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      Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery Translated title: Subescala de Depressão da Escala Hospitalar de Depressão e Ansiedade no pré-operatório de coluna vertebral

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          Abstract

          OBJECTIVE: To evaluate the accuracy of the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D) in spine surgery, comparing it to Beck Depression Inventory (BDI). METHODS: In a cross-sectional study, the HADS-D and the BDI were applied to patients undergoing spine surgery for lumbar (n=139) or cervical spondylosis (n=17). Spearman correlation tests for HADS-D and BDI were applied. The internal consistency of HADS-D was estimated by Cronbach's alpha coefficient. RESULTS: According to the BDI, the prevalence of depression was of 28.8% (n=45). The Spearman r coefficient between HADS-D and BDI was 0.714 (p<0.001). Cronbach's alpha for HADS-D was 0.795. The area of the ROC curve was 0.845. Using a cutoff for HADS-D >10, there was a sensitivity of 71.1%, specificity of 95.4%, and positive likelihood-ratio of 15.78. CONCLUSIONS: HADS-D showed a strong correlation with BDI and good reliability. HADS-D is a good alternative for screening depression and assessing its severity.

          Translated abstract

          OBJETIVO: Avaliar a acurácia da Subescala de Depressão da Escala Hospitalar de Depressão e Ansiedade (HADS-D) em cirurgia da coluna, comparando-a com o Inventário de Depressão de Beck (BDI). MÉTODOS: Estudo transversal, no qual a HADS-D e o BDI foram aplicados em pacientes submetidos à cirurgia da coluna vertebral por espondilose lombar (n=139) ou cervical (n=17). Teste de correlação de Spearman foi aplicado entre HADS-D e BDI. A consistência interna da HADS-D foi estimada pelo coeficiente alfa de Cronbach. RESULTADOS: De acordo com o BDI, a prevalência de depressão foi de 28,8% (n=45). O coeficiente r de Spearman entre HADS-D e BDI foi de 0,714 (p <0,001). Alpha de Cronbach para o HADS-D foi de 0,795. A área da curva ROC foi de 0,845. Usando um corte para HADS-D >10, houve sensibilidade de 71,1%, especificidade de 95,4% e razão de verossimilhança positiva de 15,78. CONCLUSÕES: HADS-D apresentou forte correlação com o BDI e boa confiabilidade. A HADS-D é uma boa alternativa para a triagem de depressão e verificação da gravidade dos sintomas.

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          International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results.

          More than 200 published studies from most medical settings worldwide have reported experiences with the Hospital Anxiety and Depression Scale (HADS) which was specifically developed by Zigmond and Snaith for use with physically ill patients. Although introduced in 1983, there is still no comprehensive documentation of its psychometric properties. The present review summarizes available data on reliability and validity and gives an overview of clinical studies conducted with this instrument and their most important findings. The HADS gives clinically meaningful results as a psychological screening tool, in clinical group comparisons and in correlational studies with several aspects of disease and quality of life. It is sensitive to changes both during the course of diseases and in response to psychotherapeutic and psychopharmacological intervention. Finally, HADS scores predict psychosocial and possibly also physical outcome.
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            The hospital anxiety and depression rating scale: A cross-sectional study of psychometrics and case finding abilities in general practice

            Background General practitioners' (GPs) diagnostic skills lead to underidentification of generalized anxiety disorders (GAD) and major depressive episodes (MDE). Supplement of brief questionnaires could improve the diagnostic accuracy of GPs for these common mental disorders. The aims of this study were to examine the usefulness of The Hospital Anxiety and Depression Rating Scale (HADS) for GPs by: 1) Examining its psychometrics in the GPs' setting; 2) Testing its case-finding properties compared to patient-rated GAD and MDE (DSM-IV); and 3) Comparing its case finding abilities to that of the GPs using Clinical Global Impression-Severity (CGI-S) rating. Methods In a cross-sectional survey study 1,781 patients in three consecutive days in September 2001 attended 141 GPs geographically spread in Norway. Sensitivity, specificity, optimal cut off score, and Area under the curve (AUC) for the HADS and the CGI-S were calculated with Generalized Anxiety Questionnaire (GAS-Q) as reference standard for GAD, and Depression Screening Questionnaire (DSQ) for MDE. Results The HADS-A had optimal cut off ≥8 (sensitivity 0.89, specificity 0.75), AUC 0.88 and 76% of patients were correctly classified in relation to GAD. The HADS-D had by optimal cut off ≥8 (sensitivity 0.80 and specificity 0.88) AUC 0.93 and 87% of the patients were correctly classified in relation to MDE. Proportions of the total correctly classified at the CGI-S optimal cut-off ≥3 were 83% of patients for GAD and 81% for MDE. Conclusion The results indicate that addition of the patients' HADS scores to GPs' information could improve their diagnostic accuracy of GAD and MDE.
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              Preoperative anxiety and intraoperative anesthetic requirements.

              The purpose of this study was to determine whether larger doses of anesthetics are required in the anxious patient to establish and maintain a clinically sufficient hypnotic component of the anesthetic state. Fifty-seven women undergoing bilateral laparoscopic tubal ligation with a propofol-based anesthetic regimen were enrolled in this cross-sectional study. Trait (baseline) and state (situational) anxiety were assessed in all patients immediately before surgery, and the propofol doses required for the induction and maintenance of anesthesia were recorded. A bispectral index monitor was used to assure that the hypnotic component of the anesthetic state was the same in all patients. We found that patients with high trait anxiety required more propofol for both the induction (2.1+/-0.4 vs 1.8+/-0.3 mg/kg; P = 0.01) and maintenance of anesthesia (170+/-70 vs 110+/-20 microg x kg(-1) x min(-1); P = 0.02), compared with patients with low trait anxiety. State anxiety, however, was not found to affect the propofol doses required for the induction or maintenance of anesthesia. Multiple regression models confirmed that Trait anxiety is an independent predictor for intraoperative propofol requirements (P = 0.02). We conclude that increased baseline (i.e., trait) anxiety is associated with increased intraoperative anesthetic requirements. Thus, we suggest that the initial dose of anesthetic administered by an anesthesiologist should be modified based on the anxiety level exhibited by the patient. The goal of this study was to assess the relationship between preoperative anxiety and intraoperative anesthetic requirements. We found that high baseline anxiety predicts increased intraoperative anesthetic requirements. We suggest that anesthesiologists should modify the initial induction dose based on the anxiety level exhibited by the patient.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                anp
                Arquivos de Neuro-Psiquiatria
                Arq. Neuro-Psiquiatr.
                Academia Brasileira de Neurologia - ABNEURO (São Paulo )
                1678-4227
                May 2012
                : 70
                : 5
                : 352-356
                Affiliations
                [1 ] Universidade de Caxias do Sul Brazil
                [2 ] Santa Casa de Misericórdia de Porto Alegre Brazil
                [3 ] Universidade de Caxias do Sul Brazil
                [4 ] Hospital Beneficiência Portuguesa de Porto Alegre Brazil
                Article
                S0004-282X2012000500009
                10.1590/S0004-282X2012000500009
                22618787
                dc382277-1473-4b4e-979c-3048182cc6f8

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-282X&lng=en
                Categories
                NEUROSCIENCES
                PSYCHIATRY

                Neurosciences,Clinical Psychology & Psychiatry
                spine surgery,depression,Hospital Anxiety and Depression Scale,Beck Depression Inventory,cirurgia da coluna,depressão,Escala Hospitalar de Ansiedade e Depressão,Inventário de Depressão de Beck

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