Jürgen Barth

Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients

BackgroundDepression and anxiety in patients with coronary heart disease (CHD) are associated with a poorer prognosis. Therefore the screening for psychological distress is strongly recommended in cardiac rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders.MethodsWe assessed mental distress in in-patient cardiac rehabilitation in Germany. The factor structure of the German language version of the HADS was investigated in 1320 patients with CHD. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument.ResultsThree-factor models were found to offer a superior fit to the data compared to two-factor (anxiety and depression) models. The German language HADS performs similarly to the English language version of the instrument in CHD patients. The German language HADS fundamentally comprises a tri-dimensional underlying factor structure (labelled by Friedman et al. as psychomotor agitation, psychic anxiety and depression).ConclusionDespite of clinical usefulness in screening for mental disturbances the construct validity of the HADS is not clear. The resulting scores of the tri-dimensional model can be interpreted as psychomotor agitation, psychic anxiety, and depression in individual patient data or clinical investigations.

Factor structure of the Hospital Anxiety and Depression Scale in coronary heart disease patients in three countries

BACKGROUND Depression and anxiety in patients with coronary heart disease (CHD) is associated with a poorer prognosis. Therefore, the screening for psychological distress is strongly recommended in cardiac care and rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. The factor structure of the HADS was investigated in CHD populations across three countries (Germany, Hong Kong, United Kingdom). METHODS In total, HADS data from 1793 patients with CHD were explored using confirmatory factor analysis to establish the underlying factor structure of the instrument. RESULTS Three-factor models were found to offer a superior fit to the data compared with two-factor (anxiety and depression) models in all countries. The anxiety items can be separated in a factor labelled autonomic anxiety and negative affectivity. CONCLUSIONS The HADS offers good possibilities to detect distressed patients with somatic illnesses, but the construct validity of the originally proposed two factors (depression, anxiety) remains unclear. In outcome studies, more precise scales should be used to reduce measurement errors based on the scales used.

Mental Health and Quality of Life After Genetic Testing for Huntington Disease: A Long-Term Effect Study in Germany

Predictive genetic testing for Huntington disease (HD) might cause severe short‐term psychological reactions in patients with poor mental health. Very few studies exist on the long‐term effects of genetic HD testing. The aim of this study was to assess mental health and quality of life in persons who were tested for HD mutation, to compare mental health depending on the result of the genetic test (non‐carriers, gene carriers, and patients with HD) and to identify predictors of mental health and quality of life via linear regression. The data were collected by self‐report questionnaires. In total, 121 individuals participated in this study: 52 were non‐carriers, 54 were gene carriers, and 15 were gene carriers suffering from HD. Non‐carriers and gene carriers showed better mental health and quality of life than HD‐patients but did not differ from each other. In non‐carriers four variables predicted increased depression and low mental quality of life: low perceived social support, no intimate relationship, female sex and younger age. For gene carriers three predictors were found: low perceived social support, the expectation of an unfavorable genetic test result before the testing procedure and being childless. To prevent detrimental effects of HD testing on mental health and mental quality of life, specific attention should be paid to persons with limited social networks during genetic counseling. Assessment of expectations related to the test result and mental health prior to a genetic testing procedure may help to identify gene carriers at risk of poor coping after an unfavorable test result.

Komorbidität von depressiven Störungen und kardiovaskulären Erkrankungen Implikationen für Diagnostik, Pharmako- und Psychotherapie

