| Objective:Anxiety and depression disorders are two of the most common types of mood disorders of outpatients in general hospitals, which is particularly apparent in the Gastroenterology Clinic. But at present, the identification of non-specialists on anxiety and depressive disorders in general hospital is very poor. So far there is no clear inspection method for the diagnosis of anxiety and depression disorders, it is mainly based on the medical history and symptoms. This is easily resulted in missed diagnosis or misdiagnosis. The aims of this study are to investigate the incidence and influence factors of anxiety and depression in gastrointestinal outpatients of comprehensive hospital, and to explore the feasibility to make the Hospital Anxiety and Depression Scale (HAD) as a screened tool on anxiety and depression disorders in gastrointestinal outpatients.Methods:(1) Using Hospital Anxiety and Depression Scale(HAD) as tool to screen the symptoms of anxiety and depression,5:1 consecutive case samples were selected randomly on Tuesdays and Thursdays during October 2012 to September 2014. A total of 1836 cases were studied. The eight of HAD score was determined as a critical score. The HAD norm of the patients in department of internal medicine in comprehensive hospitals in China was served as control group. (2) Another 547cases selected randomly as research subjects in proportion of 5:1 consecutive gastrointestinal outpatients in our hospital on Mondays to Saturdays during March 2015 to April 2015. HAD, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale(SDS) were used to screen the symptoms of anxiety and depression at the same time.Results:1. All of 1836 cases completed the HAD measurement during October 2012 to September 2014. The average score of HAD anxiety was 4.69 ± 2.81 and the average score of depression was 4.25 ± 2.53. Both of them were significantly higher than the control group (3.30 ± 2.40 and 2.60 ± 2.20, respectively) (P<0.01, respectively). The number of cases that its score of anxiety and depression was less than 8 was 1308 (71.24%). And the score more than or equal to 8 points (positive) was in 528 (28.76%) cases, in which the number of cases that only anxiety score more than or equal to 8 was 204 cases (11.11%), the number of cases that only depression score more than or equal to 8 was 144 cases (7.84%), and the number of cases that both of anxiety and depression score more than or equal to 8 was 180 cases (9.80%). The anxiety prevalence and anxiety score in female group were significantly higher than the male group (P<0.01), while the depression prevalence and depression score in both groups were no significant difference (P> 0.05).2. A total of 547 cases were assessed on during March to April 2015. Based on SAS,152(27.8%) cases were beyond normal value, in which the cases of mild, moderate and severe anxiety were respectively 112(20.5%),33(6.0%) and 7(1.3%). Based on SDS,158(28.9%) cases were beyond normal value, and in which the cases of mild, moderate and severe anxiety were respectively 113(20.7%),38(7.0%) and 7(1.3%). Anxiety and depression disorders were related to the gender (P<0.01). The incidence of female anxiety disorders was about twice as men, and the incidence of female depressions was about 1.6 times as men, and the incidence of both anxiety and depression in women was about 3 times as that of men. Anxiety and depression incidence of the elder (over 61 years old) were higher than the young (18-40 years old) or the middle-aged people (41-60 years old), while there was no statistical significance of their difference. Anxiety and depression disorders were related to the marital status of the patients. The incidence of anxiety and depression disorders of the divorced or widowed was higher than the unmarried or married (P<0.01), although the incidence of anxiety and depression disorders of the unmarried was higher than the married, while there was no statistical significance. Depression and anxiety disorders were related to the patients’ education level (P<0.05). The higher education level the patients have, the easier anxiety and depression may occurred.3. The coincidence rate of HADS-A diagnosis for depression was 93.23% [(96+414)/547], the positive predictive value was 89.72%(96/107), and negative predictive value was 94.09%(414/440). The true sensitivity rate and the specificity rate was respectively 78.69%(96/122) and 97.41%(414/425). It showed that the anxiety part of HAD had better diagnostic efficiency, the false positive rate and the false negative rate were respectively 2.59%(11/425) and 21.31%(26/122). The coincidence rate of HADS-D diagnosis for depression was 94.70%[(117+401)/547], the positive predictive value was 93.60%(117/125), and negative predictive value was 95.02%(401/422), the true positive rate and true negative rate was respectively 84.78%(117/138) and 98.04%(401/409). It showed that the depression part of HAD had better diagnostic efficiency, the false positive rate and false negative rate were respectively 1.96%(8/409) and 15.21%(21/138).Conclusions:1. The average score of anxiety depression of patients in the Gastroenterology Clinic is significantly higher than the domestic outpatients norm, which indicated that compared to the general internal medicine clinic, the outpatients in the gastroenterology clinic of comprehensive hospital had more anxiety and depression disorders.2. In gastrointestinal outpatients of comprehensive hospitals, more women patients have anxiety symptoms than men.3. The positive rate of anxiety and depression disorders in the outpatients of the general hospitals is high. There is a large scale of patients with both anxiety and depression symptoms. It is worthy of further attention.4. In general hospitals, the prevalence rates of anxiety and depression disorders are respectively 27.79%and 28.89%. Anxiety and depression disorders in female are higher than male, the women’s prevalence rates of anxiety and depression are respectively twice and 1.6 times as men. The eldly usually have higher incidence of anxiety and depression disorders than the young. The divorced and widowed people have high incidences of anxiety and depression disorders than the unmarried or married. Anxiety and depression disorders are related to the level of education, patients with higher education level would more easily have the higher incidence of anxiety and depression disorders.5. The results of the study showe that the diagnostic accuracy, the positive predictive value, the negative predictive value, the sensitivity and specificity of HAD are all high, and the diagnostic efficacy of anxiety and depression disorders of HAD is high, both false positive and false negative rates are low. Because the HDA is relatively simple, it is easy to be accepted by the participants. HAD can be used as a routine screening tool for rapid screening symptoms of anxiety and depression in gastroenterology outpatients even all medical clinic patients of comprehensive hospital. |
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