Examining the optimal cutoff values of HADS, PHQ-9 and GAD-7 as screening instruments for depression and anxiety in irritable bowel syndrome

Prevalence and associated factors of psychiatric comorbidities in epilepsy in the Casablanca-Settat region of Morocco: A cross-sectional study

OBJECTIVE

To determine the estimated prevalence of anxiety, depression, and anxiety-depression syndrome (ADS) and to identify the associated factors in Moroccan people with epilepsy (PWE).

METHOD

A cross-sectional study was conducted among adult PWE (June 2021-December 2022) in the Casablanca-Settat region. PWE were interviewed by completing a questionnaire collecting sociodemographic and clinical data. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Out of 21 points, a score ≥8 is in favor of considerable anxiety/depression symptoms and a sum of the two scores ≥15 indicates the presence of ADS. Data were analyzed using Statistical Package for Social Sciences (SPSS) 21.0. p-values ≤0.05 were considered statistically significant and logistic regression was performed to determine the associated factors.

RESULTS

Among 294 PWE, the median age was 39 years (interquartile range [IQR]: 25.75-54.00). The median anxiety, depression, and ADS scores were 8 (IQR: 5.00-10.00), 7 (IQR: 4.00-10.00), and 15 (IQR: 10.00-20.00), respectively. Anxiety, depression, and ADS were revealed in 51.4%, 44.9%, and 51.0% of PWE, respectively. Depression was the only predictor for anxiety (aOR = 24.20; 95%CI: 12.45-47.01). Antiseizure polytherapy (aOR = 3.35; 95%CI: 1.72-6.54) and anxiety (aOR = 24.04; 95%CI: 12.12-47.67) were the factors associated with depression. The risk of ADS was increased by female gender (aOR = 2.83; 95%CI: 1.68-4.78), antiseizure polytherapy (aOR = 2.75; 95%CI: 1.62-4.65), structural epilepsy (aOR = 1.73; 95%CI: 1.01-2.94), and the presence of concomitant conditions with epilepsy (aOR = 1.96; 95%CI: 1.16-3.31).

SIGNIFICANCE

Our study reports high psychiatric comorbidity prevalence in epilepsy, which supports the bidirectional link hypothesis. Associated factors found are important in the prognosis and prevention.

PLAIN LANGUAGE SUMMARY

The neural mechanisms underlying epilepsy tend to expose PWE to psychiatric disorders. Our study aims to quantify the rate of psychiatric comorbidities and their predictive factors in Moroccan PWE. The estimated prevalences of significant symptoms of anxiety, depression, and ADS were 51.4%, 44.9%, and 51.0%, respectively. Depression was the predictor of anxiety. Antiseizure polymedication and anxiety were the associated factors with depression. The risk of SAD was increased by female gender, antiseizure polymedication, structural epilepsy, and concomitant diseases with epilepsy. Our results are important for considering the psychiatric aspect of PWE and improving their care and quality of life.

Screening for depression and anxiety in lung cancer patients: A real-world study using GAD-7 and HADS

BACKGROUND

The psychological well-being of lung cancer patients is critical in-patient care but frequently overlooked.

METHODS

This study, employing a cross-sectional, questionnaire-based design, aimed to elucidate the prevalence of depressive and anxiety symptoms among lung cancer patients and identify associated risk factors. Participants' demographic, medical history, disease stage, and pathology were systematically collected. Psychological assessment was conducted using the general anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), and hospital anxiety and depression scale (HADS). Statistical analyses were performed using SPSS software (version 25.0).

RESULTS

Out of 294 distributed questionnaires, 247 lung cancer patients were included in the final analysis, with an average completion time of 9.08 min. Notably, 32.4% exhibited depressive symptoms, while 30% displayed signs of anxiety. A significant correlation was found between both depressive and anxiety symptoms and a history of tobacco and alcohol consumption. Specifically, increased nicotine dependence and greater cumulative tobacco use were linked to higher rates of depressive symptoms, whereas cumulative alcohol consumption was associated with increased risks of anxiety symptoms.

