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Letters to the Editor
The accuracy of the anxiety inventory respiratory disease scale for patients with chronic obstructive pulmonary disease Introduction Anxiety disorders are common in patients with chronic obstructive pulmonary disease (COPD). Studies have reported that the prevalence of anxiety symptoms range between 6% and 70% (Willgoss and Yohannes, 2013). There is no a valid disease-specific scale to measure anxiety for patients with COPD. In addition, very little evidence is available in studies that examined the occurrence of anxiety disorders using the psychiatric diagnostic tools even after the short-term follow-up. Our group developed the Anxiety Inventory Respiratory Disease scale (AIR) to assess and measure anxiety for patients with COPD (Willgoss et al., 2013). We explored prospectively the accuracy of the newly developed disease-specific the AIR scale in stable COPD patients using the diagnostic criteria the Mini-International Neuropsychiatric Interview (MINI) at three months in order to establish the diagnosis of psychiatric disorders.
The MINI (Sheehan et al., 1998) is a short, structured diagnostic interview developed for DSM-IV and ICD-10 psychiatric disorders. The MINI takes about 15 min to complete and has well established validity and reliability (Sheehan et al., 1998), for patients undergo psychiatric interview. Spirometry was performed using a Vitalograph 2120 handheld spirometer (Vitalograph, Buckingham, England) according to ATS/ERS Standardisation Guidelines (Miller et al., 2005). Those participants who consented to psychiatric interview were visited at 3 months by a researcher (an expert in psychiatric disorders and COPD) who was blinded to the previous results. The diagnostic interviews were conducted according to the MINI structured format (Sheehan et al., 1998) and, typically, lasted 15–30 min. Patients also completed the AIR scale prior to psychiatric interview. Results
Methods Chronic obstructive pulmonary disease patients were recruited from two sources: (i) patients attending pulmonary rehabilitation programme and (ii) communitybased patients who were on the list of the acute respiratory assessment service; a community nursing service for patients with COPD. Fifty-six patients were recruited to the study including 31 acute respiratory assessment service patients and 25 outpatients pulmonary rehabilitation programme. Ten patients did not respond to follow-up; an 82% follow-up rate. 29 patients originally consented to psychiatric interview and a total of 22 underwent the interview. The AIR is a disease-specific reliable and valid measure of anxiety symptoms for patients with COPD (Willgoss et al., 2013). Disability was assessed using the Manchester Respiratory Activities of Daily Living Scale (Yohannes et al., 2000). Health status was examined using the COPD assessment scale (CAT) (Jones et al., 2009). Copyright # 2014 John Wiley & Sons, Ltd.
Table 1 illustrates the characteristics and psychiatric disorders that were diagnosed in this sub-sample. Ten patients (45%) had an anxiety disorder. The most common anxiety disorder was panic disorder (PD) with or without agoraphobia, whilst the most common mood disorder was current major depressive disorders. Nine patients (41%) had more than one psychiatric disorder and seven (32%) patients had both a clinical anxiety disorder and a mood disorder. A cut-off score of ≥8 on the AIR (based on psychiatric diagnosis of an anxiety disorder) yielded a sensitivity of 0.80, a specificity of 0.75, a positive predictive value of 67% and a negative predictive value of 81%. Chronic obstructive pulmonary disease patients with clinical diagnosis of using MINI had significantly higher AIR scores (t = 4.59, p < 0.001), and CAT scores (t = 4.10, p < 0.001), and significantly lower Manchester Respiratory Activities of Daily Living Scale scores (U = 125.5, p = 0.001). The study was approved by the local research ethics committee. Int J Geriatr Psychiatry 2015; 30: 105–110
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Table 1 The socio-demographic characteristics anxiety disorders (n = 22) Variables Age (years) Gender (% male) FEV1% predicted COPD severity (%) Mild Moderate Severe Very severe Smoking status (%) Current smoker Previous smoker Never smoked Pack years Anxiety disorders % Any anxiety disorder GAD PD with or without agoraphobia Agoraphobia without history of PD Social phobia Mood disorders % Any mood disorder Current MDD Past MDD Recurrent MDD Both anxiety and mood disorder
Mean (SD) 71.12 (5.47) 27.3 44.85 (18.31) 9.1 31.8 36.4 22.7 27.3 59.1 13.6 37.63 (20.55) 45 23 36 9 5 41 32 5 5 32
FEV1, forced expiratory volume in 1 second; GAD, generalised anxiety disorder; PD, panic disorder; MDD, major depressive disorder. One pack year = 20 cigarettes/day for 1 year.
