BackgroundWhile it is recognised that depression is prevalent in Rheumatoid Arthritis (RA), recent studies have also highlighted significant levels of anxiety in RA patients. This study compared two commonly used scales, the Depression Anxiety and Stress Scale (DASS) and the Hospital Anxiety and Depression Scale (HADS), in relation to their measurement range and cut points to consider the relative prevalence of both constructs, and if prevalence rates may be due to scale-specific case definition.MethodsPatients meeting the criteria for RA were recruited in Leeds, UK and Sydney, Australia and asked to complete a survey that included both scales. The data was analysed using the Rasch measurement model.ResultsA total of 169 RA patients were assessed, with a repeat subsample, resulting in 323 cases for analysis. Both scales met Rasch model expectations. Using the 'possible+probable' cut point from the HADS, 58.3% had neither anxiety nor depression; 13.5% had anxiety only; 6.4% depression only and 21.8% had both 'possible+probable' anxiety and depression. Cut points for depression were comparable across the two scales while a lower cut point for anxiety in the DASS was required to equate prevalence.ConclusionsThis study provides further support for high prevalence of depression and anxiety in RA. It also shows that while these two scales provide a good indication of possible depression and anxiety, the estimates of prevalence so derived could vary, particularly for anxiety. These findings are discussed in terms of comparisons across studies and selection of scales for clinical use.
This study reports the high value of VERT breast cancer-targeted education programs in improving RT knowledge and perhaps decreasing patient anxiety. Continued efforts are required to improve patients' accessibility to VERT in Australia, and to better understand the effect of VERT's unique educational features on patients' emotional and physical needs throughout their RT.
Objective. Rheumatoid arthritis (RA) is not commonly associated with central nervous system and brain changes. However, a number of studies have reported high rates of cognitive impairment in adults with RA. The objective of this systematic review was to identify and explore the rates and types of cognitive impairment in RA. Methods. Multiple databases were searched for articles published between 1994 and 2016, to identify studies that have included: adults with RA; standardized neuropsychological tests; and sufficient information to ascertain the relationship between cognitive impairment and demographic, clinical, and psychological factors. Of 1,980 titles, 75 were retained at the abstract level, 36 at the full-text level, and 15 studies in the final review. These were evaluated using a modified Newcastle-Ottawa Scale, and the findings were synthesized using a narrative approach. Results. Ten of 15 studies compared RA to other clinical groups and/or a control group. Based on summed effect size analyses, individuals with RA significantly underperformed on cognitive function tests compared to the control groups, particularly on verbal function, memory, and attention. Less clear differences were found between RA and other clinical groups. Some demographic (age and education), clinical (disease activity), and psychological (depression) factors were associated with cognitive impairment, but inconsistently so across studies. A number of limitations were identified: small and predominantly female samples, limited cognitive domain inclusion, lack of study details, and management of confounding variables. Conclusion. There is evidence of cognitive impairment in adults with RA. Further studies are needed to confirm prevalence rates and examine potential mechanisms.
The Internet has often been argued to have adverse psychological consequences, such as depression or anxiety symptoms, among "over-users." The present study offers an alternative understanding, suggesting the Internet may be used as a forum for expanding social networks and consequently enhancing the chance of meaningful relationships, self-confidence, social abilities, and social support. An online sample of 188 people was recruited over the Internet, while paper and pencil tests were administered to an offline sample group of 27 undergraduate university students, who were regular Internet users. Subjects completed the Zung Depression Scale (ZDS), Depression, Anxiety and Stress Scales (DASS), Eysenck Personality Questionnaire?Revised Short Scale (EPQ-R Short), Fear of Negative Evaluation (FNE) scale, Internet Use Questionnaire (IUQ), and an Internet Effects Questionnaire (IEQ). Results suggested that there was no relationship between time spent online and depression, anxiety, or social fearfulness. Those who primarily used the Internet for online chat believed that the Internet is psychologically beneficial to them, but also believed that frequent Internet users are lonely and that the Internet can be addictive. It is argued that "chat" users who are socially fearful may be using the Internet as a form of low-risk social approach and an opportunity to rehearse social behavior and communication skills, which, may help them improve interaction with offline, face-to-face, social environments.
These results suggest that a brief cognitive screen at hospital admission, focusing on executive function, would have a useful prognostic value in depression. Determining early predictors of individuals at risk of poorer outcomes is important for identifying those who may need altered or additional treatment approaches.
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