Biomedical subjects

Alv A Dahl

Publications and source records attributed to Alv A Dahl.

At least 19 recordsLinked to original sources

PubMed2007

Association of low blood pressure with anxiety and depression: the Nord-Trøndelag Health Study.

BACKGROUND: Low blood pressure has mainly been regarded as ideal, but recent studies have indicated an association with depression in elderly people. OBJECTIVE: To investigate whether low blood pressure is associated with anxiety and depression in the general population. DESIGN: Cross-sectional study. SETTING: Participants in the population-based Nord-Trøndelag Health Study (HUNT-2, 1995-7), Norway. PARTICIPANTS: 60,799 men and women aged 20-89 years filled in the Hospital Anxiety and Depression Scale as part of a general health study. Systolic and diastolic blood pressure was classified in age-stratified and sex-stratified centile groups. MAIN RESULTS: Compared with participants with systolic blood pressure within the 41-60 centile (reference) group, the odds ratio for anxiety was 1.31 (95% confidence intervals (CI) 1.16 to 1.49), for depression 1.22 (95% CI 1.03 to 1.46), and for comorbid anxiety and depression 1.44 (95% CI 1.24 to 1.68) in the group with < or =5 centile systolic blood pressure. Slightly weaker associations were found of low diastolic blood pressure with anxiety and depression. These associations were similar across sex and age groups. Physical impairment, smoking and angina pectoris influenced the associations only marginally, whereas stroke, myocardial infarction, use of drugs for hypertension, body mass index and several other covariates had no influence. CONCLUSIONS: This study represents epidemiological evidence for an association of low blood pressure with anxiety and depression, which is not caused by cardiovascular disease.

Adult↗

PubMed2006

General practitioners' self-perceived ability to recognize severity of common mental disorders: an underestimated factor in case identification?

BACKGROUND: Several studies have shown that general practitioners (GPs) under-diagnose common mental disorders, and that training courses hardly improve this practice. The influence of GPs' self-perceived ability to recognize the severity of such disorders on these facts has not been investigated. This study explores: 1) GPs' perceived ability to recognize major depressive episode (MDE) and generalized anxiety disorder (GAD) in their patients; 2) The GPs' observed ability to recognize severity of these disorders; and 3) If the observed ability to recognize severity is associated with their perceived ability. METHODS: In a cross-sectional design 40 Norwegian GPs examined 15-28 patients each (total N = 724). The GPs' rated their perceived ability to recognize MDE and GAD on a four-point Likert-scale. The GPs' observed ability to recognize severity was defined as the mean of the correlations between the GPs rating of Clinical Global Impression-Severity Scale and the diagnostic reference standards for MDE and GAD filled in by patients. RESULTS: Twenty-two GPs considered their perceived ability to recognize MDE as rather good, and the other 18 as moderate/bad. For GAD 12 GPs' perceived their ability as rather good, while 28 considered their ability to be moderate/bad. The observed ability to recognize severity concerning MDE was 0.63 and concerning GAD 0.45. There was no significant association between GPs' perceived and observed abilities to recognize MDE (p = 0.19) and GAD (p = 0.34) CONCLUSION: This study found a discrepancy between the GPs' perceived and observed ability to recognize common mental disorders. The lack of association between GPs' perceived and observed ability to recognize such disorders indicate low understanding of own recognition abilities. This might contribute to explain the low effectiveness of interventions aimed to increase GPs' abilities to recognize mental disorders.

Journal Article↗

PubMed2006

Primary caregivers of cancer patients in the palliative phase: a path analysis of variables influencing their burden.