CONCLUSION

The study affirms the feasibility of GAD-7, PHQ-9, and HADS as screening tools for depressive and anxiety symptoms in lung cancer patients. It further highlights tobacco and alcohol consumption as significant risk factors for poor psychological health in this population.

Characteristics and Risk Factors of Functional Dyspepsia Fulfilling the Rome IV Criteria Overlapping With Gastroesophageal Reflux Disease, Irritable Bowel Syndrome, and Functional Constipation in South China

Background/Aims

Functional dyspepsia (FD) overlapping with other gastrointestinal disorders are quite common. The characteristics of FD overlap in Chinese population with latest Rome IV criteria were unclear. This large-scale outpatient-based study assessed the characteristics of FD overlap in South China.

Methods

Consecutive FD patients visited the Gastroenterology Clinic at 2 tertiary medical centers in Hangzhou, China who fulfilled the Rome IV criteria were enrolled. Complete questionnaires related to the gastrointestinal symptoms (Rome IV criteria), Reflux Disease Questionnaire, anxiety and depression, quality of sleep and life, and demographic information were collected.

Results

Among the total of 3281 FD patients, 50.69% overlapped with gastroesophageal reflux disease, 21.46% overlapped with irritable bowel syndrome, 6.03% overlapped with functional constipation. FD overlap had higher proportion of single/divorced/widowed rate, high education level, being employed, drinking, night shift, unhealthy dietary habit than FD only (P < 0.05). They had higher frequency of consultation and economic burden, as well as lower scores in quality of life (P < 0.001). Multivariate logistic regression showed that increasing age, female, low body mass index, history of gastroenteritis, anxiety, depression, and poor sleep quality were independent risk factors for FD overlap.

Conclusions

FD overlap was quite common in China with high economic burden and poor quality of life, FD patients with history of gastroenteritis, anxiety, depression, and poor sleep quality were more likely to have overlap disorders. Awareness of the physical and psychosocial stressors in overlapping condition would help optimize the management of FD overlap in clinical practice.

Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype

BACKGROUND

Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established.

AIM

To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS.

METHODS

A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups.

KEY RESULTS

A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01).

CONCLUSIONS & INFERENCES

The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.

Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder

OBJECTIVE

Orthorexia nervosa (ON) is characterized as obsessional healthy eating that results in malnutrition and/or psychosocial impairment. Yet, ON shares theoretical overlap with eating disorders (EDs), especially anorexia nervosa (AN), as well as obsessive-compulsive disorder (OCD). This study aimed to further understand ON and its overlap with related disorders by assessing the ability of ON for detecting the presence/absence of threshold ED, AN, and OCD symptoms.

METHOD

An observational survey was completed by 197 participants recruited through eating disorder, dieting, and mental health support groups. Receiver operating characteristic (ROC) curve analyses determined the predictive ability of ON symptoms (assessed by Eating Habits Questionnaire [EHQ] orthorexia nervosa [OrNe] and healthy orthorexia [HeOr] subscales, and the Orthorexia Nervosa Inventory [ONI]) for detecting disordered eating symptoms (determined by Eating Disorder Examination Questionnaire [EDE-Q] global cut-scores), probable AN (determined by EDE-Q cut-scores and body mass index [BMI] <18.5), and OCD symptoms and obsessional thinking (assessed by the Revised Obsessive-Compulsive Inventory [OCI-R]).

RESULTS

Results showed both the ONI and EHQ OrNe measures are able to adequately predict ED symptoms and AN; however, both were poor to moderate at detecting OCD symptoms and obsessional thinking. Healthy orthorexia was poor to moderate at detecting outcomes.

DISCUSSION

These results suggest that ON, as it is currently operationalized, may be more closely related to EDs than OCD, and that ON may represent a subtype of AN. Results also support healthy orthorexia as a distinct construct to ON. While results are limited by the lack of definitive ON diagnostic criteria, findings suggest that treatments developed for EDs might be most suited to ON.

