The Depression, Anxiety and Stress Scale (DASS-21) as a Screener for Depression in Substance Use Disorder Inpatients: A Pilot Study.

Depression is a common co-morbid disorder in substance use disorder (SUD) patients. Hence, valid instruments are needed to screen for depression in this subpopulation. In this study, the predictive validity of the Depression, Anxiety and Stress Scale (DASS-21) for the presence of a depressive disorder was investigated in SUD inpatients. Furthermore, differences between DASS-21 scores at intake and those recorded one week after inpatient detoxification were assessed in order to determine the measurement point of the assessment of the DASS-21 leading to the best predictive validity. The DASS-21 was administered to 47 patients at intake and shortly after inpatient detoxification. The results of the DASS-21 were compared to the Mini International Neuropsychiatric Interview (MINI), which served as the gold standard. Levels of sensitivity and specificity of 78-89% and 71-76% were found for the DASS-21 assessed after detoxification, satisfactorily predicting depression as diagnosed with the MINI. Total DASS-21 scores as well as the DASS subscale for depression were significantly reduced at the second measurement, compared to the DASS at intake. We conclude that the DASS-21 may be a suitable instrument to screen for depressive disorders in SUD patients when administered (shortly) after detoxification. Future research is needed to support this conclusion.

Moderators of the response to a nurse-led psychosocial intervention to reduce depressive symptoms in head and neck cancer patients.

PURPOSE: Little is known about the variables that moderate the response to psychosocial interventions to decrease depressive symptoms in cancer patients. The purpose of this study was to determine whether variables associated with depressive symptoms in cancer patients in general moderate the response to a nurse-led psychosocial intervention in patients with head and neck cancer. METHODS: This study is a secondary analysis of a randomized controlled trial evaluating the effect of the nurse counseling and after intervention (NUCAI) on depressive symptoms 12 months after cancer treatment in patients with head and neck cancer. Of 205 patients, 103 received the NUCAI and 102 care as usual. Twenty-one variables were selected for analysis and a linear regression analyses including interaction terms was performed for each variable separately. Significant moderators were post hoc probed. RESULTS: Four moderators were found: marital status, global quality of life, emotional functioning, and social functioning. Patients who were married/living together or had low scores for global quality of life, and emotional or social functioning at baseline benefited more from the NUCAI than patients who were single or with high scores for global quality of life and emotional or social functioning. CONCLUSIONS: Marital status, global quality of life, and emotional and social functioning of head and neck cancer patients should be evaluated to determine whether they might benefit from a psychosocial intervention to combat depressive symptoms. Further research is necessary to replicate results and to contribute to the knowledge needed to make screening and personalized patient care possible.

One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: a randomized controlled trial.

BACKGROUND: Many patients with head and neck cancer (HNC) experience depressive symptoms after treatment. This randomized controlled trial investigated the effects of a psychosocial nurse counseling and after intervention (NUCAI) versus usual care on the depressive and HNC-related physical symptoms of patients with HNC at 1 year after diagnosis. METHODS: A total of 205 patients with HNC were randomly assigned to either intervention (n = 103) or usual care (n = 102), with stratification for gender and tumor stage. The NUCAI, which consisted of six bimonthly 45-minute counseling sessions, was a problem-focused intervention aimed at helping patients to manage the physical, psychological, and social consequences of HNC and its treatment. It was nurse-led and offered in combination with regular medical follow-up visits at the University Medical Center Utrecht, the Netherlands. Depressive symptoms at 1 year after diagnosis were the primary outcome. Analyses were performed on an intention-to-treat basis for the total sample and for a predefined subgroup of patients with raised levels of depressive symptoms (Center for Epidemiologic Studies-Depression score ≥ 12; n = 91) at baseline using mixed-effect models. RESULTS: One year after HNC treatment, levels of depressive symptoms were significantly lower in the intervention group than in the control group in the total sample and in the subgroup of patients with raised levels of depressive symptoms. CONCLUSION: The NUCAI was feasible and effective in reducing depressive symptoms in patients with HNC 1 year after HNC treatment, and especially in patients with raised levels of depressive symptoms. The results of this study need to be confirmed in future studies before the NUCAI can be used in daily clinical practice.

Internet and game behaviour at a secondary school and a newly developed health promotion programme: a prospective study.

BACKGROUND: This study investigated the Internet and game use of secondary school children, the compulsiveness of their use and the relationship with other health behaviours. It also evaluated the preliminary results of a recently developed school health promotion programme, implemented at a secondary school in the Netherlands in January 2008. This programme is one of the first to combine seven health behaviours in one educational programme and is a pilot project for a case-control study. METHODS: A total of 475 secondary school children completed an extensive questionnaire before and a year after starting the programme. Of these children, 367 were in first, second and third grade; the grades in which the lessons about internet and game behaviour were implemented. Questionnaires contained questions about personal information, Internet and game use (Compulsive Internet Use Scale), and other health behaviours (alcohol use, physical activity, psychosocial wellbeing and body mass index). RESULTS: Heavy Internet use was significantly associated with psychosocial problems, and heavy game use was significantly associated with psychosocial problems and less physical activity. No relationship was found with alcohol use or body mass index. The time spent on Internet (hours/day) and the number of pathological Internet users increased during the study. The number of game users decreased but heavy game use increased. CONCLUSION: The association between heavy Internet use and psychosocial problems and between game use and psychosocial problems and less physical activity emphasizes the need to target different health behaviours in one health education programme. A case-control study is needed to further assess the programme-induced changes in Internet and game behaviour of school children.