Discussion Although further validation is certainly required, these findings indicate that the AIR is able to identify accurately patients with clinical anxiety disorders, particularly the two common disorders of panic disorder (PD) and generalised anxiety disorder (GAD). The AIR appears to perform well as a screening tool in identifying clinical anxiety in patients with COPD with the relatively high sensitivity. The findings from the current research suggest that 45% of patients had a clinical anxiety disorder based on psychiatric diagnosis, which is similar to Canadian study 46% (Laurin et al., 2007). Whilst the sample in this study is small (n = 22), it is comparable in size to two frequently cited studies who report prevalence based on samples of 20–30 subjects (Aghanwa and Erhabor, 2001; Vögele and von Leupoldt, 2008). In the current study, PD was diagnosed in 36% of patients making it the most prevalent disorder amongst the sample. In addition, 23% of patients were diagnosed with GAD. These findings are inline with previous studies, which suggest that PD and Copyright # 2014 John Wiley & Sons, Ltd.
GAD are the most common anxiety disorders in patients with COPD (Dowson et al., 2004 and Laurin et al., 2007). The AIR scale is a valid, reliable scale and promising tool to measure anxiety disorders in patients with COPD. However, further studies are required to determine the minimal clinical important difference and responsiveness of the AIR scale to interventions prospectively in larger sample size in patients with COPD. Conflict of interest None declared. Key points
• • • •
The Anxiety Inventory Respiratory disease scale is a valid and reliable scale for measuring anxiety in patients with COPD. Panic and generalized anxiety disorders are common in patients with COPD. About one-third of COPD patients had both major depression and anxiety disorders. The AIR scale requires further validation to determine its minimal clinical important difference, diagnostic accuracy and responsiveness to interventions in larger sample size.
Acknowledgements We appreciate the input of Dr Francis Fatoye and Professor Juliet Goldbart for the help they have given us during the data collection. Dr Yohannes is most grateful to the Manchester Metropolitan University for providing the sabbatical leave towards the preparation of this manuscript. References Aghanwa HS, Erhabor GE. 2001. Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital. J Psychosom Res 50: 179–183. Dowson CA, Town GI, Frampton C, Mulder RT. 2004. Psychopathology and illness beliefs influence COPD self-management. J Psychosom Res 56: 333–340. Jones P, Harding G, Berry P, et al. 2009. Development and first validation of the COPD Assessment Test. Eur Respir J 34: 648–654. Laurin C, Lavoie KL, Bacon SL, et al. 2007. Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest 132: 148–155. Miller MR, Hankinson J, Brusasco V, et al. 2005. Standardisation of spirometry. Eur Respir J 26: 319–338. Sheehan DV, Lecrubier Y, Sheehan KH, et al. 1998. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a
Int J Geriatr Psychiatry 2015; 30: 105–110
108 structured diagnostic psychiatric interview for DSM-IV-TR and ICD-10. J Clin Psychiatry 59(Suppl. 20): 22–30. Vögele C, von Leupoldt A. 2008. Mental disorders in chronic obstructive pulmonary disease (COPD). Respir Med 102: 764–773. Willgoss TG, Goldbart J, Fatoye FA, Yohannes AM. 2013. The development and validation of the Anxiety Inventory for Respiratory Disease. Chest 144: 1587–1596. Willgoss TG, Yohannes AM. 2013. Anxiety disorders in patients with chronic obstructive pulmonary disease: a systematic review. Respir Care 58: 858–866. Yohannes AM, Roomi J, Winn S, Connolly MJ. 2000. The Manchester Respiratory Activities of Daily Living questionnaire: development, reliability, validity and responsiveness to pulmonary rehabilitation. J Am Geriatr Soc 48: 1496–1500.