Research has shown that several variables influence the burden of primary caregivers of cancer patients staying at home in the palliative phase, but the associations between these variables have hardly been explored. The aim of this study was to examine the associations of theory-driven variables with the caregivers' burden by means of path analysis. The sample consisted of 96 caregivers of cancer patients in the palliative phase staying at home recruited from a hospital trust in Norway. The dimensions of burden from the Caregiver Reaction Assessment, namely self esteem, lack of family support, impact on finances, and impact on daily schedule, were used as the dependent variable. The following independent variables were tested in the models: the patients' levels of pain, fatigue, and nausea; and the caregivers' physical quality of life, anxiety and depression, and social support. The Partial Least Squares approach to structural equation modelling was used for the path analysis. Model 1 shows the direct associations between the independent variables and the dependent variable, explaining 16% of the variance in caregiver burden. Model 1 supports the finding that only caregivers' depression has a direct significant association with caregiver burden, and shows further that the effects of the other independent variables on burden are mediated through depression. In Model 2, anxiety and depression are mediating factors between three other independent variables and caregiver burden, and 12% of the variance is explained. Model 2 supports none of the independent variables as antecedents of burden. Testing of the models suggested that caregivers' depression was the main factor associated with caregiver burden, but also an important mediator of indirect associations of indirect associations of caregivers' anxiety and physical health.

Aged↗

PubMed2006

A critical review of patient-rated quality of life studies of long-term survivors of cervical cancer.

OBJECTIVES: Increasing survival rates of cervical cancer (CC) patients and the trend towards more toxic multimodal therapy have led to focus on the quality of life (QOL) of cervical cancer survivors (CCSs). The aim of this critical review was to summarize and discuss the research findings of QOL in CCSs based on self-report measures in terms of physical, psychosocial, and sexual well-being. METHODS: Electronic databases were used to identify studies published between 1966 and August 2005. A quality assessment using methodological and treatment-related criteria was performed to distinguish between studies with good and less good methodology. RESULTS: Twenty-three studies were included, whereof eight had a good methodology. Eight studies used at least one questionnaire that had not been validated previously, and only one of the validated questionnaires had been tested in former studies of CCSs. The studies with good methodology focused primarily on sexual and social function after treatment, and less on physical and psychological well-being. The trend is that radiotherapy is more associated with reduced QOL dimensions than surgery or chemotherapy. In earlier stages of CC and following surgery alone, there seem to be minor differences between CCSs and control groups concerning various QOL domains. CONCLUSIONS: Reviewed studies indicate that quality of life in cervical cancer survivors is reduced compared to the general female population following radiotherapy, but less so following surgery and earlier stages of cervical cancer. Shortcomings of both methodology and content of the studies reviewed preclude definite conclusions concerning QOL for the moment.

Female↗

PubMed2006

A comparative study of living conditions in cancer patients who have returned to work after curative treatment.

GOALS OF WORK: The goal of this study was to explore living conditions among disease-free cancer survivors participating in the labour force after successful primary treatment. Their living conditions were compared with the conditions of matched controls from the general Norwegian population. PATIENTS AND METHODS: Living conditions are social indicators that stimulate social inclusion and reduce exclusion such as economy, employment, health, housing and social participation. A questionnaire covering living conditions with established questions from population surveys was mailed to 852 cancer survivors and 1,548 controls. Valid responses were obtained from 51% cancer survivors (216 women with breast cancer, 49 men with prostate cancer, and 165 with testicular cancer) and 39% controls (317 women and 279 men). MAIN RESULTS: Compared to their controls cancer survivors showed no difference in work hours or full-time jobs, but reported significantly poorer physical and mental work capacity. This was associated with significantly more somatic diseases among survivors and poorer general health status in male survivors. The survivors had significantly smaller households and more living space than controls. No significant differences were observed concerning economy or social participation, except that significantly more female survivors than controls stated that they had enough friends. CONCLUSIONS: In spite of poorer health, tumour-free survivors after breast, testicular, and prostate cancer report mostly equal living conditions compared to matched controls. The protection hypothesis of holding jobs as a precondition for normal living condition was confirmed in our study of a sample of cancer survivors with good outcome.

Activities of Daily Living↗

PubMed2006

Global quality of life in primary caregivers of patients with cancer in palliative phase staying at home.