PUBLIC SIGNIFICANCE

ON has been proposed as a psychiatric disorder, and it shares theoretical overlap with several existing disorders. This study adopts a novel approach to assessing and exploring the overlap of ON with EDs, AN and OCD. Results suggest that ON shares more overlap with EDs and might best be understood as a subtype of EDs or AN.

Hard Flaccid Syndrome: A Biopsychosocial Management Approach with Emphasis on Pain Management, Exercise Therapy and Education

Hard flaccid syndrome (HFS) is a rather rare, acquired clinical entity affecting young men's well-being, sexual and social life. HFS presents with a cluster of symptoms including penile-specific somatosensory disturbances, a semi-rigid penis at the flaccid state without any stimulation or desire, erectile dysfunction, perineal and/or penile pain, associated urinary symptoms, emotional distress as well as other psychosocial and stress-related manifestations. Although its pathophysiology is still not well understood, initial penile trauma causing minor nerve and vascular disturbances to the penis and associated pelvic floor musculature is suggested to trigger the syndrome. Despite the scarcity of research on HFS, the present report describes a case of a young male clinically diagnosed with HFS, who benefited from a biopsychosocial management strategy, focusing on pain management, therapeutic exercise approaches, such as pelvic floor exercise re-education, graded exposure to activity as well as education on lifestyle and stress-related modifications. This holistic management approach has been clinically reasoned in this case report, and the need for more evidence-based studies developing diagnosing criteria, elaborating pathophysiological mechanisms and testing the efficiency of different therapeutic options is highlighted.

Translation and validation of the Ukrainian version of the visceral sensitivity index for patients with irritable bowel syndrome

Introduction

Gastrointestinal-specific anxiety (GSA) is considered as an important factor in the course of irritable bowel syndrome (IBS). GSA may be evaluated by the visceral sensitivity index (VSI).

Aim

To translate original English version of the VSI into Ukrainian language (VSI-UA) and then to test its validity and reliability in patients with IBS.

Material and methods

108 patients of both sexes, aged 18-44 years, with IBS were assessed by the VSI-UA, Patient Health Questionnaire-9 (PHQ-9), Beck's Depression Inventory (BDI), and the Hospital Anxiety and Depression Scale: depression (HADS-Dep) and anxiety (HADS-Anx). Reliability was checked by Cronbach's α and test-retest method with calculation of the intraclass correlation coefficient (ICC). Content validity was assessed by calculation of the content validity ratio (CVR) and content validity index (CVI). The construct validity was assessed by estimating Pearson`s correlation between VSI-UA, PHQ-9, BDI, HADS-Anx, and HADS-Dep.

Results

Cronbach's α for VSI-UA was 0.84; the ICC between the first measurement and the one repeated 4 weeks after administration of VSI-UA was 0.92 (95% CI: 0.87-0.95). The calculated CVR for each item of the VSI-UA was higher than the critical value of 0.56, and the CVI was 0.94. A moderate positive correlation was found between VSI-UA and PHQ-9 (r = 0.65), BDI (r = 0.69), HADS-Anx (r = 0.61), and HADS-Dep (r = 0.48); p < 0.05 in all correlations.

Conclusions

VSI-UA is a reliable and valid tool for the assessment of GSA in Ukrainian-language patients with IBS, and it could be implemented in routine clinical practice to manage patients with IBS.

Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population

OBJECTIVES

The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population.

DESIGN

Our study has a cross-sectional design.

SETTING

Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1).

PARTICIPANTS

The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety.

RESULTS

The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability.

CONCLUSIONS

The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.

Personality traits that associated with generalized anxiety disorder among PhD students

There is an association between personality traits and generalized anxiety disorder (GAD). In order to differentiate the association between various personality traits and GAD, a survey was conducted among PhD students in northern China (mainland). Three conclusions could be drawn with the help of regression analysis. At first, there is a positive association between Honesty-Humility (HH)/Emotionality (E)/Conscientiousness (C)/Openness to experience (O) and GAD, whereas there is a negative association between Agreeableness (A)/eXtraversion (X) and GAD. Secondly, age, gender, major, monthly income, HH, E, X, A, C and O could explain a 21.80 % variance in GAD. Thirdly, E and C are two robust factors that associated with GAD among PhD students.