Letters to the Editor
ABEBAW M. YOHANNES* AND THOMAS G. WILLGOSS Department of Health Professions, Manchester Metropolitan University, Research Institute for Health and Social Care, Manchester, UK *E-mail: [email protected] Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/gps.4202
‘Rydym Eisiau Gwybod†’—the dementia diagnosis disclosure preferences of people in North Wales‡ Introduction Most western countries have developed strategic plans that emphasise the importance of making and disclosing early diagnosis of dementia. The implication being that this leads to early treatment and interventions aimed at promoting coping and preventing crisis in later stages of the illness (Steeman et al., 2006). The new strategic emphasis supports disclosure with emphasis placed on the individual’s right to know (Bortolotti and Widdows, 2011). This paper reports on a clinical audit regarding the preferences of 253 people with dementia, attending Memory Assessment Services across North Wales, in relation to the disclosure and sharing of their diagnoses. Table 1 provides summary characteristics for the total number of participants providing data, as well for the two independent groups separated by disclosure action. Results The majority of participants (94.8%) expressed a preference for diagnosis disclosure. Most wished their diagnosis to be disclosed jointly to themselves and a relative (84.1%) or to themselves and a third party, †English translation—‘We want to know’. ‡This clinical audit was undertaken at the following three clinical sites: Memory Assessment Service—East, Wepre House, Flintshire; Memory Assessment Service—Central, Bryn Hesketh Unit, Colwyn Bay; and Memory Assessment Service—West, Cefni Unit, Anglesey
Copyright # 2014 John Wiley & Sons, Ltd.
for example, a carer (2.7%). Twenty one participants (8.3%) preferred to receive their diagnosis alone. Of those who did not want to be made aware of their diagnosis (n = 12, 4.8%), all but one asked for their relative to be informed. People who did not have their disclosure preference actioned were more likely to have declined disclosure (Chi squared 6.300, p = 0.01) and less likely to have requested joint disclosure with a relative or other person (Chi squared = 18.986, p < 0.001). Patients expressing a preference for non-disclosure were 5.74 times more likely not to have their preferences actioned than those who requested disclosure (95% CI 1.392 to 23.664). Female gender and a diagnosis of vascular or other type of dementia marginally reduced the likelihood that patient preferences would not be actioned. Married patients or patients with a partner were more likely to have their preferences ignored (OR 14.68, 95% CI 1.10 to 195.59). Patients requesting joint disclosure with a relative or other person were less likely to have their preferences ignored than those requesting non-disclosure or disclosure to a third party only (OR 0.112, 95% CI 0.024 to 0.513).
Discussion The finding from this study is that people want to be told if they have a dementia. Patients requesting joint disclosure with a relative were less likely to have their preferences ignored. We Int J Geriatr Psychiatry 2015; 30: 105–110
Copyright of International Journal of Geriatric Psychiatry is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters to the Editor
The accuracy of the anxiety inventory respiratory disease scale for patients with chronic obstructive pulmonary disease Introduction Anxiety disorders are common in patients with chronic obstructive pulmonary disease (COPD). Studies have reported that the prevalence of anxiety symptoms range between 6% and 70% (Willgoss and Yohannes, 2013). There is no a valid disease-specific scale to measure anxiety for patients with COPD. In addition, very little evidence is available in studies that examined the occurrence of anxiety disorders using the psychiatric diagnostic tools even after the short-term follow-up. Our group developed the Anxiety Inventory Respiratory Disease scale (AIR) to assess and measure anxiety for patients with COPD (Willgoss et al., 2013). We explored prospectively the accuracy of the newly developed disease-specific the AIR scale in stable COPD patients using the diagnostic criteria the Mini-International Neuropsychiatric Interview (MINI) at three months in order to establish the diagnosis of psychiatric disorders.
The MINI (Sheehan et al., 1998) is a short, structured diagnostic interview developed for DSM-IV and ICD-10 psychiatric disorders. The MINI takes about 15 min to complete and has well established validity and reliability (Sheehan et al., 1998), for patients undergo psychiatric interview. Spirometry was performed using a Vitalograph 2120 handheld spirometer (Vitalograph, Buckingham, England) according to ATS/ERS Standardisation Guidelines (Miller et al., 2005). Those participants who consented to psychiatric interview were visited at 3 months by a researcher (an expert in psychiatric disorders and COPD) who was blinded to the previous results. The diagnostic interviews were conducted according to the MINI structured format (Sheehan et al., 1998) and, typically, lasted 15–30 min. Patients also completed the AIR scale prior to psychiatric interview. Results
Methods Chronic obstructive pulmonary disease patients were recruited from two sources: (i) patients attending pulmonary rehabilitation programme and (ii) communitybased patients who were on the list of the acute respiratory assessment service; a community nursing service for patients with COPD. Fifty-six patients were recruited to the study including 31 acute respiratory assessment service patients and 25 outpatients pulmonary rehabilitation programme. Ten patients did not respond to follow-up; an 82% follow-up rate. 29 patients originally consented to psychiatric interview and a total of 22 underwent the interview. The AIR is a disease-specific reliable and valid measure of anxiety symptoms for patients with COPD (Willgoss et al., 2013). Disability was assessed using the Manchester Respiratory Activities of Daily Living Scale (Yohannes et al., 2000). Health status was examined using the COPD assessment scale (CAT) (Jones et al., 2009). Copyright # 2014 John Wiley & Sons, Ltd.