GOAL OF WORK: Research on global quality of life (GQOL) in primary caregivers (PCGs) of cancer patients is limited. This study measured significant domains of GQOL in PCGs and their association with the patients' disease trajectory and the PCGs' background and life situation. This study also explored differences in their GQOL compared to a normative sample from the general population (NORM). PATIENT AND METHODS: In a cross-sectional design, 71 PCGs (aged > or = 50 years) of cancer patients in palliative phase rated their GQOL by the Quality of Life Scale (QOLS) and provided information concerning demography, experienced social support, and caring situation. Associations between the QOLS scores and variables of the patients' medical history were assessed, and comparisons of QOLS scores were made between the PCGs and age- and gender-adjusted NORM. MAIN RESULTS: Long duration of the curative phase for patients and holding a job for PCGs were significantly associated with a favorable GQOL in PCGs. The mean total GQOL score did not differ significantly between the PCGs and NORM groups, though subanalyses revealed significantly more favorable mean score of the relational domain in PCGs compared to NORM. CONCLUSIONS: GQOL in PCGs of cancer patients in palliative phase staying at home was as good as that of the NORM. For PCGs not employed or caring for patients with a short curative phase, getting some recreation could be of importance for improvement of GQOL.

Adaptation, Psychological↗

PubMed2006

Feasibility of mental health screening and intervention in the HUNT population study.

BACKGROUND: The aim of the current study was to investigate feasibility, response, and consequences of mental health screening and intervention in a population study setting. METHODS: In the Intervention study against Depression and Anxiety in Nord-Trøndelag (IDANT), all GPs and psychiatric nurses were invited to a psychiatric educational programme prior to the Health Study of Nord-Trøndelag County, Norway (HUNT 2, 1995-1997). Included in the HUNT 2 was the Hospital Anxiety and Depression rating Scale (HADS). All participants scoring 25 points or above (99th percentile, n = 654) were defined as the Psychiatric High Risk Group, (PHRG) and received a written notification regarding their high scores with a request to see their GP and to participate in the IDANT. RESULTS: In total 422 (64%) baseline forms could be retrieved in the IDANT. However, only 177 (27%) were returned by the GPs. Three out of four participants in the PHRG were already recognised by their GPs as patients with mental disorders prior to the IDANT. Negative reactions to the notification letter or to the invitation to the IDANT were uncommon, still only half of the subjects in the PHRG participated in the study. However, as a consequence of the IDANT in 64% of the cases the GPs started new treatment, revised ongoing treatment, or referred the respondents. CONCLUSIONS: Though attitude towards psychiatry among GPs and participants was generally positive, response to the IDANT study was inadequate. Relatively few new cases were detected, yet the results indicate that the GPs altered their psychiatric care and practice markedly within the PHRG. Whether the educational programme had an impact on psychiatric services in the county in general cannot be answered in this study.

Adult↗

PubMed2006

The caregiver reaction assessment: psychometrics, and temporal stability in primary caregivers of Norwegian cancer patients in late palliative phase.

BACKGROUND: Limited research has been done on the situation of primary caregivers (PCs) to patients staying at home with cancer in the palliative phase. This study uses the Caregiver Reaction Assessment (CRA) to examine PCs caregiver burden and well-being. PATIENTS AND METHODS: The sample consisted of 85 PCs examined at baseline, among them 42 were re-examined four months later. We explored the psychometric properties of the CRA at baseline, and introduced a CRA sum score. The CRA sum score was correlated with the Short Form 36 (SF-36) and The Hospital Anxiety and Depression Scale (HADS) scores. RESULTS: The internal consistency of the CRA dimensions varied between alpha 0.57 and 0.85, and the factor structure was in line with earlier studies. The CRA sum score correlated significantly with all mental dimensions on the SF-36 and the HADS. At baseline the PCs showed significantly worse scores except for family support when compared to newly diagnosed cancer patients. The mean scores on the CRA dimensions as well as the total score did not change significantly from baseline to follow-up. CONCLUSION: We have confirmed the psychometric properties of the CRA, which seems to be an appropriate instrument for assessment the PCs caregiver situation.

Adolescent↗

PubMed2006

Quality of life and its relation to cancer-related stress in women of families with hereditary cancer without demonstrated mutation.