Educational intervention for patients with head and neck cancer in the discharge phase.

PURPOSE: The consequences of head and neck cancer (HNC) treatment have great impact on patients' lives. Despite the importance of preparing patients for the period after discharge, patients frequently experience a lack of information. Aims of the study were to develop a nurse-led educational intervention to provide information during a discharge interview and to investigate the effects of the intervention on informational needs and satisfaction with information in HNC patients. METHODS: A total of 48 patients participated in this quasi-experimental study. The control group (n = 26) received standard care, which included a short interview using the patients' discharge letter dictated by the nurse. The intervention group (n = 22) received the educational intervention, namely a discharge interview where trained nurses used a checklist to inform patients about: general information, wound-care, physical-social problems, work and finances. Effects associated with discharge interview were measured with the Patient Information Need Questionnaire (PINQ) and the Satisfaction with Cancer Information Profile. RESULTS: The findings showed that patients need information concerning: illness, treatment, side-effects, physical fitness, impact on functioning, duration of recovery time and impact on quality of life. The educational intervention had no significant effect on the informational needs or the level of satisfaction with information. CONCLUSIONS: A nurse-led intervention to provide discharge information was developed however no effects on patient outcomes were found. Nurses need to use an instrument to assess the informational needs of patients prior to the discharge interview. The effects of the educational intervention need to be tested in a larger group of patients.

Brachytherapy for prostate cancer does not influence long-term depression rate.

PURPOSE: Current literature describes concern for an increase in depression owing to treatment of prostate cancer. Here, depression and coping up to 8 years posttreatment are described for patients treated with (125)I brachytherapy for localized prostate cancer. METHODS AND MATERIALS: Between December 2000 and June 2010, 132 patients received questionnaires at: baseline, 1 month, 6 months, 1 year, and 8 years posttreatment. The measures included the Center for Epidemiologic Studies Depression Scale (CES-D) and the Utrecht Coping List. Also general quality of life measures were used: the Short Form Health Survey (RAND-36), the European Organization for Research and Treatment of Cancer C30 questionnaire (EORTC QLQ-C30+3) and a prostate cancer specific questionnaire (EORTC-PR25). Descriptive statistics were performed and correlations among depression, coping, and general quality of life measures were investigated. RESULTS: At baseline and all follow-up moments, approximately 10% of the patients had a CES-D score of 16 or more, indicating a clinically significant level of depressive symptoms. Depression did not seem to change in time. Active coping was the most predominant style of coping in problem situations. Coping strategy did not change in time. No relevant correlations were found between coping and depression. No significant associations were found between CES-D mean score and patient characteristics (medical and demographic). Relevant negative correlations were found between depression and HRQOL variables vitality, emotional functioning, and mental health (ρ>0.5). CONCLUSION: Prostate brachytherapy does not contribute to an increased risk of depression.

Association between urogenital symptoms and depression in community-dwelling women aged 20 to 70 years.

OBJECTIVES: To determine the association between urogenital symptoms and the occurrence of depressive symptoms. METHODS: A random sample of 3200 community-dwelling women, aged 20 to 70 years, was invited to answer a questionnaire. A total of 2042 questionnaires (63.8%) were returned. Urogenital symptoms were assessed with the Urogenital Distress Inventory and depressive symptoms with the Center for Epidemiological Studies Depression scale. A cutoff value of 16 or more on the Center for Epidemiological Studies Depression scale was considered as possible clinical depression. Univariate and multivariate logistic regression statistics were used. RESULTS: The prevalence of depressive symptoms (Center for Epidemiological Studies Depression scale score of 16 or more) was significantly greater in women with urinary incontinence than in those without (odds ratio 1.9, 95% confidence interval 1.6 to 2.3). However, this statistically significant association existed for all urogenital symptoms when assessed individually. After multivariate adjustment, the statistical significant association with depressive symptoms was lost for most urogenital symptoms. Only nocturia remained significantly associated with depression throughout all analyses (odds ratio 1.4, 95% confidence interval 1.1 to 1.8 for the symptom itself; and odds ratio 2.0, 95% confidence interval 1.3 to 3.2, when considering only bothersome nocturia symptoms). CONCLUSIONS: After adjusting for the influence of coexisting urogenital symptoms, no association between urinary incontinence and depression could be demonstrated. Only nocturia remained significantly associated with depressive symptoms.

Laryngeal cancer patients: analysis of patient delay at different tumor stages.

