Preoperative anxiety in children. Predictors and outcomes.

Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV.

Department of Anesthesiology, Yale University School of Medicine, New Haven, Conn, USA.

OBJECTIVE: To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery. DESIGN: A prospective, longitudinal study. SETTING: A university children's hospital. PARTICIPANTS: One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery. MAIN OUTCOME MEASURES: In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year). RESULTS: A multiple regression model (R2 = 0.58, F = 6.4, P = .007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R2 = 0.42, F = 8.6, P = .001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems. CONCLUSIONS: Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8953995&dopt=Abstract anxiety medicine




Psychological long-term effects of sterilization on anxiety and depression.

Luo L, Wu SZ, Zhu C, Fan Q, Liu K, Sun G.

Sichuan Family Planning Research Institute, Chengdu, China.

Two-thousand cases (500 women and 500 men with sterilization; 500 women and 500 men without sterilization) in two counties and two cities in Sichuan, China, were investigated between 15 September 1992 and 30 April 1993. Information was obtained about their age, parity, marriage, contraceptives, social behavior, and present psychological characteristics. CES-D, SAS, and E.P.Q. scales were used to assess the depressive symptomatology, anxiety, and personality of the subjects. The results revealed that sterilization psychologically affected the depressive symptoms and anxiety under the neutral personality. In addition, depressive symptoms and anxiety were related to the subjects' age, educational level, income, operative doctors' attitudes to sterilization acceptors, and subjects' understanding of the sterilization.

PIP: A comparative study conducted in two counties and two cities in China's Sichuan province indicated that surgical sterilization may have long-term psychological effects. Subjects included 500 men 40-44 years of age and 500 women 35-39 years of age who underwent vasectomy or tubectomy 5 years prior to the study; 500 non-sterilized men and 500 non-sterilized women from the same site, in the same age groups, and with the same number of children were recruited as controls. Three scales measuring personality, anxiety, and depression were administered. All eight indicators of depression were significantly higher among sterilized men and women. The risk for depression was 2.34 times greater after tubal ligation and 3.97 times greater after vasectomy. Similarly, all 10 indicators of anxiety were significantly higher among sterilized subjects. The risk for anxiety was 2.88 times greater after tubal ligation and 4.79 times greater after vasectomy. The subjects' personality type did not affect their psychological disorders. In general, sterilization acceptors of relatively older ages, higher levels of education, and higher incomes were more likely to report depression and anxiety. Depression and anxiety were also associated with a lack of adequate rest after the sterilization procedure and poor communication skills on the part of the sterilization provider. These findings suggest a need for careful pre-sterilization counseling and education as well as the option of psychotherapy for those who have undergone the procedure.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8968663&dopt=Abstract anxiety medicine




Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness?

Addolorato G, Stefanini GF, Capristo E, Caputo F, Gasbarrini A, Gasbarrini G.

Institute of Internal Medicine, Universita' Cattolica del Sacro Cuore, Rome.

BACKGROUND/AIMS: Psychiatric illness and psychological behavioral pathologies may be present in celiac disease and in IBD patients. In these subjects anxiety and depression could be a main cause in the reduction of the compliance to the treatment. Aim of our study was to carry out a psychometric evaluation using appropriate means to determine the level of anxiety and depression and to distinguish between "state" and "trait" forms. The correction of such disturbances would improve the quality of life and the patients' compliance to treatment. MATERIAL AND METHODS: Sixteen adult celiac patients, 16 subjects affected by IBD and 16 healthy control subjects matched for sex, residence and marital status were studied by psychological assessment. All the subjects were given the State and Trait Anxiety Inventory and the Ipat Depression Scale Questionnaire. RESULTS: State anxiety was present in a higher percentage of celiac subjects and in the patients affected by IBD with respect to the healthy controls. Anxiety as a trait was present in a similar percentage in all the subjects evaluated. Depressive syndrome was present in a percentage of celiac patients statistically superior versus the healthy control group (p < 0.01). CONCLUSION: Our results shown that anxiety is present as a "reactive" form and personality trait anxiety has no effect in celiac and IBD patients. As regard depression, our data confirm a possible linkage between brain functions and malabsorption.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8975957&dopt=Abstract anxiety medicine




The assessment of anxiety and fear in persons with chronic pain: a comparison of instruments.