BACKGROUND: Although quality of life (QoL) and mental distress in women belonging to familial cancer families have been studied, little is known on these matters in women with absence of demonstrated mutations. The aim of this study was to examine QoL and cancer-related distress in such women. METHODS: About 330 women at risk for familial cancers in the absence of demonstrated mutations were invited to the study. About 239 women (72%) (risk group) completed the Short Form 12 (SF-12) and the Impact of Event Scale (IES). The SF-12-findings were compared to the age-adjusted findings from the general female population (controls). RESULTS: The risk group had significantly better physical QoL than controls, while no significant difference was found for mental QoL. Within the risk group the type of familial cancer did not make a significant difference in QoL, but to have a father with cancer or a deceased parent, was associated with increased risk of being a case with low QoL. Mental QoL showed moderate correlation with cancer-related distress. CONCLUSIONS: Women belonging to familial cancer families in the absence of demonstrated mutations had at least as good QoL as controls in spite of living with a permanent cancer-related threat.

Adult↗

PubMed2006

Scale for chemotherapy-induced long-term neurotoxicity (SCIN): psychometrics, validation, and findings in a large sample of testicular cancer survivors.

BACKGROUND: Neurotoxicity is common after modern chemotherapy, and can be assessed both objectively and subjectively based on symptoms reported by patients. The aim of this study was to explore the psychometric properties of a brief self-report scale for chemotherapy induced long-term neurotoxicity (the SCIN). METHODS: As part of a questionnaire survey 684 testicular cancer survivors (TCSs) filled in the SCIN, which assesses peripheral sensory neuropathy (paresthesias), Raynaud's phenomenon, and ototoxicity. Factor structure and internal consistency reliability of the SCIN were tested by the split-half method. In 538 TCSs, audiogram data were compared to the patients SCIN ratings of hearing. RESULTS: The internal consistency of the SCIN showed a Cronbach's alpha of 0.72. The three-factor structure of the SCIN was confirmed with 77% explained variance. All the SCIN items discriminated significantly between the TCSs who had been treated with cisplatin-based chemotherapy vs. those who did not receive such treatment. The individual cumulative cisplatin dose correlated significantly with all the SCIN items. The Pearson product-moment correlation coefficient was 0.54 between hearing reduction at 4000 Hertz measured by audiogram and the SCIN self-report of reduced hearing. CONCLUSION: The SCIN shows good psychometric properties, and is recommended as a brief screening instrument for chemotheraphy-indeed neurotoxicity.

Adolescent↗

PubMed2006

Assessment of male sexual function by the Brief Sexual Function Inventory.

OBJECTIVE: To present normative data from Norway using the Brief Male Sexual Function Inventory (BSFI, the first patient self-administered questionnaire to assess male sexuality, and used in the USA) in men aged 20-79 years, examine the psychometric properties of the BSFI, explore the impact of sexual function and other variables on overall sexual satisfaction, and compare American and Norwegian normative data. SUBJECTS AND METHODS: From public official address lists 3500 men aged 20-79 years were invited to take part in an anonymous questionnaire study, including the BSFI. Altogether 1185 (34%) responded, and the response rates varied with age. RESULTS: There was increasingly reduced sexual function concerning drive, erection, ejaculation, and problem assessment with age, and most of the age-effect started at >50 years old. Overall sexual satisfaction followed the same trend, but with a weaker association with age. Analyses of factor structure and internal consistency of the BSFI supported a one-factor solution with good internal consistency. Drive, erection, ejaculation, and problem assessment explained 28% of the variance in overall sexual satisfaction. Being younger and having a sexual partner were also associated with high scores of overall sexual satisfaction. American and Norwegian normative data in the BSFI dimensions were markedly similar. CONCLUSION: The BSFI is a short and discrete screening tool for sexual function, and for most clinical and research purposes we recommend using the BSFI as a one-dimensional scale.

Adult↗

PubMed2006

A population-based cohort study of the effect of common mental disorders on disability pension awards.