BACKGROUND: The aim of this study was to determine the length of stages (appraisal, illness, behavioral, and scheduling) of patient delay in patients with head and neck cancer and to find out whether these delays were related to the stage of the disease at diagnosis. METHODS: Before treatment, 117 newly diagnosed patients with laryngeal cancer were interviewed about their prediagnostic period. To determine the length of the different stages of patient delay, patients were asked about their symptoms, attributions of symptoms, and reasons to postpone medical consultation. A questionnaire was sent to the general practitioner and to a close relative to verify their answers. RESULTS: There was no significant difference in the length of patient delay between early- (T1-T2) and advanced- stage (T3-T4) disease (9 vs 5 weeks; p = .07). Only tumor site was significantly associated with patient delay. The median total patient delays for glottic and supraglottic tumors were 10 and 4 weeks, respectively (p = .00). Hoarseness/voice change was the most commonly mentioned symptom. Patients attributed their symptom most frequently to a common cold/infection or had no idea about the cause. Medical attention was postponed because symptoms were interpreted as innocuous/benign or the symptom was thought not to be serious enough. The main reason to visit the general practitioner was persistent hoarseness. Behavioral and scheduling delays were of minor importance. CONCLUSIONS: Patient delay was significantly longer in cases of glottic cancer, but diagnosis at an early stage of the disease was more frequent among these patients than among patients with supraglottic cancer. Advanced supraglottic cancer probably has a late onset of symptoms. Thus, earlier intervention will probably not result in a significantly higher proportion of small supraglottic cancers being diagnosed.

Oral and pharyngeal cancer: analysis of patient delay at different tumor stages.

BACKGROUND: The aim of this study was to examine which factors are related to patient delay in a cohort of consecutive patients with pharyngeal cancer and oral cancer and to determine whether the different stages of patient delay (ie, appraisal, illness, behavioral, and scheduling) were related to different tumor stages. METHODS: Before treatment, 55 patients with pharyngeal cancer and 134 patients with oral cancer were interviewed about their prediagnostic period. To verify the data, a questionnaire was sent to the general practitioner and/or dentist and a close relative. RESULTS: Patients with a delay of more than 30 days were significantly more often diagnosed with late-stage (T3-T4) disease (pharynx, p = .01, odds ratio [OR] = 4.5; oral, p = .01, OR = 3.2). No sociodemographic characteristics were associated with patient delay. CONCLUSIONS: Prolonged patient delay was associated with late-stage disease for both patients with pharyngeal cancer and patients with oral cancer. Although for most patients the symptoms are vague or might look like a common cold or infection, the general public should be better informed about tumor symptoms. This may enhance earlier visits to a health care professional.

Patient factors associated with delay in primary care among patients with head and neck carcinoma: a case-series analysis.

BACKGROUND: Head and neck cancer patients are often diagnosed with advanced stage disease, while the location is easily accessible for examination or distinct symptoms are present. Professional delay in primary care affects tumour stage and survival. There has been little research on the role of the patient in delaying referral or diagnosis once the patient has visited a primary health care professional. OBJECTIVES: Our aim was to identify patient-related factors which are associated with delay in primary care and the referral to hospital. METHODS: Case-series analysis using semi-structured interviews combined with questionnaires was conducted among 306 consecutive patients newly diagnosed in a tertiary referral centre for head and neck oncology patients in The Netherlands. The main outcome measure was delay in returning to the GP or dentist after the first consultation. Logistic regression analyses were performed to test which patient-related variables made delay more likely. RESULTS: 155 patients (53%) were not referred or followed up after the first medical contact with the GP or dentist. Fifty per cent (n = 78) of them delayed returning to the health professional for more than three weeks. Patients were more likely to delay when they experienced voice change, were not familiar with head and neck cancer, were not suspicious of cancer or were generally not inclined to seek support. CONCLUSIONS: Delay in returning to the health professional is partly dependent on patient-related factors. Therefore, patients should be educated about the possible meaning and expected time-course of the symptoms and be strongly advised to return, or be followed up, within three to four weeks if the symptoms do not disappear.

Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited.

AIMS: Symptoms of urogenital dysfunction are known to negatively affect health-related quality of life in women. To assess effectiveness of treatment, it is currently recommended to include measurements of quality of life in outcome analysis. One of the questionnaires that is commonly used is the combination of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). Unfortunately, the validity of the UDI and IIQ has only been tested in highly selected subgroups of female patients. Therefore, it is unclear whether this questionnaire is suitable for use in populations with different characteristics. METHODS: We analyzed the scale construction and validity of the UDI and IIQ in a random sample of 2,042 women, aged 20-70 years old and a clinical sample of 196 women. RESULTS: Our results show that the UDI can be divided into five subscales, namely discomfort/pain, urinary incontinence, overactive bladder, genital prolapse, and obstructive micturition. The internal consistency (Cronbach's alpha) ranged between 0.74 and 0.82. In addition to the original four subscales of the IIQ (mobility, physical, social, and emotional functioning), we identified a fifth subscale with four items about embarrassment. Internal consistency of these subscales ranged between 0.83 and 0.93. In addition to the internal consistency, we tested the criterion and construct validity of these new subscale division. CONCLUSIONS: We found these subscales to be reliable and of clinical use. It is recommended to use the revised UDI and IIQ in outcome analysis of treatments for urogenital symptoms in women.