Table 1 illustrates the characteristics and psychiatric disorders that were diagnosed in this sub-sample. Ten patients (45%) had an anxiety disorder. The most common anxiety disorder was panic disorder (PD) with or without agoraphobia, whilst the most common mood disorder was current major depressive disorders. Nine patients (41%) had more than one psychiatric disorder and seven (32%) patients had both a clinical anxiety disorder and a mood disorder. A cut-off score of ≥8 on the AIR (based on psychiatric diagnosis of an anxiety disorder) yielded a sensitivity of 0.80, a specificity of 0.75, a positive predictive value of 67% and a negative predictive value of 81%. Chronic obstructive pulmonary disease patients with clinical diagnosis of using MINI had significantly higher AIR scores (t = 4.59, p < 0.001), and CAT scores (t = 4.10, p < 0.001), and significantly lower Manchester Respiratory Activities of Daily Living Scale scores (U = 125.5, p = 0.001). The study was approved by the local research ethics committee. Int J Geriatr Psychiatry 2015; 30: 105–110
Letters to the Editor
107
Table 1 The socio-demographic characteristics anxiety disorders (n = 22) Variables Age (years) Gender (% male) FEV1% predicted COPD severity (%) Mild Moderate Severe Very severe Smoking status (%) Current smoker Previous smoker Never smoked Pack years Anxiety disorders % Any anxiety disorder GAD PD with or without agoraphobia Agoraphobia without history of PD Social phobia Mood disorders % Any mood disorder Current MDD Past MDD Recurrent MDD Both anxiety and mood disorder
Mean (SD) 71.12 (5.47) 27.3 44.85 (18.31) 9.1 31.8 36.4 22.7 27.3 59.1 13.6 37.63 (20.55) 45 23 36 9 5 41 32 5 5 32
FEV1, forced expiratory volume in 1 second; GAD, generalised anxiety disorder; PD, panic disorder; MDD, major depressive disorder. One pack year = 20 cigarettes/day for 1 year.
Discussion Although further validation is certainly required, these findings indicate that the AIR is able to identify accurately patients with clinical anxiety disorders, particularly the two common disorders of panic disorder (PD) and generalised anxiety disorder (GAD). The AIR appears to perform well as a screening tool in identifying clinical anxiety in patients with COPD with the relatively high sensitivity. The findings from the current research suggest that 45% of patients had a clinical anxiety disorder based on psychiatric diagnosis, which is similar to Canadian study 46% (Laurin et al., 2007). Whilst the sample in this study is small (n = 22), it is comparable in size to two frequently cited studies who report prevalence based on samples of 20–30 subjects (Aghanwa and Erhabor, 2001; Vögele and von Leupoldt, 2008). In the current study, PD was diagnosed in 36% of patients making it the most prevalent disorder amongst the sample. In addition, 23% of patients were diagnosed with GAD. These findings are inline with previous studies, which suggest that PD and Copyright # 2014 John Wiley & Sons, Ltd.
GAD are the most common anxiety disorders in patients with COPD (Dowson et al., 2004 and Laurin et al., 2007). The AIR scale is a valid, reliable scale and promising tool to measure anxiety disorders in patients with COPD. However, further studies are required to determine the minimal clinical important difference and responsiveness of the AIR scale to interventions prospectively in larger sample size in patients with COPD. Conflict of interest None declared. Key points
• • • •
The Anxiety Inventory Respiratory disease scale is a valid and reliable scale for measuring anxiety in patients with COPD. Panic and generalized anxiety disorders are common in patients with COPD. About one-third of COPD patients had both major depression and anxiety disorders. The AIR scale requires further validation to determine its minimal clinical important difference, diagnostic accuracy and responsiveness to interventions in larger sample size.