OBJECTIVE: Mental illness is consistently underrecognized in general health care, which may lead to underestimation of its effects on awards for social security payments. The authors investigated empirically the contribution of psychiatric morbidity to the award of disability pensions, in particular those awarded for physical diagnoses. METHOD: Using a historical cohort design, the authors utilized a unique link between a large epidemiological cohort study and a comprehensive national database. Baseline information on mental and physical health was gathered from a 1995-1997 population-based health study of those of working age (20-66 years) in Nord-Trøndelag County, Norway, who were not recipients of disability pension (N=45,782). The outcome assessed was the awarding of disability pensions ascribed to specific ICD-10 diagnoses within 6 to 30 months as registered in the National Insurance Administration. RESULTS: Anxiety and depression were robust predictors of disability pension awards in general, even when disability pensions awarded for any mental disorder were excluded. These effects were only partly explained by baseline somatic symptoms and diagnoses and were stronger in individuals aged 20-44 than in those aged 45-66. Somatic symptoms accounted for far more disability pension awards than did somatic diagnoses. CONCLUSIONS: The cost of common mental disorders in terms of disability pensions and lost productivity may have been considerably underestimated by official statistics, particularly for younger claimants. The results suggest this might be due both to overuse of physical diagnoses and underrecognition of common mental disorders in primary care.

Adult↗

PubMed2006

Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden.

OBJECTIVES: This study assessed the prevalence rate of generalized anxiety disorder among patients of general practitioners in Denmark, Finland, Norway, and Sweden and determined whether general practitioners recognize the condition and its correlates. METHODS: Data were gathered in September 2001. Participating patients received a questionnaire that included the Generalized Anxiety Questionnaire and the Depression Screening Questionnaire. The scale used DSM-IV criteria to identify generalized anxiety disorder and major depressive episode. General practitioners filled in a questionnaire about their patients' mental and physical illnesses, including generalized anxiety and major depressive episode. General practitioners' basic sociodemographic data and professional career information were also gathered. RESULTS: A total of 648 general practitioners and 8,879 patients participated in the study. The age-standardized rates for generalized anxiety disorder ranged from 4.1 to 6.0 percent for males and from 3.7 to 7.1 percent for females; for major depressive episode the rates ranged from 7.2 to 11.5 percent for males and from 9.9 to 14.2 percent for females. The proportion of generalized anxiety disorder cases recognized by general practitioners varied from 33 percent in Denmark to 53 percent in Norway. Recognition of generalized anxiety disorder by general practitioners was associated with presentation of anxiety problems by the patients. Physical symptoms as a reason for a consultation was associated with lowered recognition of generalized anxiety disorder. Previous diagnoses of generalized anxiety disorder or anxiety neurosis were associated with increased recognition of generalized anxiety disorder. CONCLUSIONS: Of the total percentage of cases of generalized anxiety disorder in general practice (4.8 percent for males and 6.0 percent for females), only one-third to one-half of the cases were identified by the general practitioners.

Anxiety Disorders↗

PubMed2005

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 > or =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 > or =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 > or =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.

Adult↗

PubMed2005

Side effects and cancer-related stress determine quality of life in long-term survivors of testicular cancer.

PURPOSE: The prevalence of long-term survivors after treatment for testicular cancer (TC) is increasing, and most studies display normal or only slightly reduced quality of life (QOL) in TC survivors (TCSs). Impaired QOL is claimed to be associated with treatment modality and its side effects, although most studies in this field can be criticized for various methodologic shortcomings. We wanted to examine variation in long-term QOL in TCSs in relation to TC treatment modality, side effects, and TC-related stress in a large population. PATIENTS AND METHODS: QOL, side effects, and TC-related stress were self-rated by a questionnaire at a mean of 11 years of follow-up in 1,409 TCSs treated from 1980 to 1994. Norm data was obtained from 2,678 males who were representative of the general population. QOL was measured with the Short Form-36 (SF-36), and TC-related stress was measured with the Impact of Event Scale. RESULTS: There were no clinically relevant differences in QOL between TCSs and age-adjusted norm data, although there was a slightly lowered SF-36 Physical Component Summary Score in TCSs. Variation of QOL in TCSs was related to self-reported side effects and TC-related stress but not to TC treatment modality. A significant association was found between side effects and TC-related stress. CONCLUSION: TCSs do not suffer long term from reduced QOL, and only minor differences in QOL were found between different treatment modalities. TCSs who report more side effects or TC-related stress have increased risk for reduced QOL, but these associations are not explained by TC treatment modalities. Further QOL research in this area should explore vulnerability factors for side effects and TC-related stress.

