Factor structure of the 28-item general health questionnaire in a sample of antenatal women.

Aderibigbe YA, Riley W, Lewin T, Gureje O.

Virginia Commonwealth University, Richmond, USA.

OBJECTIVE: The factor structure of responses to the twenty-eight-item General Health Questionnaire (GHQ-28) in a sample of 277 Nigerian antenatal women was examined. METHOD: Principal Component Analysis (PCA) and Varimax rotation were used. RESULTS: A four factor structure interpretable as social dysfunction, somatic-anxiety, depression-anxiety, and severe depression was obtained. CONCLUSION: Although the factor structure in this sample is similar to that previously reported with this instrument, the factor loadings particularly for the anxiety subscale differed. Thus, the factor structures of the GHQ may differ depending on the cultural background of the sample.

PIP: A study was undertaken to determine the factor structure of the 28-item General Health Questionnaire (which has four subscales measuring somatic symptoms, anxiety and insomnia, social dysfunction, and severe depression) in a sample of 277 Nigerian women receiving prenatal care. After the women completed the questionnaire, additional data were gathered from semistructured interviews with 106 of the subjects. Principal component analysis and varimax rotation were used to determine whether the psychopathological subsets could be identified in this sample. It was found that the factor structure of the questionnaire was similar to that found in other samples but had important differences, especially in the clustering of the somatic and anxiety symptoms into a "somatization" factor. In this study, anxiety loaded with depression items define a depression-anxiety factor. Thus, the factor structure in this population was social dysfunction, somatic-anxious, depression-anxiety, and severe depression. Based on these results and on findings reported in a Mexican study, it may prove necessary to consider alternative factor scales for use with different cultures and groups.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8976467&dopt=Abstract anxiety medicine




Anxiety among widowed elders: is it distinct from depression and grief?

Prigerson HG, Shear MK, Newsom JT, Frank E, Reynolds CF 3rd, Maciejewski PK, Houck PR, Bierhals AJ, Kupfer DJ.

Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.

The purpose of this study was to test the validity and utility of distinguishing symptoms of anxiety from those of depression and grief in recently spousally bereaved elders. We also examined pathways from baseline (six months or less post-spousal death) to follow-up (12 and 18 months post-death) levels of anxiety, depression and grief-related symptoms. Baseline and follow-up data were available from 56 recently widowed elderly subjects recruited for an investigation of physiological changes in bereavement. Confirmatory factor analyses indicated that a model in which anxiety was specified as a third factor, apart from depression and grief factors, fit the data well and significantly better than either the one or two factor models. Path analyses revealed that both baseline severity of grief and anxiety had significant lagged effects and predicted follow-up severity of depression. Symptoms of anxiety appeared distinct from those of depression and grief, and the anxiety, depression and grief factors differentially predicted subsequent symptomatology. These findings suggest a need for more specific identification and treatment of anxiety, depression and grief symptoms within the context of late-life spousal bereavement.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9160593&dopt=Abstract anxiety medicine




Childhood adversity, attachment and personality styles as predictors of anxiety among elderly caregivers.

Prigerson HG, Shear MK, Bierhals AJ, Zonarich DL, Reynolds CF 3rd.

Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pennsylvania, USA.

The purpose of this study was to examine the ways in which childhood adversity, attachment and personality styles influenced the likelihood of having an anxiety disorder among aged caregivers for terminally ill spouses. We also sought to determine how childhood adversity and attachment/personality styles jointly influenced the likelihood of developing an anxiety disorder among aged caregivers. Data were derived from semistructured interviews with 50 spouses (aged 60 and above) of terminally ill patients. The Childhood Experience of Care and Abuse (CECA) record provided retrospective, behaviorally based information on childhood adversity. Measures of attachment and personality styles were obtained from self-report questionnaires, and the Structured Clinical Interview for the DSM-III-R (SCID) was used to determine diagnoses for anxiety disorders. Logistic regression models estimated the effects of childhood adversity, attachment/personality disturbances, and the interaction between the two on the likelihood of having an anxiety disorder. Results indicated that childhood adversity and paranoid, histrionic and self-defeating styles all directly increase the odds of having an anxiety disorder as an elderly spousal caregiver. In addition, childhood adversity in conjunction with borderline, antisocial and excessively dependent styles increased the likelihood of having an anxiety disorder. The results indicate the need to investigate further the interaction between childhood experiences and current attachment/personality styles in their effects on the development of anxiety disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9160628&dopt=Abstract anxiety medicine




Anxiety, depression and worry in gastrointestinal cancer patients attending medical follow-up control visits.