McCracken LM, Gross RT, Aikens J, Carnrike CL Jr.

Department of Psychiatry, University of Chicago, IL 60637, USA.

Instruments used to study anxiety and fear responses related to chronic pain vary along two dimensions. They differ in terms of the stimuli or situations that evoke anxiety responses and the types of anxiety responses included (i.e. cognitive, motoric, and physiological). This study examined relations of variables from the Pain Anxiety Symptoms Scale (PASS), the Fear-Avoidance Beliefs Questionnaire (FABQ), the Fear of Pain Questionnaire (FPQ), and the trait version of the Spielberger State-Trait Anxiety Inventory (STAI) with variables related to pain severity, perceived disability, and pain behavior. Subjects were 45 consecutive referrals to a university pain clinic who completed these measures during their evaluation. Results suggested that anxiety responses directly related to the patient's particular pain sensations are more relevant to the understanding of chronic pain than are more general tendencies to respond anxiously or fear more varied pain stimuli. Regression analyses showed that empirically selected subsets of the anxiety variables predict from 16 to 54% of the variance in pain severity, disability and pain behavior. Also, assessment of multiple anxiety response types appears useful for understanding pain behavior and disability. Further study of fear and anxiety responses of persons with pain is likely to benefit from careful selection of measures dependent on the stimulus and response dimensions assessed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8990544&dopt=Abstract anxiety medicine




Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.

Jonas BS, Franks P, Ingram DD.

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md, USA.

OBJECTIVE: To test the hypothesis that symptoms of anxiety and depression increase the risk of experiencing hypertension, using the National Health and Nutrition Examination I Epidemiologic Follow-up Study. DESIGN: A cohort of men and women without evidence of hypertension at baseline were followed up for 7 to 16 years. The association between 2 outcome measures (hypertension and treated hypertension) and baseline anxiety and depression was analyzed using Cox proportional hazards regression adjusting for hypertension risk factors (age; sex; education; cigarette smoking; body mass index; alcohol use; history of diabetes, stroke, or coronary heart disease; and baseline systolic blood pressure). Analyses were stratified by race and age (white persons aged 25-44 years and 45-64 years and black persons aged 25-64 years). SETTING: General community. PARTICIPANTS: A population-based sample of 2992 initially normotensive persons. MAIN OUTCOME MEASURES: Incident hypertension was defined as blood pressure of 160/95 mm Hg or more, or prescription of antihypertensive medications. Treated hypertension was defined as prescription of antihypertensive medications. RESULTS: In the multivariate models for whites aged 45 to 64 years, high anxiety (relative risk [RR], 1.82; 95% confidence interval [CI], 1.30-2.53) and high depression (RR, 1.80; 95% CI, 1.16-2.78) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 2.36; 95% CI, 1.73-3.23) and high depression (RR, 1.89; 95% CI, 1.25-2.85). For blacks aged 25 to 64 years, high anxiety (RR, 2.74; 95% CI, 1.35-5.53) and high depression (RR, 2.99; 95% CI, 1.41-6.33) remained independent predictors of incident hypertension. The risks associated with treated hypertension were also increased for high anxiety (RR, 3.24; 95% CI, 1.59-6.61) and high depression (RR, 2.92; 95% CI, 1.37-6.22). For whites aged 25 to 44 years, intermediate anxiety (RR, 1.62; 95% CI, 1.18-2.22) and intermediate depression (RR, 1.60; 95% CI, 1.17-2.17) remained independent predictors of treated hypertension only. CONCLUSION: Anxiety and depression are predictive of later incidence of hypertension and prescription treatment for hypertension.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9003169&dopt=Abstract anxiety medicine




Parental anxiety in febrile convulsions.

Shuper A, Gabbay U, Mimouni M.

Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva.

Febrile convulsions can cause extreme anxiety to parents. Factors associated with parental anxiety and its relief during and after admission of their child for simple febrile convulsions were studied by questionnaire. Of the 70 parents approached 46 responded (66%), all of whom reported feeling anxiety. Factors directly associated with parental anxiety were lack of knowledge regarding the management of seizures and the performance of a spinal tap or EEG. There was no correlation between a previous seizure in the same child or in a first-degree relative and a decrease in anxiety in the present seizure. Hospital admission of the child yielded no relief of anxiety in 27.3% and some relief in 34.1%. Staff activity was insufficient regarding parental instruction in handling the child in the event of a recurrence. About two-thirds of the parents wished to continue neurologic follow-up after discharge, and about one-half preferred that the child be treated with anticonvulsants. Our findings show that a very intensive effort is required to relieve parental anxiety after febrile convulsions. It is suggested that routine parental preventive education in this area be conducted in well-baby clinics.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9007172&dopt=Abstract anxiety medicine




Anxiety during pregnancy and fetal attachment after in-vitro fertilization conception.