Adult↗

PubMed2005

Testing the Job Demand-Control-Support model with anxiety and depression as outcomes: the Hordaland Health Study.

AIM: To test the strain/iso-strain, interaction and buffer hypotheses of the Job Demand-Control-Support model in relation to anxiety and depression. METHODS: Five thousand five hundred and sixty-two workers with valid Demand-Control-Support Questionnaire (DCSQ) scores were examined with the sub-scales of the Hospital Anxiety and Depression Scale as outcomes. Multiple statistical methods were applied. RESULTS: The strain and iso-strain hypotheses were confirmed. Generally, additive and non-interaction effects were found between psychological demands, control and social support. The buffer hypotheses were refuted. Results from analyses testing different interaction operationalizations were complementary. CONCLUSIONS: High demands, low control and low support individually, but particularly combined, are risk factors for anxiety and depression. Support is the DCSQ index most strongly associated with anxiety and depression in women. Assessment of psychosocial work environment may identify workers at risk, and serve as a basis for job-redesign.

Adult↗

PubMed2005

Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy.

PURPOSE: To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness (CRF), mental distress, and health-related quality of life (HRQOL) parameters in young and middle-aged cancer patients shortly after curative chemotherapy. PATIENTS AND METHODS: One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast, gynecologic, or testicular cancer completed the trial. These patients were randomly allocated to either an intervention group (n = 59), which underwent a 14-week training program, or a control group (n = 52) that received standard care. Primary outcome was change in CRF, as determined by Astrand-Rhyming indirect bicycle ergometer test (maximum oxygen uptake [VO(2max)]), between baseline (T0) and follow-up (T1). Secondary outcomes were mental distress, as assessed by the Hospital Anxiety and Depression Scale, and HRQOL, as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire. Two-way analysis of covariance was used to analyze changes from T0 to T1. RESULTS: VO(2max) increased by 6.4 mL/kg(-1)/min(-1) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1) in patients in the control group (P < .01). The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group (P < .01). There were no intergroup differences in mental distress or HRQOL. CONCLUSION: A supervised, home-based, flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy, but it has no favorable effect on patients' experience of fatigue, mental distress, or HRQOL.

Adolescent↗

PubMed2005

Study of anxiety disorder and depression in long-term survivors of testicular cancer.

PURPOSE: To increase our knowledge of the prevalence of anxiety disorder and depression in long-term testicular cancer survivors (TCSs), and to identify variables associated with such caseness. PATIENTS AND METHODS: Participants were 1,408 TCSs treated between 1980 and 1994 in Norway. Participants provided information about their medical, social, and familial situation on a questionnaire. They also completed the Hospital Anxiety and Depression Scale (HADS). Anxiety disorder and depression were defined by a score >/= 8 on the HADS subscales. The prevalence rates were compared with age-adjusted norm data. RESULTS: HADS-defined anxiety disorder was more prevalent in TCSs (19.2%; 95% CI, 17.2% to 21.3%) than in the norm sample (13.5%; 95% CI, 13.1% to 13.9%; P < .001), whereas the prevalence of HADS-defined depression did not differ from the norm (TCSs, 9.7%; 95% CI, 8.1% to 11.2% v norm, 10.1%, 95% CI, 9.5 to 10.5; P = .56). The relative risk for anxiety disorder was 1.49 (95% CI, 1.31 to 1.69) and for depression the relative risk was 0.96 (95% CI, 0.81 to 1.14) in TCSs compared with norm. In multivariate analyses, HADS-defined anxiety disorder in TCSs was associated with young age, peripheral neuropathy, economic problems, alcohol problems, sexual problems, relapse anxiety, and having been treated for mental problems. CONCLUSION: Long-term TCSs have an increased risk of HADS-defined anxiety disorder that warrants clinical attention. Checking easily available demographic and TC-related data and use of a simple screening test such as HADS assists the identification of TCSs with anxiety disorder.

Adult↗