Nordin K, Glimelius B, Pahlman L, Sjoden PO.

Department of Oncology, Uppsala University, Sweden.

Anxiety, depression and worry were assessed in 141 consecutive gastrointestinal cancer patients scheduled for follow-up control visits. Participants completed two questionnaires, one including the Hospital Anxiety and Depression Scale (HAD) in conjunction with the visit and one completed after. The overall levels of anxiety before, during and after the visit were low. There were no differences between those who were considered cured and those who were not. Anxiety levels after the visit were higher for those patients for whom less than one year had passed since diagnosis. Mean HAD scores for anxiety and depression were 4.2 and 4.3 respectively. Women reported a higher degree of anxiety than men. Using a score of 8 or more for 'borderline-possible cases', 15% fell into these categories on the anxiety scale and 12% on the depression scale. About 30% of the patients worried about seeing a new physician and 25% about what the examination or tests would show. It is concluded that regular, scheduled control visits pose a significant threat to the psychological well-being of only a minority of gastrointestinal cancer patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8695153&dopt=Abstract anxiety medicine




[Coincidence of anxiety and sleep disorders. Overview and case reports]

[Article in German]

Hajak G, Bandelow B.

Psychiatrische Klinik und Poliklinik der Universitat Gottingen.

Anxiety disorders and sleep disorders show various interrelations. This paper stresses the clinical importance of sleep problems in relation to anxiety disorders and of anxiety symptoms in patients with sleep disorders, in context with the relevant literature. Differential diagnostic aspects of overlapping of anxiety, sleep disturbances and organic diseases with anxiety-like symptoms are presented. Sleep-related panic attacks and anxiety in insomnia provide examples of the development of pathophysiological concepts coming from the coupling of sleep and anxiety. Case reports illustrate the relevance for clinical practice.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8850093&dopt=Abstract anxiety medicine




Psychological changes in parents eight months after the loss of an infant from stillbirth, neonatal death, or sudden infant death syndrome--a longitudinal study.

Vance JC, Najman JM, Thearle MJ, Embelton G, Foster WJ, Boyle FM.

University of Queensland, Department of Child Health, Mater Children's Hospital, Brisbane, Australia.

OBJECTIVE. We proposed to measure part of the natural history of grief by determining the changes in the psychological symptoms experienced by bereaved parents over the 8 months after the loss of an infant from sudden infant death syndrome (SIDS), neonatal death (NND), or stillbirth (SB). Parents were interviewed twice, at 2 and 8 months after the loss. METHODOLOGY. A total of 220 bereaved families (45 SIDS, 93 NND, and 82 SB) were compared with 226 control families who had a live born child. Comparison was based on responses to a standardized measure of anxiety and depression (Delusions-Symptoms-States Inventory). RESULTS. For separate cross-sectional comparison at both 2 and 8 months, significant differences were noted in the frequency of maternal symptoms of anxiety and depression between bereaved and control groups (P < .001). Such differences were present for paternal anxiety and depression at 2 months, but not 8 months. A second series of analysis examined longitudinal changes in symptom frequency between 2 and 8 months for each bereaved group. For mothers, the changes were significant for anxiety and depression: SIDS and NND (P < .001), SB (P < .01). For fathers, the changes for anxiety and depression in SIDS were P < .01; NND, P < .05 for anxiety and P < .01 per depression; changes were not significant for SB. At 2 months, relative risks for symptoms of maternal anxiety were significant for all three bereaved groups: SIDS, 22.4; NND, 5.4; and SB, 5.1. Comparable significant figures at 8 months were: SIDS, 5.5; NND, 3.9; and SB, 3.0, respectively. For depression the results for 2 months were: SIDS, 8.6; NND, 5.9; and SB, 6.7 (all significant) while at 8 months the results were: SIDS, 5.1; NND, 3.8; and SB, 2.4 (SB group not significant). For fathers the relevant risks were generally lower. At 2 months, anxiety levels were higher than controls in all three groups, and for depression in the SIDS and SB groups. At 8 months, significant results persisted only in the SB group. CONCLUSION. These data indicate that bereaved parents have a marked reduction in the symptoms of mental illness over the first 8 months after the loss. Although the changes over time are significant for both mothers and fathers, mothers at 8 months still demonstrated higher levels of anxiety and depression when compared with controls. These levels of symptoms are far less evident for fathers at 8 months.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7478838&dopt=Abstract anxiety medicine




"If I feel anxious, there must be danger": ex-consequentia reasoning in inferring danger in anxiety disorders.

