Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders

Background. The present paper describes a component of a large Population cost-effectiveness study that aimed to identify the averted burden and economic efficiency of current and optimal treatment for the major mental disorders. This paper reports on the findings for the anxiety disorders (panic disorder/agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder and obsessive-compulsive disorder). Method. Outcome was calculated as averted 'years lived with disability' (YLD), a population summary measure of disability burden. Costs were the direct health care costs in 1997-8 Australian dollars. The cost per YLD averted (efficiency) was calculated for those already in contact with the health system for a mental health problem (current care) and for a hypothetical optimal care package of evidence-based treatment for this same group. Data sources included the Australian National Survey of Mental Health and Well-being and published treatment effects and unit costs. Results. Current coverage was around 40% for most disorders with the exception of social phobia at 21%. Receipt of interventions consistent with evidence-based care ranged from 32% of those in contact with services for social phobia to 64% for post-traumatic stress disorder. The cost of this care was estimated at $400 million, resulting in a cost per YLD averted ranging from $7761 for generalized anxiety disorder to $34 389 for panic/agoraphobia. Under optimal care, costs remained similar but health gains were increased substantially, reducing the cost per YLD to < $20 000 for all disorders. Conclusions. Evidence-based care for anxiety disorders would produce greater population health gain at a similar cost to that of current care, resulting in a substantial increase in the cost-effectiveness of treatment.

From a Vicious Circle of Anxiety to a Virtuous Circle of Learning: Experience of Teaching to a Heterogenous Clientele

A considerable body of literature suggests that significant psychological barrier and anxiety characterize the teaching and learning process in statistics. This study investigates the incidence of statistics anxiety, the extent to which it can be overcome and the factors that contribute to the process of overcoming it. Self-study and overall teaching quality, amongst others, significantly contributed to this outcome. This study identifies factors contributing to overall teaching quality. The teaching and learning process typified a highly effective communication mechanism based on an appropriate diagnosis of individual needs. This cumulative change resulted from circular causation. It is argued that given appropriate conditions the vicious circle of anxiety can be transformed into a virtuous circle of learning.

The relationship between religion and anxiety: A study among anglican clergymen and clergywomen

The 20-item anxiety scale proposed by the Eysenck Personality Profiler (EPP) was completed by 1,148 Anglican male clergy and 523 Anglican female clergy during their first year in ordained ministry. The data demonstrate that male clergy recorded higher scores on the index of anxiety than men in general. Female clergy recorded lower levels on the index of anxiety than women in general. These findings are consistent with the findings from earlier studies that male clergy tend to project a characteristically feminine personality profile while female clergy tend to project a characteristically masculine personality profile.

Efficacy of sertraline in a 12-week trial for generalized anxiety disorder

Objective: Sertraline's efficacy and tolerability in treating generalized anxiety disorder were evaluated. Method: Adult outpatients with DSM-IV generalized anxiety disorder and a total score of 18 or higher on the Hamilton Anxiety Rating Scale were eligible. After a 1-week single-blind placebo lead-in, patients were randomly assigned to 12 weeks of double-blind treatment with placebo (N=188, mean baseline anxiety score=25) or flexible doses (50-150 mg/day) of sertraline (N=182, mean anxiety score=25). The primary outcome measure was baseline-to-endpoint change in the Hamilton anxiety scale total score. A secondary efficacy measure was the Clinical Global Impression (CGI) improvement score; response was defined as a score of 2 or less. Results: Sertraline patients had significantly greater improvement than placebo patients on all efficacy measures at week 4. Analysis of covariance of the intent-to-treat group at endpoint (with the last observation carried forward) showed a significant difference in the decrease from baseline of the least-square mean total score on the Hamilton anxiety scale between sertraline (mean=11.7) and placebo (mean=8.0). Significantly greater endpoint improvement with sertraline than placebo was obtained for mean scores on the Hamilton anxiety scale psychic factor (6.7 versus 4.1) and somatic factor (5.0 versus 3.9). The rate of responders, based on CGI improvement and last observation carried forward, was significantly higher for sertraline (63%) than placebo (37%). Sertraline was well tolerated; 8% of patients versus 10% for placebo dropped out because of adverse events. Conclusions: Sertraline appears to be efficacious and well tolerated in the treatment of generalized anxiety disorder.

A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample

This study examined the psychometric properties of the parent version of the Spence Children's Anxiety Scale (SCAS-P); 484 parents of anxiety disordered children and 261 parents in a normal control group participated in the study. Results of confirmatory factor analysis provided support for six intercorrelated factors, that corresponded with the child self-report as well as with the classification of anxiety disorders by DSM-IV (namely separation anxiety, generalized anxiety, social phobia, panic/agoraphobia, obsessive-compulsive disorder, and fear of physical injuries). A post-hoc model in which generalized anxiety functioned as the higher order factor for the other five factors described the data equally well. The reliability of the subscales was satisfactory to excellent. Evidence was found for both convergent and divergent validity: the measure correlated well with the parent report for internalizing symptoms, and lower with externalizing symptoms. Parent-child agreement ranged from 0.41 to 0.66 in the anxiety-disordered group, and from 0.23 to 0.60 in the control group. The measure differentiated significantly between anxiety-disordered children versus controls, and also between the different anxiety disorders except GAD. The SCAS-P is recommended as a screening instrument for normal children and as a diagnostic instrument in clinical settings. (C) 2003 Elsevier Ltd. All rights reserved.

