Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)

Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and depression in primary care practice are high. Different studies had shown an increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the anxiety and depression scales in the treatment of CTS, either with corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS either with I or with S correlates with an improvement in the punctuations of the Hospital Anxiety and Depression scales (HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and open-label clinical trial, comparing I and S. Patients with symptoms suggestive of CTS (nocturnal paraesthesias) of at least 3 months duration and neurophysiological confirmation were included. Patients with clinically apparent motor impairment were excluded. The subjective evaluation of symptoms was carried out using the visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and 12 months after treatment. Each patient completed the HADS questionnaire and a VAS-p at 0, 3, 6, and 12 months. Statistical significance was established using the Student’s t test and the Mann-Whitney U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both scales. Results: 65 patients were included (30 in group I and 35 in group S). There was no statistical difference between both groups in terms of age, gender distribution, disease duration, VAS-p, neurophysiological testing severity of CTS or the 8 subscales of HADS. Both groups improved significantly in relation to the baseline VAS-p values, in the reviews at 3, 6 and 12 months, with no significant differences between I and S. At 6 months, the reduction in the anxiety scale was around 3 points for both treatments (S = 3.6 and I = 3.2), without reaching significant differences. At 12 months, it was somewhat higher for those treated with I, but always around 3 points and without significant differences. The Depression scale score was slightly reduced at 6 months, and in a similar way for both groups (I = 1 and S = 1.19;p = 0.8). After 12 months, group I doubled the previous reduction, with group S experiencing a very slight change (I = 1.96 and S = 1.03;p = 0.3). When analysing the effect of group S on group I, the result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete improvement in Anxiety scores on the HADS scale at 6 and 12 months. For both types of treatment, the Depression scores barely changed at 6 months, being somewhat higher in group I after 12-month follow-up. The independent effect of the S on both scales is small and not significant.

Evaluation of the Relationship between the Levels of Knowledge about Prostate Cancer and the Anxiety-Depression Scale of Adult Individuals in Four Different Provinces of Türkiye

Prostate cancer is one of the most common types of cancer in men. The rate of early detection of prostate cancer is low in Türkiye. Therefore, it is important to measure the level of awareness regarding prostate cancer. In our research, we investigate the knowledge levels of prostate cancer among adult individuals in four different geographic region in Türkiye. In addition, we aimed to compare the level of awareness regarding prostate cancer and the depression and anxiety levels among the individuals. The prostate cancer awareness level survey was selected as the data collection tool. In the survey, 20 questions are asked to measure the knowledge level of the participants about prostate cancer. In addition, an evaluation of anxiety and depression was conducted by using the Hospital Anxiety and Depression Scale (HADS). Between April 2022 and December 2022, 834 participants were reached.72.9% of the participants answered the questionnaire correctly. A significant difference was found in terms of correct response rates in four different provinces located in four different regions of Türkiye (79% in Eskisehir, 75.2% in Canakkale, 73% in Ankara, and 54.4% in Maras;p < 0.05). According to the HADS scale, 240 (28.8%) individuals were found to have anxiety and 129 (15.5%) of them had depression. The knowledge level of most of the participants about prostate cancer was found to be above the average. There was a significant difference between provinces in terms of knowledge levels. A significant relationship was observed between depression and knowledge level. However, no significant difference was found for anxiety.

Is Cancer Still the Villain, Even during COVID 19 Outbreak?

Background :Anxiety and depression are two common psychiatric conditions encountered in cancer treatment. Prevalence rate and risk factors show wide variations in different countries and the environment. COVID 19 outbreak has increased psychological disorders in general public and health workers. Whether this pandemic has increased the psychiatric morbidity in cancer patients needs to be addressed for planning strategies. Methods: This cross-sectional study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in the state of Kerala, India. The aim was to assess hospital prevalence and risk factors of anxiety and depression among cancer patients during COVID 19 pandemic. Patients on treatment for cancer and willing for the study were recruited. Hospital Anxiety and Depression Scale (HADS), a self-assessment valid tool for screening both anxiety (HADS-A) and depression (HADS-D) are used. HADS-A & D were calculated separately & categorized as normal, borderline and abnormal with a score of 0 - 7, 8 - 10 & 11 - 21 respectively. Separate structured questionnaire for COVID19 related questions and patient master file for patient & treatment characteristics were used in risk assessment. Data were entered in an Excel sheet and SPSS version 22 for statistical analysis. Findings: 208 patients were included in this study. The overall prevalence rate of anxiety was 7.2%, with borderline cases 4.3% and abnormal cases 2.9%. The overall prevalence of the rate of depression was 5.3% (3.4% borderline & 1.9% abnormal). Risk factors like age, sex, socioeconomic status, primary site, stage of the disease and default of disease had no statistical significance. Interpretation: The prevalence rate of anxiety and depression among cancer patients in this study is one among the lowest ever reported. COVID 19 outbreak has not brought any impact in the rate of psychological distress in our patients and the low rate may be due to the robust medical care including mental health interventions and reassurance by the Government.