Acknowledgements We appreciate the input of Dr Francis Fatoye and Professor Juliet Goldbart for the help they have given us during the data collection. Dr Yohannes is most grateful to the Manchester Metropolitan University for providing the sabbatical leave towards the preparation of this manuscript. References Aghanwa HS, Erhabor GE. 2001. Specific psychiatric morbidity among patients with chronic obstructive pulmonary disease in a Nigerian general hospital. J Psychosom Res 50: 179–183. Dowson CA, Town GI, Frampton C, Mulder RT. 2004. Psychopathology and illness beliefs influence COPD self-management. J Psychosom Res 56: 333–340. Jones P, Harding G, Berry P, et al. 2009. Development and first validation of the COPD Assessment Test. Eur Respir J 34: 648–654. Laurin C, Lavoie KL, Bacon SL, et al. 2007. Sex differences in the prevalence of psychiatric disorders and psychological distress in patients with COPD. Chest 132: 148–155. Miller MR, Hankinson J, Brusasco V, et al. 2005. Standardisation of spirometry. Eur Respir J 26: 319–338. Sheehan DV, Lecrubier Y, Sheehan KH, et al. 1998. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a
Int J Geriatr Psychiatry 2015; 30: 105–110
108 structured diagnostic psychiatric interview for DSM-IV-TR and ICD-10. J Clin Psychiatry 59(Suppl. 20): 22–30. Vögele C, von Leupoldt A. 2008. Mental disorders in chronic obstructive pulmonary disease (COPD). Respir Med 102: 764–773. Willgoss TG, Goldbart J, Fatoye FA, Yohannes AM. 2013. The development and validation of the Anxiety Inventory for Respiratory Disease. Chest 144: 1587–1596. Willgoss TG, Yohannes AM. 2013. Anxiety disorders in patients with chronic obstructive pulmonary disease: a systematic review. Respir Care 58: 858–866. Yohannes AM, Roomi J, Winn S, Connolly MJ. 2000. The Manchester Respiratory Activities of Daily Living questionnaire: development, reliability, validity and responsiveness to pulmonary rehabilitation. J Am Geriatr Soc 48: 1496–1500.
Letters to the Editor
ABEBAW M. YOHANNES* AND THOMAS G. WILLGOSS Department of Health Professions, Manchester Metropolitan University, Research Institute for Health and Social Care, Manchester, UK *E-mail: [email protected] Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/gps.4202
‘Rydym Eisiau Gwybod†’—the dementia diagnosis disclosure preferences of people in North Wales‡ Introduction Most western countries have developed strategic plans that emphasise the importance of making and disclosing early diagnosis of dementia. The implication being that this leads to early treatment and interventions aimed at promoting coping and preventing crisis in later stages of the illness (Steeman et al., 2006). The new strategic emphasis supports disclosure with emphasis placed on the individual’s right to know (Bortolotti and Widdows, 2011). This paper reports on a clinical audit regarding the preferences of 253 people with dementia, attending Memory Assessment Services across North Wales, in relation to the disclosure and sharing of their diagnoses. Table 1 provides summary characteristics for the total number of participants providing data, as well for the two independent groups separated by disclosure action. Results The majority of participants (94.8%) expressed a preference for diagnosis disclosure. Most wished their diagnosis to be disclosed jointly to themselves and a relative (84.1%) or to themselves and a third party, †English translation—‘We want to know’. ‡This clinical audit was undertaken at the following three clinical sites: Memory Assessment Service—East, Wepre House, Flintshire; Memory Assessment Service—Central, Bryn Hesketh Unit, Colwyn Bay; and Memory Assessment Service—West, Cefni Unit, Anglesey
Copyright # 2014 John Wiley & Sons, Ltd.
for example, a carer (2.7%). Twenty one participants (8.3%) preferred to receive their diagnosis alone. Of those who did not want to be made aware of their diagnosis (n = 12, 4.8%), all but one asked for their relative to be informed. People who did not have their disclosure preference actioned were more likely to have declined disclosure (Chi squared 6.300, p = 0.01) and less likely to have requested joint disclosure with a relative or other person (Chi squared = 18.986, p < 0.001). Patients expressing a preference for non-disclosure were 5.74 times more likely not to have their preferences actioned than those who requested disclosure (95% CI 1.392 to 23.664). Female gender and a diagnosis of vascular or other type of dementia marginally reduced the likelihood that patient preferences would not be actioned. Married patients or patients with a partner were more likely to have their preferences ignored (OR 14.68, 95% CI 1.10 to 195.59). Patients requesting joint disclosure with a relative or other person were less likely to have their preferences ignored than those requesting non-disclosure or disclosure to a third party only (OR 0.112, 95% CI 0.024 to 0.513).
Discussion The finding from this study is that people want to be told if they have a dementia. Patients requesting joint disclosure with a relative were less likely to have their preferences ignored. We Int J Geriatr Psychiatry 2015; 30: 105–110
Copyright of International Journal of Geriatric Psychiatry is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