Anxiety in Response to Sustaining Spinal Cord Injuries and Disorders: When Should Clinicians Be Concerned?

OBJECTIVE

To recommend a cut-off score for the brief 2-item Generalized Anxiety Disorder (GAD-2) measure for persons with spinal cord injuries/disorders (PwSCI/D) and to estimate anxiety occurrence within this population using the full 7-item Generalized Anxiety Disorder (GAD-7).

DESIGN

Multicenter retrospective analyses.

SETTING

One inpatient rehabilitation center and 2 community sites for PwSCI/D.

PARTICIPANTS

PwSCI/D 18 years or older (N=909) were included for analysis using retrospectively collected GAD-2 and GAD-7 data.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Occurrence of anxiety symptoms were compared using cut-off scores of ≥8 and ≥10 on the GAD-7. A cut-off score recommendation for the GAD-2 was determined using ROC curve, and sensitivity and specificity analyses.

RESULTS

Occurrence of anxiety symptoms was 21% using a GAD-7 cut-off of ≥8 and 15% using a cut-off of ≥10. Analyses indicated optimal sensitivity for a GAD-2 score of ≥2 when a GAD-7 cut-off of ≥8 was used.

CONCLUSIONS

Anxiety occurrence is elevated among PwSCI/D compared with the general population. For PwSCI/D, it is recommended that a cut-off score of ≥2 is used for the GAD-2 to maximize sensitivity and that a threshold of ≥8 is used for the GAD-7 to ensure the maximum number of individuals presenting with symptoms of anxiety are recognized for diagnostic interview. Study limitations are discussed.

Association of psychological distress with arm morbidity symptoms in breast cancer survivors: outcomes from the use of PHQ-9 and GAD-7 questionnaires

BACKGROUND

Although higher survival rates of breast cancer are achieved these days, breast cancer survivors are challenged with unwanted side effects from treatment or management that affect physical, functional, and psychological well-being of an individual. This study aimed to assess psychological distress status in Malaysian breast cancer survivors and factors that affected the condition.

METHODS

A cross-sectional study design was conducted on 162 breast cancer survivors from various breast cancer support groups in Malaysia. Psychological distress status was assessed based on depression and anxiety scores by applying the Malay version of Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7). Both instruments were self-administered along with a set of questionnaires comprising demographic, medical history, quality of life, and upper extremity function assessment. Outcomes from the PHQ-9 and GAD-7 were analyzed for severity level of psychological distress, and its association with relevant variables, arm morbidity symptoms, as well as the duration of cancer survivorship.

RESULTS

The univariate analysis showed that breast cancer survivors with arm morbidities after breast surgery had a higher score of depression (5.0 vs 4.0, p = 0.011) and anxiety (3.0 vs 1.0, p = 0.026) than those who did not. Besides that, receiving fewer post-rehabilitation treatments (p = 0.049) and having a family history of cancer (p = 0.022) were correlated with higher anxiety level. The level of depression and anxiety was inversely proportionate with quality of life and positively correlated with greater disability of the arm function (p < 0.05). Subsequent analysis showed that arm morbidity symptoms including difficulties in finding a t-shirt that fits and pain in the arm area after breast cancer surgery were positively associated with a higher level of psychological distress.

CONCLUSION

Our study demonstrated the association between psychological distress with arm morbidities in breast cancer survivors. Given that arm morbidities can affect not only physical, but psychological well-being, continuous or serial assessment on both aspects during cancer treatment may effectively help to address mental health issue experienced by this cancer population.

Depression and anxiety among Macau residents during the COVID-19 outbreak: A network analysis perspective

Background

The 2019 novel coronavirus disease (COVID-19) outbreak affected people's lifestyles and increased their risk for depressive and anxiety symptoms (depression and anxiety, respectively hereafter). We assessed depression and anxiety in residents of Macau during "the 6.18 COVID-19 outbreak" period and explored inter-connections of different symptoms from the perspective of network analysis.

