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      Anxiety and depressive features in chronic disease patients in Cambodia, Myanmar and Vietnam

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          Abstract

          Objective

          The aim of this study was to estimate the prevalence and relationship of anxiety and depressive features among patients diagnosed with a variety of chronic diseases in three Southeast Asian countries (Cambodia, Myanmar and Vietnam).

          Methods

          A cross-sectional survey was conducted in 2014 among 4803 adult patients with chronic diseases who were recruited cross-sectionally from health facilities. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale.

          Results

          Overall, 17.0% of patients screened positive for anxiety disorder and 39.1% for depressive disorder. Patients with cancer (47.8%) had the highest rate of anxiety features, and those with chronic obstructive pulmonary disease (COPD) (62.1%), kidney disease (55.5%), Parkinson’s disease (53.7%) and cardiovascular disorders (CVDs) (52.6%) the highest prevalence of depressive features. Stomach and intestinal diseases, CVDs, migraine or frequent headaches and kidney disease were positively associated with anxiety and depression after adjusting for sociodemographics and illness duration. In addition, cancer and Parkinson’s disease were positively associated with anxiety, and arthritis, diabetes, and COPD were positively associated with depression. In multivariate logistic regression, having two or more chronic conditions and poor quality of life was associated with anxiety and depression.

          Conclusion

          Considering the high rate of anxiety and depression among these patients with chronic disease, more efforts should directed to on the psychosocial management of these patients.

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          Most cited references21

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          Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.

          To review the evidence for an association between depression and anxiety and the National Health Priority Area conditions -- heart disease, stroke, diabetes mellitus, asthma, cancer, arthritis and osteoporosis -- and for the effectiveness of treatments for depression and anxiety in these settings. Systematic literature search of systematic reviews, meta-analyses and evidence-based clinical practice guidelines published between 1995 and 2007, inclusive. Each review was examined and summarised by two people before compilation. Depression is more common in all disease groups than in the general population; anxiety is more common in people with heart disease, stroke and cancer than in the general population. Heterogeneity of studies makes determination of risk and the direction of causal relationships difficult to determine, but there is consistent evidence that depression is a risk factor for heart disease, stroke and diabetes mellitus. Antidepressants appear to be effective for treating depression and/or anxiety in patients with heart disease, stroke, cancer and arthritis, although the number of studies in this area is small. A range of psychological and behavioural treatments are also effective in improving mood in patients with cancer and arthritis but, again, the number of studies is small. The evidence for the association of physical illness and depression and anxiety, and their effects on outcome, is very strong. Further research to establish the effectiveness of interventions is required. Despite the limits of current research, policy and practice still lags significantly behind best evidence-based practice. Models of integrated care need to be developed and trialled.
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            Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys.

            Prior research on the association between affective disorders and physical conditions has been carried out in developed countries, usually in clinical populations, on a limited range of mental disorders and physical conditions, and has seldom taken into account the comorbidity between depressive and anxiety disorders. Eighteen general population surveys were carried out among adults in 17 countries as part of the World Mental Health Surveys initiative (N=42, 249). DSM-IV depressive and anxiety disorders were assessed using face-to-face interviews with the Composite International Diagnostic Interview (CIDI 3.0). Chronic physical conditions were ascertained via a standard checklist. The relationship between mental disorders and physical conditions was assessed by considering depressive and anxiety disorders independently (depression without anxiety; anxiety without depression) and conjointly (depression plus anxiety). All physical conditions were significantly associated with depressive and/or anxiety disorders but there was variation in the strength of association (ORs 1.2-4.5). Non-comorbid depressive and anxiety disorders were associated in equal degree with physical conditions. Comorbid depressive-anxiety disorder was more strongly associated with several physical conditions than were single mental disorders. Physical conditions were ascertained via self report, though for a number of conditions this was self-report of diagnosis by a physician. Given the prevalence and clinical consequences of the co-occurrence of mental and physical disorders, attention to their comorbidity should remain a clinical and research priority.
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              Anxiety disorders and comorbid medical illness.

              To provide an overview of the role of anxiety disorders in medical illness. The Anxiety Disorders Association of America held a multidisciplinary conference from which conference leaders and speakers reviewed presentations and discussions, considered literature on prevalence, comorbidity, etiology and treatment, and made recommendations for research. Irritable bowel syndrome (IBS), asthma, cardiovascular disease (CVD), cancer and chronic pain were reviewed. A substantial literature supports clinically important associations between psychiatric illness and chronic medical conditions. Most research focuses on depression, finding that depression can adversely affect self-care and increase the risk of incident medical illness, complications and mortality. Anxiety disorders are less well studied, but robust epidemiological and clinical evidence shows that anxiety disorders play an equally important role. Biological theories of the interactions between anxiety and IBS, CVD and chronic pain are presented. Available data suggest that anxiety disorders in medically ill patients should not be ignored and could be considered conjointly with depression when developing strategies for screening and intervention, particularly in primary care. Emerging data offer a strong argument for the role of anxiety in medical illness and suggest that anxiety disorders rival depression in terms of risk, comorbidity and outcome. Research programs designed to advance our understanding of the impact of anxiety disorders on medical illness are needed to develop evidence-based approaches to improving patient care.
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                Author and article information

                Journal
                S Afr J Psychiatr
                S Afr J Psychiatr
                SAJPsy
                The South African Journal of Psychiatry : SAJP : the Journal of the Society of Psychiatrists of South Africa
                AOSIS
                1608-9685
                2078-6786
                28 July 2016
                2016
                : 22
                : 1
                : 940
                Affiliations
                [1 ]ASEAN Institute for Health Development, Madidol University, Thailand
                [2 ]Department of Research Innovation and Development, University of Limpopo, South Africa
                [3 ]HIV/AIDS/STIs and TB (HAST), Human Sciences Research Council, Pretoria, South Africa
                Author notes
                Corresponding author: Karl Peltzer, karl.pel@ 123456mahidol.ac.th
                Article
                SAJPsy-22-940
                10.4102/sajpsychiatry.v22i1.940
                6138068
                30263167
                899eaa6c-b687-4647-8f0c-65d38f0ab1ef
                © 2016. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 04 January 2016
                : 23 May 2016
                Categories
                Original Research

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