically significant improvement between the mean (+/-SD) precamp total score (172.95 +/- 36.61) and the mean postcamp total score (178.71 +/- 40.97; P = 0.035), bowel symptoms scores (P = 0.036), social functioning scores (P = 0.022), and treatment interventions scores (P = 0.012). No difference was found between anxiety scores before and after camp on either the state or trait anxiety inventories (n = 55; P > 0.05). CONCLUSIONS: Overall, HRQOL improved in children after attending IBD summer camp. This exploratory study suggests that contributing factors for these improvements may be an increase in social functioning, a better acceptance of IBD symptoms, and less distress regarding treatment interventions, suggesting that a camp that is specifically designed for children with IBD may normalize the chronic illness experience. However, future research using a multimodal measurement approach is warranted to support these conclusions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15677910&dopt=Abstract anxiety medicine




[Nursing undergraduates' anxiety about the first surgical instrumentation]

[Article in Portuguese]

Carvalho R, Farah OG, Galdeano LE.

Faculdade de Enfermagem, Hospital Israelita Albert Einstein, Universidade Paulista. rachel einstein.br

This study aimed to identify nursing undergraduates' anxiety about the first surgical instrumentation. The sample consisted of 30 sixth-period students who were enrolled in the subject surgical nursing. Data were collected through the STAI (State-Trait Anxiety Inventory). We identified that 90% of the students demonstrated low levels of trait anxiety. As to state anxiety, the most frequent observations were: low anxiety level on the first day of theoretical class (76.7%). medium anxiety level at the lab (53%) and medium anxiety level during supervised training (80%). Furthermore, we identified a small number of students with high anxiety levels. The statistical analysis shows significant differences among the mean levels of state-anxiety during the three data collection phases.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15678219&dopt=Abstract anxiety medicine




Anxiety symptoms and disorders at eight weeks postpartum.

Wenzel A, Haugen EN, Jackson LC, Brendle JR.

Department of Psychology, University of North Dakota, Grand Forks, ND 58202-8380, USA.

Although the prevalence, risk factors for, and consequences of postpartum depression have been studied extensively, little work has examined the nature of postpartum anxiety disorders in community samples. In the present study, 147 community women completed a diagnostic interview and a battery of self-report inventories approximately eight weeks after childbirth. The rate of generalized anxiety disorder was elevated as compared to the rate in women representative of the general population. Depending on the particular domain of anxiety being considered, 10-50% of women reporting anxiety symptoms endorsed comorbid depressive symptoms. In hierarchical multiple regression analyses, different combinations of demographic and vulnerability variables predicted symptoms of somatic anxiety, social anxiety, and depression, although there were no significant predictors of worry symptoms. In addition, number of children, depression, and social anxiety predicted postpartum relationship distress. These results suggest that postpartum anxiety disorders are more common than postpartum depression and worthy of systematic study.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15686858&dopt=Abstract anxiety medicine




Assessment of anxiety and quality of life in fibromyalgia patients.

Pagano T, Matsutani LA, Ferreira EA, Marques AP, Pereira CA.

Rheumatology clinic, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. tathipag yahoo.com.br

CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients' quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE OF STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clinicas (Medical School, Universidade de Sao Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student's t test and Pearson's correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15692719&dopt=Abstract anxiety medicine




Regular dental visits and dental anxiety in an adult dentate population.

Sohn W, Ismail AI.

Department of Cariology, Restorative Sciences & Endodontics, School of Dentistry, University of Michigan, Ann Arbor 48109-1078, USA. woosung umich.edu

BACKGROUND: The objective of this study was to investigate factors associated with regular dental visits in an adult population. METHODS: A representative sample of non-institutionalized dentate adults (aged 18 through 69 years) from the Detroit tricounty area (Wayne, Macomb and Oakland counties) was randomly selected using list-assisted random digit dialing. The authors collected the data through a self-administered questionnaire that asked for information about regular dental visits, private dental insurance, perceived oral health status and dental treatment experience. The authors used Corah's Dental Anxiety Scale to measure respondents' dental anxiety level. They also conducted a descriptive analysis and a logistic regression analysis. RESULTS: A final sample of 630 adults who resided in 368 households participated in this study. Seventy-two percent of respondents had dental insurance (excluding Medicaid). About 63 percent reported that they visited a dentist regularly. About 12 percent of adults had high dental anxiety (a score of 13 or higher on the Corah scale). A logistic regression model found that dental anxiety, dental insurance status and perceived oral health status were significantly associated with regular dental visits after accounting for sociodemographic factors such as sex, age and income. Among those who had dental insurance, dentally anxious adults were significantly less likely to visit dentists regularly. However, this association was not significant among respondents without dental insurance. CONCLUSION: Dental insurance, perceived oral health status and dental anxiety were associated with regular dental visits. Dental anxiety was an influencing factor in regular dental visit behavior, especially among adults who had private dental insurance. CLINICAL IMPLICATIONS: Practitioners need to be educated about the causes of dental anxiety and receive training in how to treat the problem.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15693497&dopt=Abstract anxiety medicine




Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease.