Methods

In this cross-sectional study, 1,008 Macau residents completed an online survey comprising the nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder Scale (GAD-7) to measure depression and anxiety, respectively. Central and bridge symptoms of the depression-anxiety network model were evaluated based on Expected Influence (EI) statistics, while a bootstrap procedure was used to test the stability and accuracy of the network model.

Results

Descriptive analyses indicated the prevalence of depression was 62.5% [95% confidence interval (CI) = 59.47-65.44%], the prevalence of anxiety was 50.2% [95%CI = 47.12-53.28%], and 45.1% [95%CI = 42.09-48.22%] of participants experienced comorbid depression and anxiety. "Nervousness-Uncontrollable worry" (GADC) (EI = 1.15), "Irritability" (GAD6) (EI = 1.03), and "Excessive worry" (GAD3) (EI = 1.02) were the most central symptoms, while "Irritability" (GAD6) (bridge EI = 0.43), "restlessness" (GAD5) (bridge EI = 0.35), and "Sad Mood" (PHQ2) (bridge EI = 0.30) were key bridge symptoms that emerged in the network model.

Conclusion

Nearly half of residents in Macau experienced comorbid depression and anxiety during the 6.18 COVID-19 outbreak. Central and bridge symptoms identified in this network analysis are plausible, specific targets for treatment and prevention of comorbid depression and anxiety related to this outbreak.

Nurse practitioner-delivered cognitive-behavioral treatment as a novel implementation route for irritable bowel syndrome: A proof of concept

BACKGROUND

Exposure-based cognitive-behavioral therapy (exposure-CBT) is efficacious for irritable bowel syndrome (IBS). However, few patients receive exposure-CBT due to a lack of behavioral health providers trained in brain-gut behavior therapies. Nurse practitioners (NPs) could fill a critical need for scalable delivery methods. In a pragmatic investigation of a 5-session NP-delivered exposure-CBT for adults with Rome IV-defined IBS, we evaluated treatment feasibility and acceptability and explored changes clinical outcomes.

METHODS

Exposure-CBT was delivered as part of routine care involving four sessions every other week and a 2-month booster session. Patients could electively participate in an observational study including pre-, mid-, and post-treatment surveys and a post-treatment qualitative interview. Independently coded ratings of NP treatment protocol adherence and competence ratings were completed from audio recordings, rated on a 1 (not at all) to 5 (completely) scale.

RESULTS

Twenty-five patients consented (ages 22-67 years; 76% female; 48% IBS-diarrhea predominant). There was high feasibility-adherence average = 4.1, NP competence average = 4.8, 72% treatment completion, 93% satisfaction scores ≥3. Treatment satisfaction was high (rated as 4/4 "very satisfied" by n = 9 and as 3/4 "mostly satisfied" by n = 5). There were improvements in clinical outcomes across treatment with large effects for IBS-symptom severity (-53%; Hedge's g = 1.0; 95% confidence interval [CI] = 0.5, 1.5) and IBS quality of life (+31%; Hedge's g = 0.8; 95% CI = 0.4, 1.2).

CONCLUSIONS

NP-delivered exposure-CBT for IBS was initially feasible and acceptable with promising clinical improvements. Findings will inform a future NIH Stage 1B/ORBIT Phase IIB pilot randomized control trial.

Mental health of international students in the United States during the COVID-19 pandemic and its relevant political climate: A descriptive cross-sectional study

Objective: To address the impact of the COVID-19 pandemic and its relevant political climate on college-level international students in the United States. Participants: International students aged 18 years and older in the San Francisco Bay Area. Methods: A descriptive cross-sectional survey using PHQ-9 and the GAD-7. Results: The prevalence of depression and anxiety significantly decreased during the last two weeks from the survey completion in April or May in 2021 (Time 2) as compared to the two weeks after the July 6th policy directive in 2020 (Time 1). However, both depression severity, 2.172 (95% CI: 1.900, 2.445), and anxiety severity, 1.897 (95% CI: 1.655, 2.138), during Time 2 were still mild, indicating the ongoing COVID-19 pandemic had still negatively impacted their mental health status. Conclusions: Future research can expand the target population and analyze the long-term effects of policy changes and disease outbreaks on international students in the United States.