ZusammenfassungKontrollierte Untersuchungen und Metaanalysen zeigen, dass Depressionen und kardiovaskuläre Erkrankungen nicht nur häufig gemeinsam auftreten, sondern dass depressive Erkrankungen einen eigenständigen Risikofaktor für die Entwicklung und Prognose einer koronaren Herzerkrankung (KHK) darstellen. Zwischen einer reaktiven Verstimmung im Sinne einer Anpassungsstörung und einer behandlungsbedürftigen depressiven Episode nach Myokardinfarkt zu unterscheiden, kann mit diagnostischen Unsicherheiten verbunden sein. Dennoch ist in beiden Fällen eine psychopharmakologische und psychotherapeutische Behandlung überlegenswert. U. a. aus Sorge vor kardiovaskulären Nebenwirkungen wird die Indikation zur medikamentösen Behandlung eher zurückhaltend gestellt, wodurch nur die Minderheit der Patienten adäquat behandelt wird. Durch einige in den letzten Jahren neu zugelassene Antidepressiva hat sich das Spektrum der Behandlungsmöglichkeiten aber erweitert. Insbesondere die selektiven Serotonin-Wiederaufnahmehemmer stellen bei Herzerkrankungen eine wertvolle Alternative zu den bei komorbiden Koronarerkrankungen problematischen trizyklischen Antidepressiva dar.In diesem Beitrag werden einerseits die Vor- und Nachteile der verschiedenen Pharmaka dargestellt. Andererseits wird der bisherige Kenntnisstand zur psychotherapeutischen Behandlung bei Komorbidität von Depression und KHK referiert und diskutiert, welche Psychotherapieverfahren für diese Indikation geeignet sind.SummaryControlled studies and meta-analyses show not only that depression and cardiovascular disease often occur together, but that depressive illnesses are an independent risk factor in the development and the progression of coronary heart disease. It can be difficult to distinguish between reactive mood disturbance after myocardial infarction and depressive episodes that may have preceded the infarction and which require treatment. Due to this difficulty, depressive disorders are rarely diagnosed, and only a minority of patients receive adequate treatment. However, owing to the introduction of new antidepressants in recent years, the number of treatment options has increased. Specifically, selective serotonin reuptake inhibitors (SSRI) offer a valuable alternative to tricyclic antidepressants, which are problematic in heart disease. The authors describe on the one hand controlled studies of SSRIs and discuss differential therapeutic consequences. On the other hand, studies of psychotherapeutic interventions in comorbid patients with depression and coronary heart disease are reported. Finally, the authors discuss which psychotherapeutic interventions may be suitable.

Variations in subjective breast cancer risk estimations when using different measurements for assessing breast cancer risk perception

Abstract Objective: To investigate whether different measurements for breast cancer risk perception can lead to variations in breast cancer risk estimations and to different conclusions about risk accuracy. Methods: Women with no history of breast cancer (N = 377) estimated their breast cancer risk on four different scales (percentage scale, visual analogue scale, 7-point scale, comparative scale). We examined the associations between the risk estimations and assessed womens confidence in risk judgements. Results: Women overestimated their breast cancer risk on the percentage and visual analogue scales. In contrast, judgements on the 7-point scale indicated a more adequate risk perception, whereas on the comparative scale women tended to underestimate their breast cancer risk. Women felt least confident in their judgement on the percentage scale and most confident using the comparative scale. Conclusions: Some scales for assessing breast cancer risk perception (e.g., percentages) might trigger increased uncertainty, which in turn may provoke risk estimations which do not accurately reflect womens actual views and feelings about their breast cancer risk. Thus, due to differences in confidence in risk judgements, different scales might lead to dissimilar risk estimations and thus to different and potentially invalid conclusions about subjective breast cancer risk concepts.

Predicting perceived vulnerability for breast cancer among women with an average breast cancer risk

OBJECTIVES The purpose of the present study was to investigate predictors of perceived vulnerability for breast cancer in women with an average risk for breast cancer. On the basis of empirical findings that suggested which variables might be associated with perceived vulnerability for breast cancer, we investigated whether knowledge of breast cancer risk factors, cancer worry, intrusions about breast cancer, optimism about not getting cancer and perceived health status have a predictive value for perceived breast cancer vulnerability. DESIGN In a 3-step approach, we recruited 292 women from the general public in Germany who had neither a family history of breast cancer nor breast cancer themselves. After receiving an initial informational letter about study objectives, the women were interviewed by telephone and then asked to fill in a self-administered questionnaire. METHODS We used structural equation modelling and hypothesized that each of the included variables has a direct influence on perceived vulnerability for breast cancer. RESULTS We found a valid model with acceptable fit indices. Optimism about not getting cancer, intrusions about breast cancer and womens perceived health status explained 32% of the variance of perceived vulnerability for breast cancer. Cancer worry and knowledge about breast cancer did not influence perceived vulnerability for breast cancer. CONCLUSION Perceived vulnerability for breast cancer is associated with health-related variables more than with knowledge about breast cancer risk factors.