results of anxiety and depression screening as part of...
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Results of anxiety and depression
screening as part of routine HIV care
Marie Jose Kleene Nurse Practitioner
Barcelona8 September 2018
Kees Brinkman
Guido van den Berk
Erik van Gorsel
Jeroen Lijmer
Ineke Schouten
Daoud Ait Moha
Background
• More attention for health related QoL in general
• Anxiety and depression frequent comorbidities in HIV
• More focus on mental health disorders
Mortality :causes of death HIV patients OLVG 2011-2016
0% 5% 10% 15% 20% 25% 30% 35% 40% 45%
trombosis
respiratory failure
cva
pneumonia
sepsis
livercirrosis
other
unknown
suicide
cvd
oncology
N=121
Suicide
Suicide remains an important cause of death in OLVG
(12%)
Methods
• Standard evaluation mental health in hiv care
path (VBHiC)
• Hospital Anxiety Depression Scale (HADS)
• Retrospective data collection• november 2016-december 2017
• OLVG cohort (>3000 patients)
• All patients with complete HADS score
• Analysis of outcomes
Hospital & Anxiety Depression Scale
HADS
• 14 items
• - 2 subscales 7 items each
• Scores range from 0 to 42
• Higher scores represent more distress
• > 15 points ( total scale) potential mental disorder
• Protocol: HADS > 15 needs action = “referral”
questionnairesnovember 2016 - december 2017
• > 1800 questionnaires distributed
• 1091 complete questionnaires (response rate 60.3%)
• 1032 male (94.6 %)
• median age 50.9 yrs (range 20-81)
HADS evaluation
N=1091
HADS <12
N=665
HADS 12-15
N=128HADS >15
N=298(27.3%)
not referred
N=242(81.2%)
referred
N=56(18.79%)
no psychiatric
diagnosis
N=4(1.34%)
ongoing
N=4( 1.34%)
new psychiatric
diagnosis
N=48(16.11%)
discussed:
no referral
N=110( 36.9%)
not discussed
N=83(27.9%)
care elsewhere
N=49(16.4%)
Discussion/ limitations
• Not all questionnaires are returned by patients
• More analysis on missing scores necessary
• In 83 of the cases the score was not discussed during the
outpatient visits
Conclusion
• Screening on mental health in HIV patients is feasible
• An elevated HADS score > 15 was observed (27.3%).
• Regular assessment of mental health leads to earlier
recognition of psychiatric disorders.
• In most other cases the HADS initiated a conversation
between doctor and patient about his/her mental health.