McMahon CA, Ungerer JA, Beaurepaire J, Tennant C, Saunders D.

Department of Psychological Medicine, Sydney University at Royal North Shore Hospital, Australia.

The aim of this study was to compare 70 couples who had conceived by in-vitro fertilization (IVF) with 63 matched controls for the prevalence of anxiety and quality of attachment to the baby during pregnancy. Results for mothers showed no group differences using a global measure of anxiety, the Spielberger State-Trait Anxiety Inventory. However, pregnancy-specific measures revealed significantly higher levels of anxiety in IVF mothers about the survival and normality of their unborn babies, about damage to their babies during childbirth and about separating from their babies after birth. When IVF mothers were differentiated according to the number of treatment cycles, more differences in anxiety level were revealed, with most increases occurring in mothers who had experienced two or more treatment cycles. IVF fathers did not differ from controls on the global anxiety measure. No data on pregnancy-specific anxiety were available for fathers. Neither IVF mothers nor IVF fathers differed from controls on measures of attachment to the baby during pregnancy. Results are discussed in the context of the need for researchers to employ differentiated and issue-specific measures to identify concerns that may be unique to IVF couples. Clinical implications regarding the need for psychological support during pregnancy are also discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9043925&dopt=Abstract anxiety medicine




Lack of effect of laboratory-provoked anxiety on plasma homovanillic acid concentration in normal subjects.

Zemishlany Z, Davidson M.

Psychiatry Service, Bronx VA Medical Center, New York, USA.

The present study was undertaken to investigate if acute anxiety can affect plasma concentrations of homovanillic acid (pHVA). Since elevated pHVA levels have been associated with severity of schizophrenic symptoms, the results of this study will help determine if the pHVA elevations are directly related to psychosis or if anxiety is also a contributory factor. Anxiety was provoked in 10 young normal subjects by a combined paradigm of mental arithmetic task and threat of electrical shock. A significant increase in self-ratings of anxiety, blood pressure, and plasma levels of norepinephrine, 3-methoxy-4-hydroxyphenylethyleneglycol and growth hormone indicated that the paradigm used was effective in provoking anxiety; however, anxiety did not affect pHVA concentrations. The results may support the notion that increased pHVA levels in severely ill schizophrenic patients are related to the schizophrenic pathophysiology rather than to anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8871770&dopt=Abstract anxiety medicine




The study of biology as a cause of anxiety in student nurses undertaking the common foundation programme.

Nicoll L, Butler M.

Buckinghamshire College of Nursing and Midwifery, Lovelock Jones Nurse Education Centre, High Wycombe, Bucks, England.

The subject of biology was identified as a cause of anxiety amongst student nurses on the common foundation programme (CFP), both verbally and in each of the written course evaluations, at a college of nursing and midwifery in the South of England. The aim of this study was to identify the major causes of anxiety and identify methods of reducing this anxiety in the present students, as well as minimizing anxiety in those students commencing their nurse education. Action research was considered the most appropriate design for this study. Student nurse participation was encouraged throughout the study (n = 66). A modified Delphi technique was used to identify and prioritize the causes of anxiety and a student quality circles group was formed for the purpose of problem solving by the students. This stimulated some of the biology teachers to form biology sub-groups to consider the students' proposals. Many changes were implemented. A focus group data collection method was used to evaluate the effectiveness of the relevant changes for the present students. The meeting was recorded and the tape examined for relevant data. The data indicated that although the students perceive biology as a subject that causes anxiety they did acknowledge that many of the changes made by the teachers were a positive step towards reducing the anxiety. Although the results were encouraging, it is noted that to gain a true understanding of the effect of the changes, further evaluation would need to be completed. The use of triangulation may be considered more appropriate to enhance the quality of the data obtained.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8876424&dopt=Abstract anxiety medicine