Bonnet F, Irving K, Terra JL, Nony P, Berthezene F, Moulin P.

Department of Medicine, Unit 11, Cardiovascular Hospital Louis Pradel, 69394 Lyon, France. fab.so.bonnet free.fr

Adherence to lifestyle recommendations for prevention of cardiovascular disease remains a critical issue. We examined the association of anxiety and depression with healthy behaviors in a large population of subjects at risk of cardiovascular disease. We studied 1612 consecutive subjects referred for evaluation of cardiovascular risk factors. Separated scores reflecting unhealthy behaviors (physical inactivity, smoking and poor diet) were combined to produce a global unhealthy lifestyle score. The Hospital Anxiety and Depression scale (HAD) was used to assess both anxiety and depression. Both anxiety and depression were significantly associated with physical inactivity in both sexes and with an unhealthy diet in men but not in women. Anxiety and depression were both significantly correlated to smoking habits in men whereas only depression was related to smoking in women. In both sexes, the global score reflecting unhealthy lifestyles was positively associated with the degree of anxiety and depression. In multivariate analysis, both anxiety and depression appeared as independent determinant of unhealthy lifestyle in both sexes, with a stronger influence for depression. Depression and to a lesser extent anxiety are associated with a cluster of unhealthy behaviors in subjects at risk of cardiovascular disease, suggesting the difficulty of modifying lifestyle in patients with anxious-depressive disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15694943&dopt=Abstract anxiety medicine




Depression and anxiety in women with early breast cancer: five year observational cohort study.

Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A.

Cancer Research UK London Psychosocial Group, Institute of Psychiatry, King's College London, St Thomas's Hospital, London SE1 7EH.

OBJECTIVE: To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis. DESIGN: Observational cohort study. SETTING: NHS breast clinic, London. PARTICIPANTS: 222 women with early breast cancer: 170 (77%) provided complete interview data up to either five years after diagnosis or recurrence. MAIN OUTCOME MEASURES: Prevalence of clinically important depression and anxiety (structured psychiatric interview with standardised diagnostic criteria) and clinical and patient risk factors, including stressful life experiences (Bedford College life events and difficulties schedule). RESULTS: Nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. Point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis. Previous psychological treatment predicted depression, anxiety, or both in the period around diagnosis (one month before diagnosis to four months after diagnosis). Longer term depression and anxiety, were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Clinical factors were not associated with depression and anxiety, at any time. Lack of intimate confiding support also predicted more protracted episodes of depression and anxiety. CONCLUSION: Increased levels of depression, anxiety, or both in the first year after a diagnosis of early breast cancer highlight the need for dedicated service provision during this time. Psychological interventions for women with breast cancer who remain disease free should take account of the broader social context in which the cancer occurs, with a focus on improving social support.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15695497&dopt=Abstract anxiety medicine




The structure of genetic and environmental risk factors for anxiety disorders in men and women.

Hettema JM, Prescott CA, Myers JM, Neale MC, Kendler KS.

Virginia Institute for Psychiatry and Behavioral Genetics and Department of Psychiatry, Virginia Commonwealth University, Richmond, USA. jhettema hsc.vcu.edu <jhettema hsc.vcu.edu>

BACKGROUND: The anxiety disorders exhibit high levels of lifetime comorbidity with one another. Understanding the underlying causes of this comorbidity can provide insight into the etiology of the disorders and inform classification and treatment. OBJECTIVE: To explain anxiety disorder comorbidity by examining the structure of the underlying genetic and environmental risk factors. DESIGN: Lifetime diagnoses for 6 anxiety disorders (generalized anxiety disorder, panic disorder, agoraphobia, social phobia, animal phobia, and situational phobia) were obtained during personal interviews from a population-based twin registry. Multivariate structural equation modeling that allowed for sex differences was performed. SETTING: General community sample. PARTICIPANTS: More than 5000 members of male-male and female-female twin pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. MAIN OUTCOME MEASURES: Parameter estimates for best-fitting model. RESULTS: The full model, which contained 2 common genetic, shared environmental, and unique environmental factors plus disorder-specific factors, could be constrained to equality across male and female study participants. In the best-fitting model, the genetic influences on anxiety were best explained by 2 additive genetic factors common across the disorders. The first loaded most strongly in generalized anxiety disorder, panic disorder, and agoraphobia, whereas the second loaded primarily in the 2 specific phobias. Social phobia was intermediate in that it was influenced by both genetic factors. A small role for shared environmental influences was observed owing to a single common factor that accounted for less than 12% of the total variance for any disorder. Unique environmental influences could be explained by a single common factor plus disorder-specific effects. CONCLUSIONS: The underlying structure of the genetic and environmental risk factors for the anxiety disorders is similar between men and women. Genes predispose to 2 broad groups of disorders dichotomized as panic-generalized-agoraphobic anxiety vs the specific phobias. The remaining associations between the disorders are largely explained by a unique environmental factor shared across the disorders and, to a lesser extent, a common shared environmental factor.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15699295&dopt=Abstract anxiety medicine