Hypnotherapy for irritable bowel syndrome: patient expectations and perceptions

INTRODUCTION

Numerous studies have shown that hypnotherapy (HT) is effective in irritable bowel syndrome (IBS) using traditional symptom severity end points. However, there is now interest in capturing the patient's perception of their illness and treatment because what patients expect from their treatment may differ from that of their healthcare provider.

OBJECTIVE

To record patient perceptions and expectations of hypnotherapy as well as their symptom response.

METHODS

150 consecutive IBS patients (116 females, 34 males, aged 16-81 years) receiving hypnotherapy completed questionnaires recording IBS symptom severity, quality of life, noncolonic symptoms, anxiety and depression levels before and after treatment. Their expectations and perceptions of HT were also recorded, including a free text reflection.

RESULTS

121 patients (81%) responded to treatment consistent with our previous experience. Symptom severity scores, noncolonic symptoms, quality of life, anxiety and depression significantly all improved after HT (p < 0.001). Expectancy of an improvement with hypnotherapy was greater in those who did not respond to treatment (63%) than those who did (57%, p < 0.001). Scepticism and apprehension were common before treatment and replaced with enthusiasm afterwards. Free text responses after treatment were overwhelmingly positive. Patients also reported a variety of other benefits and even 20 of 29 symptom nonresponders (70%) still considered treatment worthwhile.

CONCLUSION

Although initially perceived negatively, hypnotherapy improved symptoms and resulted in a wide range of additional benefits. Expectation did not necessarily influence outcome. Recording IBS symptoms alone does not fully capture the patient's experience of treatment and needs to be considered in future research.

The Impact of Psychological Health on Patient Recovery After Arthroplasty

PURPOSE

The purpose of this study was to determine the relationship between psychological health and postoperative recovery and satisfaction in patients undergoing total joint arthroplasty (TJA).

METHODS

We prospectively enrolled patients undergoing TJA from July 2019 to December 2020. A psychological evaluation was conducted according to the Hospital Anxiety and Depression Scale (HADS). Based on the preoperative HADS scores, we grouped the patients into two groups: the symptomatic group and the asymptomatic group. Data on the Harris Hip Score (HHS), Knee Society Knee Scoring System (KSS), Forgotten Joint Score-12 (FJS-12), Short Form-12 (SF-12), and Numeric Rating Scale (NRS) for pain in these two groups were collected preoperatively and postoperatively. Then, these data were analyzed by Statistical Package for Social Sciences (SPSS) version 19.

RESULTS

The final cohort consisted of 80 patients. Patients undergoing TJA had significantly decreased HADS and NRS scores and improved HHS, KSS, SF-12, and FJS-12 scores (all p < 0.001). Compared with the symptomatic group, the asymptomatic group showed better postoperative recovery (p < 0.05), especially after total knee arthroplasty (TKA) (p < 0.05). Good postoperative recovery positively impacted the patients' postoperative psychological state.

CONCLUSION

Finally, the psychological state can affect recovery after TJA, and successful TJA can help improve patients' psychological states, especially after TKA.

Integrated fecal microbiome-metabolome signatures reflect stress and serotonin metabolism in irritable bowel syndrome