The roles of depression and anxiety in the understanding and treatment of Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome (OSAS) is a debilitating condition stemming from disruption to the respiratory system during sleep. At present, the nature of the relationship between OSAS and mood, specifically depression and anxiety, is still unclear. The purpose of this paper is to shed some light on this relationship. PsycINFO was used to locate relevant papers on this topic. This literature search formed the basis of our investigation. Results showed that the anxiety and depression methodology is weak. It is now clear that there is an urgent need to better understand the roles of anxiety and depression in OSAS. For example, the research literature suggests that depression and anxiety covary with OSAS. However, because of methodological issues, such as difficulties involved in diagnosis and the use of inappropriate instruments, this conclusion remains tenuous. Future directions are discussed. (C) 2004 Elsevier Ltd. All rights reserved.

Employment restrictions among persons with ICD-10 anxiety disorders: characteristics from a population survey

Disability, employment, and employment restrictions among persons with ICD-10 anxiety disorders were investigated at a population level in comparison to persons without disability or long-term health conditions. Data were provided by the Australian Bureau of Statistics (ABS) collected in a 1998 national survey. Multistage sampling obtained a probability sample of 37,580 individuals in the household component of the survey. Trained lay interviewers using ICD-10 computer-assisted interviews identified household residents with anxiety disorders. Details of employment restrictions are reported and discussed. The four most commonly reported restrictions were: restricted in the type of job (24.0%); need for a support person (23.3%); difficulty changing jobs (18.6%); and restricted in the number of hours (15.4%). The nature and extent of employment restrictions characterizing persons with anxiety disorders indicates a need for strengthened disability and health condition screening at application for Government income support and at gateways to public funded vocational assistance. (c) 2004 Elsevier Inc. All rights reserved.

Thermal biofeedback, locus of control and precompetitive anxiety in young athletes

Small groups of athletes (maximum size 8) were taught to voluntarily control their finger temperature, in a test of the feasibility of thermal biofeedback as a tool for coaches. The objective was to decrease precompetitive anxiety among the 140 young, competitive athletes (track and field, N=61; swimming, N=79), 66 females and 74 males, mean age 14.8 years, age range 8.9-20.5 years, from local high schools and swimming clubs. The biofeedback (visual and auditory) was provided by small, battery-powered devices that were connected to thermistors attached to the middle finger of the dominant hand. An easily readable digital LCD display, in 0.01 degrees C increments, provided visual feedback, while a musical tone, which descended in pitch with increased finger temperature, provided the audio component via small headphones. Eight twenty minute sessions were scheduled, with 48 hours between sessions. The measures employed in this prestest-posttest study were Levenson's locus of control scale (IPC), and the Competitive Sport Anxiety Inventory (CSAI-2). The results indicated that, while significant control of finger temperature was achieved, F(1, 160)=5.30, p

Prevalence and patterns of anxiety and depression in patients undergoing elective percutaneous transluminal coronary angioplasty

Background The use of elective percutaneous transluminal coronary angioplasty (PTCA) as a treatment for coronary heart disease is increasing. Despite this, little is known about the prevalence and patterns of anxiety and depression experienced by patients undergoing and recovering from this procedure. Anxiety and depression are factors known to negatively influence recovery after a cardiac event. Objective The purpose of this study was to (1) describe the levels of anxiety and depression reported by patients pre- and postelective PTCA, and (2) determine associations evident between anxiety and depression and the sociodemographic and clinical variables of gender, marital status, history of acute myocardial infarction, and attendance at cardiac rehabilitation. Methods In this descriptive, repeated-measures investigation, patients (n = 140) were requested to complete the Spielberger State Trait Anxiety Inventory and Cardiac Depression Scale (CDS) at three time points: 0(1) before admission for elective PTCA (T1); (2) 6 to 8 weeks (T2) after PTCA; and (3) 6 to 8 months (T3) after PTCA. Results A typical participant was male (75%), of European ethnicity (90%), aged 62 years (standard deviation = 10.7) with single or double vessel disease, and had attended cardiac rehabilitation in the past. At T1, 16% of men and 24% of women had state anxiety scores comparable to those experienced by neuropsychiatric patients. Trait anxiety scores remained relatively constant over time; higher scores at T1 were associated with past acute myocardial infarction. CDS scores at T2 and T3 were significantly lower than those at T1. However, an unexpected increase in CDS scores occurred at T3, compared with T2. At T3, 14% of men and 10% of women were depressed, relative to T1. Conclusion The findings lend support for the closer surveillance of emotional status in this population. Specialist nurses have the potential to play a greater role in identifying those at risk of developing anxiety and depression. However, this unmet need will remain unmet until specialist nurses who spend the most face-to-face time with patients are equipped with the skills and resources to systematically identify those “at risk.”

The effect of music on preoperative anxiety in day surgery

Aim. This paper reports a study to test the hypothesis that day surgery patients who listen to music during their preoperative wait will have statistically significantly lower levels of anxiety than patients who receive routine care. Background. Although previous day surgery research suggests that music effectively reduces preoperative anxiety, methodological issues limit the generalizability of results. Methods. In early 2004, a randomized controlled trial design was conducted to assess anxiety before and after listening to patient preferred music. Participants were allocated to an intervention (n = 60), placebo (n = 60) or control group (n = 60). Pre- and post-test measures of anxiety were carried out using the State-Trait Anxiety Inventory. Results. Music statistically significantly reduced the state anxiety level of the music (intervention) group. No relationships were found between socio-demographic or clinical variables such as gender or type of surgery. Conclusion. The findings support the use of music as an independent nursing intervention for preoperative anxiety in patients having day surgery.