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      Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study

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          Abstract

          Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient’s well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD.

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            The validity of the Hospital Anxiety and Depression Scale. An updated literature review.

            To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? Most factor analyses demonstrated a two-factor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from.40 to.74 (mean.56). Cronbach's alpha for HADS-A varied from.68 to.93 (mean.83) and for HADS-D from.67 to.90 (mean.82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range.49 to.83. HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population.
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              The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease

              Background Interpretation of the Hospital Anxiety and Depression Scale (HADS), commonly used to assess anxiety and depression in COPD patients, is unclear. Since its minimal important difference has never been established, our aim was to determine it using several approaches. Methods 88 COPD patients with FEV1 ≤ 50% predicted completed the HADS and other patient-important outcome measures before and after an inpatient respiratory rehabilitation. For the anchor-based approach we determined the correlation between the HADS and the anchors that have an established minimal important difference (Chronic Respiratory Questionnaire [CRQ] and Feeling Thermometer). If correlations were ≥ 0.5 we performed linear regression analyses to predict the minimal important difference from the anchors. As distribution-based approach we used the Effect Size approach. Results Based on CRQ emotional function and mastery domain as well as on total scores, the minimal important difference was 1.41 (95% CI 1.18–1.63) and 1.57 (1.37–1.76) for the HADS anxiety score and 1.68 (1.48–1.87) and 1.60 (1.38–1.82) for the HADS total score. Correlations of the HADS depression score and CRQ domain and Feeling Thermometer scores were < 0.5. Based on the Effect Size approach the MID of the HADS anxiety and depression score was 1.32 and 1.40, respectively. Conclusion The minimal important difference of the HADS is around 1.5 in COPD patients corresponding to a change from baseline of around 20%. It can be used for the planning and interpretation of trials.
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                Author and article information

                Contributors
                Role: Academic Editor
                Role: Academic Editor
                Journal
                Medicina (Kaunas)
                Medicina (Kaunas)
                medicina
                Medicina
                MDPI
                1010-660X
                1648-9144
                25 February 2021
                March 2021
                : 57
                : 3
                : 197
                Affiliations
                [1 ]Descartes’ Error Student Research Association, Department of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland; oliver.czech@ 123456student.po.edu.pl (O.C.); k.buchta@ 123456student.po.edu.pl (K.B.); s.zablotni@ 123456student.po.edu.pl (S.Z.); e.gos@ 123456student.po.edu.pl (E.G.); lukasz.tluczykont@ 123456student.po.edu.pl (Ł.T.); d.gorecka8223@ 123456student.po.edu.pl (D.G.); agnieszka.pastula@ 123456student.po.edu.pl (A.P.); ma.adamczyk@ 123456student.po.edu.pl (M.A.); ewa.jach@ 123456student.po.edu.pl (E.J.); swierkowski.eu@ 123456gmail.com (I.Ś.)
                [2 ]Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; p-szary@ 123456o2.pl
                [3 ]Department of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland; j.szczegielniak@ 123456po.edu.pl
                Author notes
                [* ]Correspondence: adam.wrzeciono@ 123456student.po.edu.pl ; Tel.: +48-505525007
                Author information
                https://orcid.org/0000-0002-8515-9920
                Article
                medicina-57-00197
                10.3390/medicina57030197
                7996584
                33669130
                c6c746b6-2541-434c-a889-47c51861ae69
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 09 January 2021
                : 20 February 2021
                Categories
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                pulmonary rehabilitation,respiratory disease,behavioral symptoms,emotions

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