To gain insight into the complex microbiome-gut-brain axis in irritable bowel syndrome (IBS), several modalities of biological and clinical data must be combined. We aimed to identify profiles of fecal microbiota and metabolites associated with IBS and to delineate specific phenotypes of IBS that represent potential pathophysiological mechanisms. Fecal metabolites were measured using proton nuclear magnetic resonance (¹H-NMR) spectroscopy and gut microbiome using shotgun metagenomic sequencing (MGS) in a combined dataset of 142 IBS patients and 120 healthy controls (HCs) with extensive clinical, biological and phenotype information. Data were analyzed using support vector classification and regression and kernel t-SNE. Microbiome and metabolome profiles could distinguish IBS and HC with an area-under-the-receiver-operator-curve of 77.3% and 79.5%, respectively, but this could be improved by combining microbiota and metabolites to 83.6%. No significant differences in predictive ability of the microbiome-metabolome data were observed between the three classical, stool pattern-based, IBS subtypes. However, unsupervised clustering showed distinct subsets of IBS patients based on fecal microbiome-metabolome data. These clusters could be related plasma levels of serotonin and its metabolite 5-hydroxyindoleacetate, effects of psychological stress on gastrointestinal (GI) symptoms, onset of IBS after stressful events, medical history of previous abdominal surgery, dietary caloric intake and IBS symptom duration. Furthermore, pathways in metabolic reaction networks were integrated with microbiota data, that reflect the host-microbiome interactions in IBS. The identified microbiome-metabolome signatures for IBS, associated with altered serotonin metabolism and unfavorable stress response related to GI symptoms, support the microbiota-gut-brain link in the pathogenesis of IBS.

The overlapping relationship among depression, anxiety, and somatic symptom disorder and its impact on the quality of life of people with epilepsy

Background:

Emotional disorder is an important indicator for assessing the quality of life (QOL) of people with epilepsy (PWE). Depression, somatic symptom disorder (SSD) and anxiety are among the most frequently occurring mental disorders and overlap with each other.

Objectives:

This study examines the overlap of these three emotional disorders and their effects separately and in combination on the QOL of PWE.

Design:

Cross-sectional study.

Data Sources and Methods:

Adults attending our epilepsy clinic between 1 July 2020 and 1 May 2022 were consecutively enrolled. They were screened for depression, SSD, and anxiety by structured interviews, and demographic, epilepsy-related and QOL indicators were collected. Multivariate analysis, propensity score matching (PSM) and stratified analysis were used to explore the effects of their respective and combined effects on QOL.

Results:

Among the 749 patients, 189 patients (25%) were diagnosed with depression, 183 patients (24%) were diagnosed with SSD, and 157 patients (21%) were diagnosed with anxiety. The frequency of occurrence of each emotional disorder together with other emotional disorders was higher than the frequency of occurrence of an emotional disorder alone. Depression, SSD, and anxiety all had an independent effect on QOL of PWE ( p < 0.001). Depression had the greatest effect, followed by SSD, and then anxiety ( β: multivariate analysis, −11.0 versus –7.8 versus –6.5; PSM, −14.7 versus –9.4 versus –6.8). The QOL of PWE decreased more significantly with the increasing number of comorbid emotional disorders ( β: –12.1 versus –20.7 versus –23.0).

Conclusion:

It is necessary to screen for three emotional disorders, that is, depression, SSD, and anxiety, in PWE. Attention should be paid to people with multiple comorbid emotional disorders.

The impact of family function on mental health status in patient with inflammatory bowel disease: The mediating role of self-esteem

OBJECTIVE

Family function is a protective factor for mental health status in IBD patients; however, the underlying processes are unknown. This study aimed to investigate the mediating influence of self-esteem on family functioning and mental health.

METHODS

This cross-sectional study comprised a total of 133 IBD patients who were assessed for family function (APGAR) and depression symptoms. (PHQ-9), anxiety symptoms. (GAD-7) and self-esteem (RSES) via self-administered questionnaires. Mediating effects were tested using the SPSS Process program with bootstrap.

RESULTS

The total score of PHQ-9 was 7.44 ±5.54. The total score of GAD-7 was 6.15±4.78. Significant associations were identified among family function, self-esteem, depression, and anxiety symptoms. Results revealed a significant indirect effect, suggesting that the effects of family function on depression and anxiety symptoms were mediated by self-esteem; the indirect effects percentages were 41.63 and 29.25.

CONCLUSION

These results indicate that the family function of IBD patients can predict their mental health condition. As self-esteem is a mediating element, which may have been influenced by family function, mental health status is indirectly affected. Therefore, promoting the self-esteem of IBD patients is crucial for facilitating long-term mental wellness.