Anxiety and Depression Short Scale: norms for its use in rehabilitation

In the rehabilitation setting it is important to identify clinically significant conditions of distress so as to be able to provide, in addition to the conventional multidisplinary rehabilitation treatment, specific psychotherapeutic interventions targeted to the individual's problems. This paper presents the findings from a psychometric test for the measurement of anxiety and depression (AD-R Scale) administered at the start and end of a rehabilitation program in patients with cardiopulmonary disease. The study population consisted of 765 patients affected by cardiac and pulmonary disease undergoing an in-hospital course of intensive rehabilitation. We observed that AD-R scores are related to sex, age and diseases. Among anxiety and depression scores there are statistically significant differences regarding sex: women achieved higher AD-R scores compared with men. Depression scores are influenced by age: younger subjects reached lower scores compared with the older ones. Among patients with respiratory disease, the subjects affected by chronic respiratory failure showed statistically significant higher depression scores compared to subjects affected by chronic obstructive pulmonary disease and bronchial asthma. Anxiety and depression scores among subjects affected by cardiac diseases did not show important differences. At the end of the multidisciplinary rehabilitation program, a significant reduction in both anxiety and depression scores was observed, compared to values at the start, particularly for those that, at the beginning of the rehabilitation program, reached clinically remarkable AD-R scores and in general for the youngest subjects. The paper also presents the means, standard deviations and percentile range of scores for anxiety and depression in the population studied, according to age, sex, underlying pathology or hospital division. The Scale AD-R appears to be a valid instrument for the screening of patients undergoing cardio-pulmonary rehabilitation and as an outcome index

Anxiety and Depression Short Scale: norms for its use in rehabilitation

In the rehabilitation setting it is important to identify clinically significant conditions of distress so as to be able to provide, in addition to the conventional multidisplinary rehabilitation treatment, specific psychotherapeutic interventions targeted to the individual’s problems. This paper presents the findings from a psychometric test for the measurement of anxiety and depression (AD-R Scale) administered at the start and end of a rehabilitation program in patients with cardiopulmonary disease. The study population consisted of 765 patients affected by cardiac and pulmonary disease undergoing an in-hospital course of intensive rehabilitation. We observed that AD-R scores are related to sex, age and diseases. Among anxiety and depression scores there are statistically significant differences regarding sex: women achieved higher AD-R scores compared with men. Depression scores are influenced by age: younger subjects reached lower scores compared with the older ones. Among patients with respiratory disease, the subjects affected by chronic respiratory failure showed statistically significant higher depression scores compared to subjects affected by chronic obstructive pulmonary disease and bronchial asthma. Anxiety and depression scores among subjects affected by cardiac diseases did not show important differences. At the end of the multidisciplinary rehabilitation program, a significant reduction in both anxiety and depression scores was observed, compared to values at the start, particularly for those that, at the beginning of the rehabilitation program, reached clinically remarkable AD-R scores and in general for the youngest subjects. The paper also presents the means, standard deviations and percentile range of scores for anxiety and depression in the population studied, according to age, sex, underlying pathology or hospital division. The Scale AD-R appears to be a valid instrument for the screening of patients undergoing cardio-pulmonary rehabilitation and as an outcome index

Best practice in psychological activities in cardiovascular prevention and rehabilitation: Position Paper

Recent guidelines on cardiovascular disease prevention suggest multimodal behavioral interventions for psychosocial risk factors and referral for psychotherapy in the case of clinically significant symptoms of depression and anxiety overall. Accordingly, psychologists of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (GICR-IACPR) have reviewed the key components of psychological activities in cardiovascular prevention and rehabilitation (CPR). The aim of this study was to elaborate a position paper on the best practice in routine psychological activities in CPR based on efficacy, effectiveness and sustainability. The steps followed were: i) a review of the latest international guidelines and position papers; ii) analysis of the evidence-based literature; iii) a qualitative analysis of the psychological services operating in some reference Italian cardiac rehabilitation facilities; iv) classification of the psychological activities in CPR as low or high intensity based on the NICE Guidelines on psychological interventions on anxiety and depression. We confirm the existence of an association between depression, anxiety, social factors, stress, personality and illness onset/outcome and coronary heart disease. Evidence for an association between depression, social factors and disease outcome emerges particularly for chronic heart failure. Some positive psychological variables (e.g., optimism) are associated to illness outcome. Evidence is reported on the impact of psychological activities on \u2018new\u2019 conditions which are now indicated for cardiac rehabilitation: pulmonary hypertension, grown-up congenital heart, end-stage heart failure, implantable cardioverter-defribrillator and mechanical ventricular assist devices, frail and oldest-old patients, and end-of-life care. We also report evidence related to caregivers. The Panel divided evidence-based psychological interventions into: i) low intensity (counseling, psycho-education, self-care, self-management, telemedicine, self-help); or ii) high intensity (individual, couples and/or family and group psychotherapy, such as stress management). The results show that psychotherapy is mainly consisting of cognitive-behavior therapy, interpersonal therapy, and short-term psycho-dynamic therapy. The current data further refine the working tools available for psychological activities in CPR, giving clear directions about the choice of interventions, which should be evidence-based and have at least a minimum standard. This document provides a comprehensive update on new knowledge and new paths for psychologists working in the CPR settings

A public early intervention approach to first-episode psychosis: Treated incidence over 7 years in the Emilia-Romagna region

AimTo estimate the treated incidence of individuals with first-episode psychosis (FEP) who contacted the Emilia-Romagna public mental healthcare system (Italy); to examine the variability of incidence and user characteristics across centres and years. MethodsWe computed the raw treated incidence in 2013-2019, based on FEP users aged 18-35, seen within or outside the regional program for FEP. We modelled FEP incidence across 10 catchment areas and 7 years using Bayesian Poisson and Negative Binomial Generalized Linear Models of varying complexity. We explored associations between user characteristics, study centre and year comparing variables and socioclinical clusters of subjects. ResultsThousand three hundred and eighteen individuals were treated for FEP (raw incidence: 25.3 / 100.000 inhabitant year, IQR: 15.3). A Negative Binomial location-scale model with area, population density and year as predictors found that incidence and its variability changed across centres (Bologna: 36.55; 95% CrI: 30.39-43.86; Imola: 3.07; 95% CrI: 1.61-4.99) but did not follow linear temporal trends or density. Centers were associated with different user age, gender, migrant status, occupation, living conditions and cluster distribution. Year was associated negatively with HoNOS score (R = -0.09, p < .001), duration of untreated psychosis (R = -0.12, p < .001) and referral type. ConclusionsThe Emilia-Romagna region presents a relatively high but variable incidence of FEP across areas, but not in time. More granular information on social, ethnic and cultural factors may increase the level of explanation and prediction of FEP incidence and characteristics, shedding light on social and healthcare factors influencing FEP