Arntz A, Rauner M, van den Hout M.

Department of Medical Psychology, Limburg University, Maastricht, The Netherlands.

It has been suggested that neurotic patients engage in 'emotional reasoning', i.e. draw invalid conclusions about a situation on the basis of their subjective emotional response. The present experiment investigated whether anxiety patients infer danger on the basis of their anxious response, whereas normals infer danger only on the basis of objective information. Four groups of anxiety patients (52 spider phobics, 41 panic patients, 38 social phobics, and 31 other anxiety patients) and 24 normal controls made ratings of the danger they perceived in scripts in which information about objective safety vs objective danger, and anxiety response vs non-anxiety response information were systematically varied. As hypothesized, anxiety patients were not only influenced by objective danger information, but also by anxiety response information, whereas normal controls were not. The effect was neither situation-specific, nor specific for panic patients. This tendency to infer danger on the basis of subjective anxiety ('ex-consequentia reasoning') may play a role in the development and maintenance of anxiety disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7487851&dopt=Abstract anxiety medicine




The Modified Dental Anxiety Scale: validation and United Kingdom norms.

Humphris GM, Morrison T, Lindsay SJ.

Department of Clinical Psychology, University of Liverpool, UK.

The Corah Dental Anxiety Scale (CDAS) has been used extensively in epidemiology and clinical research. It is brief and is claimed to have good psychometric properties. However, it does not include any reference to local anaesthetic injections, a major focus of anxiety for many. Also, the multiple choice answers for three of the four questions are not clearly in order of severity of anxiety as the CDAS intends. The answers differ among the questions thus making them difficult to compare. They include descriptions of physiological reactions and anxiety, confusing two loosely related components of the experience. The Modified Dental Anxiety Scale (MDAS) described, added a question on anxiety about oral injections. New multiple choice answers, in clear order of anxiety and the same for each question, were provided. Twenty five dental personnel all confirmed independently the order of the multiple choice answers for the MDAS. They disagreed among themselves however, about the appropriate sequence for the answers denoting intermediate anxiety in the CDAS. Therefore the CDAS, unlike the MDAS, can provide meaningful measures only of extremely high or extremely low dental anxiety. Of 1392 subjects tested, 13 per cent expressed extreme anxiety about injections on the MDAS but were only 'fairly' or less anxious about drilling. Thus, the CDAS, unlike the MDAS, must overlook subjects very afraid of injections only. Data confirm the high reliability and validity of the MDAS and provide norms for phobic and nonphobic subjects.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7584581&dopt=Abstract anxiety medicine




Generalized anxiety disorders three to four months after ischemic stroke.

Leppavuori A, Pohjasvaara T, Vataja R, Kaste M, Erkinjuntti T.

Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.

BACKGROUND AND OBJECTIVE: The main objective of our study was to detail the frequency and clinical determinants of poststroke generalized anxiety disorders in a large, well-defined stroke cohort. METHODS: A total of 277 stroke patients aged 55-85 were subjected to a comprehensive psychiatric evaluation between 3 and 4 months after ischemic stroke. Primary generalized anxiety disorder or generalized anxiety disorder due to stroke were diagnosed according to DSM-IV symptom criteria. RESULTS: The frequency of any generalized anxiety disorder was 20.6% (n = 57). According to a logistic model, any generalized anxiety disorder was associated with a history of epilepsy, comorbid depressive disorder, severity of depression, severity of anxiety, and the use of anxiolytic drugs. A discriminant analysis identified four factors that distinguished the two diagnostic subgroups from one another: the level of psychosocial functioning (worse score in patients with generalized anxiety due to stroke), a history of migraine, anterior circulation stroke localization (more frequent in patients with generalized anxiety disorder due to stroke), and a history of insomnia (more frequent in patients with primary generalized anxiety disorder). CONCLUSIONS: Clinically significant anxiety is common in ischemic stroke patients and may hamper their rehabilitation. Copyright 2003 S. Karger AG, Basel

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12865614&dopt=Abstract anxiety medicine