Development and Validation of the Geriatric Anxiety Inventory

Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people. Methods:We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale. Results: Cronbach's alpha for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test-retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%. Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD

Animal farm: Do our four-legged friends hold the answer to inflammatory bowel disease?

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Hygiene hypothesis in inflammatory bowel disease: A critical review of the literature

The hygiene hypothesis is thought to be a significant contributor to the growing incidence of inflammatory bowel disease (IBD) around the world, although the evidence for specific factors that underlie the hygiene hypothesis in IBD is unclear. We aimed to systematically review the literature to determine which hygiene-related factors are associated with the development of IBD. Publications identified from a broad based MEDLINE and Current Contents search between 1966 and 2007 on key terms relevant to the 'hygiene hypothesis' and IBD including H pylori exposure, helminths, cold chain hypothesis, measles infection and vaccination, antibiotic use, breastfeeding, family size, sibship, urban upbringing, day care attendance and domestic hygiene were reviewed. The literature suggests that the hygiene hypothesis and its association with decreased microbial exposure in childhood probably plays an important role in the development of IBD, although the strength of the supporting data for each of the factors varies considerably. The most promising factors that may potentially be associated with development of IBD include H pylori exposure, helminths, breastfeeding and sibship. However, the vast majority of studies in this area are plagued by serious methodological shortcomings, particularly the reliance on retrospective recall of information making it difficult to truly ascertain the importance of a 'hygiene hypothesis' in IBD. The 'hygiene hypothesis' in IBD is an important area of research that may give clues to the aetiology of this disease. Directions for future research are recommended

A history of abuse in community subjects with irritable bowel syndrome and functional dyspepsia: The role of other psychosocial variables

Background/Aims: Why abuse is associated with irritable bowel syndrome and functional dyspepsia remains unclear but other psychosocial factors may be important. We hypothesized that other psychosocial variables may confound the association. Methods: 207 subjects identified from a previous population survey who also met Rome I criteria for IBS (n = 156) or functional dyspepsia (n = 51) were included in the study. Controls (n = 100) did not report having any abdominal pain in a previous population survey. Sexual, physical, emotional/ verbal abuse as a child (≤ 13 years) and adult (≥ 14 years) was assessed using validated self-report questions. Other psychological variables were assessed via validated self-report. Results: Adulthood abuse was significantly more common in IBS and/or functional dyspepsia (40%) compared with healthy controls (25%). Abuse was not an independent predictor for IBS or functional dyspepsia when psychological and buffering factors were controlled for in the analyses. Having a diagnosis of depression and using a self-controlling coping style were significantly associated with having a history of abuse. Conclusions: Abuse occurring as an adult was significantly associated with IBS and/or functional dyspepsia, but it was not an important factor when psychosocial factors were controlled for in these disorders

Somatization an independent psychosocial risk factor for irritable bowel syndrome but not dyspepsia: A population-based study

BACKGROUND: A psychosocial conceptualization for irritable bowel syndrome and unexplained dyspepsia has been proposed, but remains untested. We conducted a comprehensive population-based study to determine what psychiatric and psychosocial factors, if any, are important in irritable bowel syndrome and dyspepsia. METHODS: Two hundred and seven participants identified from two previous Australian population surveys who also met Rome I criteria for irritable bowel syndrome (n=156) or unexplained dyspepsia (n=51) were included in the study. Consulters (n=103) were those who had had visited their general practitioner for gastrointestinal symptoms at least once in the prior 12 months. Nonconsulters had not sought medical care for gastrointestinal symptoms in the past year. Controls (n=100) did not report having any abdominal pain in a previous population survey. Psychosocial variables were assessed using structured interviews and validated self-report measures. RESULTS: Psychiatric diagnoses, neuroticism, more highly threatening life event stress, an external locus of control and ineffectual coping styles were significantly associated with having a diagnosis of irritable bowel syndrome and/or dyspepsia. Only somatization (odds ratio=5.28, 95% confidence interval 1.57-17.68), however, was independently associated with irritable bowel syndrome. Psychosocial factors did not discriminate between consulters and nonconsulters. CONCLUSIONS: Somatization is likely play a key role in explaining irritable bowel syndrome but not dyspepsia

Sexual, physical, verbal/emotional abuse and unexplained chest pain

Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress. Methods: Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n = 27) had chest pain in the past 12 months that was not heartburn or heart disease. People in the comparison group (n = 60) did not have chest pain for more than 12 months. Self-reported abuse and psychological variables were assessed using validated measures. Results: Emotional/verbal abuse (20.8% versus 4.4%, P = 0.032) and physical abuse (16.7% versus 2.2%, P = 0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR = 5.66; 95%CI 1.01–31.80, P = 0.049) even after controlling for IBS and/or FD (OR = 5.45; 95%CI 0.96–30.83, P = .05), but not when depression was controlled for (OR = 4.70; 95%CI 0.90–27.61), P = 0.08. Conclusions: A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression