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PubMed2026

Perioperative Depression and Anxiety Care in Older Patients: A Randomized Clinical Trial.

IMPORTANCE: Depression and anxiety are common among older adults undergoing surgery and are associated with adverse postoperative outcomes. However, effective tailored perioperative mental health interventions are lacking. OBJECTIVE: To evaluate a perioperative intervention to optimize mental health. DESIGN, SETTING, AND PARTICIPANTS: A single-blind, hybrid, type 1, effectiveness-implementation randomized clinical trial was conducted (November 1, 2022, to March 31, 2025), with 3-month postoperative follow-up, at a US academic and community practice hospital network. Participants were 60 years or older; scheduled for cardiac, oncologic, or orthopedic surgery; and had clinically meaningful symptoms of depression and/or anxiety based on the Patient Health Questionnaire-Anxiety and Depressive Symptom (PHQ-ADS) scale. A total of 3159 patients were screened for eligibility, with 1518 ineligible, 1079 declining participation, and 236 excluded for other reasons. A total of 326 patients were enrolled and randomized (1:1), with 20 excluded after surgery cancelation. INTERVENTION: Participants were assigned to receive a perioperative intervention combining psychological management and pharmacologic optimization or enhanced usual care (materials for self-managing symptoms). MAIN OUTCOMES AND MEASURES: The primary outcome was change in PHQ-ADS score from baseline to 3 months after surgery. Other outcomes included persistent postsurgical pain, delirium, falls, quality of life, patient satisfaction, length of stay, and rehospitalizations. Implementability was evaluated through semistructured interviews and reach, acceptability, feasibility, appropriateness, and fidelity measures. RESULTS: A total of 306 older adults were included in analysis (mean [SD] age, 68.5 [6.1] years; 209 [68.3%] female; 153 randomized to intervention and 153 randomized to enhanced usual care): 102 cardiac, 100 oncologic, and 104 orthopedic patients. Participants' mean (SD) baseline PHQ-ADS score was 18.5 (7.4). At 3 months, there was a significant decrease in PHQ-ADS scores in the intervention group compared with the enhanced usual care group (mean difference, 2.20; 95% CI, 0.16-4.24; P = .03). Effects varied by surgical subgroups (oncologic patients: mean difference, 4.93; 95% CI, 1.51-8.36; P = .005; cardiac patients: mean difference, 2.68; 95% CI, -0.98 to 6.35; P = .15; and orthopedic patients: mean difference, -1.11; 95% CI, -4.62 to 2.40; P = .54). Patients and interventionists perceived the intervention as appropriate, with high-fidelity delivery and broad reach across the target population. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, psychological management and pharmacologic optimization reduced anxiety and depression in older adults undergoing surgery. Future studies should assess reproducibility and determine which patients benefit most. TRIAL REGISTRATION: ClinicalTrials.gov Identifiers: NCT05575128, NCT05685511, and NCT05697835.

Humans↗
PubMed1978

Emotional disturbance in newly registered general practice patients.

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ inherent in a 'present state' inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.

Adult↗
PubMed1979

Effects of a self-administered health history on new-patient visits in a general medical clinic.

Self-administered health history questionnaires (SAHHQs) are widely used in ambulatory care settings to save provider time and to assure completeness of the clinical data base. A controlled, prospective study was undertaken in a general medical clinic to evaluate the impact of an extensively pretested, highly reliable, 120-item self-administered health history questionnaire developed for new patient visits. Seventy-seven patients were randomly assigned to the SAHHQ or control groups. Time analyses were performed on audiotapes of the encounters. Patients' charts were scored on explicit criteria for data completeness. Problem recognition was determined by comparison of pre-encounter and postencounter problem lists. SAHHQ and control visits did not differ significantly in total encounter time (44.7 versus 48.3 minutes, respectively). Less time was spent in SAHHQ encounters on data base questions (2.5 versus 3.9 minutes, p = .003). Chart data were more complete for SAHHQ patients (p less than .001). The completeness of senior staff charts was more affected by the presence of the SAHHQ than residents' charts (p = .03). Physicians tended to recognize more new problems in SAHHQ visits. Mutual (physician and patient) recognition of problems occurred more often in the SAHHQ visits (p = .05). Carefully designed SAHHQs increase recorded data base completeness and may increase problem recognition, but do not result in major time savings.

Attitude of Health Personnel↗
PubMed1979

A method for determining patients' perceptions of their health needs.

Success or failure in establishing a meaningful relationship between physician and patient depends to a large extent on how fully the patient communicates, and the physician understands, his/her health needs. Return visits, compliance with the physician's prescribed regimen, and the effectiveness of the treatment and rehabilitation are also closely related to the disclosure and assessment of the patient's health needs. A model of how health needs are determined is presented. Various behavioral outcomes which follow the identification of a health problem and assessment of health needs by a patient are discussed. A Health Needs Assessment Questionnaire is presented in English and Spanish to be used and tested as an aid to the family physician in assessing patient's health needs at the first encounter.

Attitude to Health↗
PubMed1979

Patient dental values and their relationship to oral health status, dentist perceptions and quality of care.

In this study, 1287 patients completed a questionnaire assessing knowledge of home care procedures, adherence to home care instructions, obstacles presented to the dentist in delivering care, and ability to pay for optimal care. Ninety-seven dentists that provided treatment for these patients completed a parallel questionnaire. Measures of oral health and the quality of restorative care were based on clinical examinations. It was found that though patient values and dental perceptions were associated, dentist perceptions did not closely match patient dental values. Analysis of variance indicated that patient dental values were related positively to both oral health measures and the quality of restorations. Patient-reported compliance with home care recommendations showed the strongest relationship to both oral health and quality of restorations.

Adult↗
PubMed1979

Determinants of the ability of general practitioners to detect psychiatric illness.

This study of psychiatric illness among 4098 patients attending 91 general practitioners compares 2 methods of case identification: 'conspicuous morbidity' by the doctor's own assessments, and 'probable prevalence' by the patients' responses to the General Health Questionnaire (GHQ). In general, the latter gives somewhat higher estimates than the former, but there are wide variations in morbidity between practices. The ability of each general practitioner to detect psychiatric illness was measured by computing Spearman's correlation coefficient between his assessments and the GHQ scores of his patients. The mean correlation coefficient was + 0.36, but the range was very wide (0.09-0.60). The first part of the study deals with various demographic characteristics of the patients themselves which are associated with an increased likelihood of the doctor detecting a psychiatric illness; such factors include unemployment, female sex, and marriages which have ended by separation, divorce or death. The second part of the study examines characteristics of the doctors themselves in an attempt to account for the wide variation between them in their ability to detect psychiatric illness. A research psychiatrist made detailed observations on 2098 interviews carried out by 55 general practitioners. Each doctor's verbal and non-verbal styles were recorded minutely, and in addition various global ratings were made. The doctors completed personality inventories and supplied details of training and professional background. It was possible to account for 67% of the variance of correlation coefficient mainly in terms of 2 dimensions: 'interest and concern' and 'conservatism'. The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality.

Adolescent↗
PubMed1977

The incidence of malignant transformation in giant pigmented nevi.

151 patients with benign giant pigmented nevi registered in the Danish Health system during the 60-year period 1915-75 were retrieved via the national register. A questionnaire was sent to all surviving patients asking for information about their health and especially whether they had had any treatment or had observed any changes in the nevus. All of the patients replied to the questionnaire. No patients had been cured from malignancy or were alive with known malignancy. Three patients had died from malignant melanoma during the period of observation. These case histories are reported. It is calculated that 4.6% of the patients with congenital giant nevi should be expected to develop malignant melanoma provided the incidence is the same in all age groups. Some uncertainty remains on account of the limited number of cases and an unsettled question about a higher incidence in childhood.

Adult↗
PubMed2025

Men's Knowledge, Attitudes, Practices, Cultural Beliefs, and Perceived Risk and Susceptibility Regarding Prostate Cancer in the Vhembe District, Limpopo Province, South Africa.

BACKGROUND: Prostate cancer (PCa) awareness and knowledge among men in Vhembe District, Limpopo Province, South Africa, remain inadequately studied despite the high local burden of the disease. This study investigates the knowledge, attitudes, practices, cultural beliefs, and perceived risk of PCa among men aged 40 and above in selected villages under the Mphaphuli and Niani tribal authorities. METHODS: A quantitative survey was conducted with 431 men, utilizing a questionnaire adapted from the African Women Awareness of Cancer (AWACAN) tool. The questionnaire, translated into Tshivenda, assessed socio-demographic data, awareness, knowledge of risk factors and symptoms, health-seeking behavior, and barriers to seeking medical help. RESULTS: The study revealed that 51.3% of participants had heard of PCa, while 48.7% had not. Awareness varied significantly with age, relationship status, education level, and language. Older men and those with higher education levels were more knowledgeable about PCa. Clinics, hospitals, and media were the primary sources of information. Misconceptions about risk factors were prevalent, with 24.0% of men indicating a preference for traditional healers for PCa symptoms. Barriers to medical help included fear of the disease, procedural fears, and cultural taboos. Multivariate analysis identified significant factors associated with PCa knowledge, including age, language, access to tap water, and cell phone ownership. CONCLUSION: These findings underscore the importance of targeted educational interventions considering sociodemographic and cultural contexts. Future public health initiatives should focus on bridging the gap between traditional and modern medical practices to enhance health outcomes in the Vhembe District and similar settings.

Humans↗
PubMed1977

A clinical trial of clomipramine and diazepam in the treatment of phobic and obsessional illness.

A double-blind comparative study of clomipramine and diazepam was carried out in patients suffering from phobic and obsessional disorders. Nineteen doctors submitted 58 patients. Seventeen patients withdrew from the trial, twelve because of side-effects. Forty-one patients completed the trial and of these 14 were on clomipramine and 27 were taking diazepam. Patients were assessed for phobias, obsessions, general psychiatric symptoms and side-effects and each was rated on a special symptom inventory at 0, 2, 4 and 6 weeks of treatment. A General Health Questionnaire and Burns Questionnaire was completed for each patient at the beginning and end of the study. General level of anxiety for diffuse phobic anxiety and situational anxiety for illness and death fears responded better to clomipramine than to diazepam. Global assessment showed significantly more progress on clomipramine than diazepam between weeks 4 and 6.

Adolescent↗
PubMed1978

Psychiatric disturbances in neurological patients: detection, recognition, and hospital course.

The Mini-Mental State and General Health Questionnaire were used to detect cognitive defects and emotional disturbances, respectively, in 126 consecutively admitted neurological patients. The Mini-Mental State was revalidated in this sample as a measure related to cerebral disorder. Sixty-seven percent of the patients tested had cognitive defect, emotional disturbance, or both. Thirty percent of the patients with psychiatric disturbance were not recognized by their physician. The majority of psychiatric disturbances persisted at the time of discharge. Since psychiatric disturbances are common among neurological inpatients and are frequently unrecognized, further evaluation of the psychiatric training of neurologists is needed. Simple screening tests may help to increase the recognition of psychiatric disturbance. It is concluded that the Board requirement for neurologists to know psychiatry accurately reflects "the nature of their case material."

Adolescent↗
PubMed1979

The symptoms of newly diagnosed pulmonary tuberculosis and patients' attitudes to the disease and to its treatment in Hong Kong.

A questionnaire was applied by Government Health Visitors in Hong Kong to 201 consecutive patients with smear-positive, and 199 with smear-negative pulmonary tuberculosis who were attending one of the 7 full-time Government chest clinics for the first time on account of their current illness. Information was obtained about the symptoms of the disease and its diagnosis and management outside the Government service, and about patients' knowledge and attitudes towards the Government service. Among the 343 patients who sought treatment because of respiratory symptoms, the first symptom for the great majority (81 %) was cough, 15 % having sputum and 27 % haemoptysis as well. However, treatment was sought by only 15 % because of cough alone, compared with 40 % because of haemoptysis. Most patients (76 %) attended their first source of treatment or investigation within a month of the onset of symptoms, but some allowed long delays, and only 35 % attended a Government chest clinic within a month (whether this was the first source of treatment or not). The first source attended was a private practitioner for 53 % of the patients, another private medical establishment for 4 %, a Government chest clinic for only 11 % and another Government medical establishment for 17 %, 9 % went first to a herbalist and 5 % went to a drug store or treated themselves. The delays between the patients' first attendance at a source of treatment and their first attendance at a Government clinic were important, because outside the Government chest clinics only 49 % were investigated by chest radiograph and only 7 % by sputum bacteriology. Only 33 % were even suspected of having pulmonary tuberculosis, and many were correspondingly inadequately treated. The patients were, in general, ill informed about the Government chest clinic service; 52 % did not know, before their current illness, of the existence of the service, only 9 % knew that it was free, and only 12 % that it specialised in the management of tuberculosis. This study thus revealed a need to educate the public about the symptoms of tuberculosis, and about the possibility of their being investigated and treated, free, in a Government chest clinic.

Adolescent↗
PubMed1979

How much do patients know? A multiple choice question paper for patients in the waiting room.

A questionnaire about knowledge of personal preventive medicine, treatment, and the appropriate use of health services was put to a population of patients attending their doctors' surgeries. The population was probably biased toward the younger and those willing to fill in such a questionnaire. The results showed a social class gradient in knowledge and a distressing degree of ignorance on some topics. Suggestions are made for using the method in a positive educational way in practices, and for further studies with improved methods.

Adult↗
PubMed1979

Validity and reliability of a self-administered health history questionnaire.

A self-administered, health history questionnaire devised for routine use in a general medical clinic is completed without the assistance of clinic personnel and used, unedited, by the providers. The reliability and validity of the responses of 23 patients to this questionnaire were tested statistically. In our setting, more than 90 percent of the patients referred for care are capable of completing the questionnaire. The 23 patients averaged 32 minutes to complete the questionnaire. An average of 34 minutes of encounter time is required to obtain the same historical data by interview. Test-retest reliability of patients' responses to the questionnaire was 90 percent. More than 92 percent of the patients' written responses to health history items agreed with the data obtained in a blinded fashion by internists in the traditional interview. The questionnaire accurately obtains items of history frequently missing from the recorded ambulabory care data base, and in some instances obtains items of history more effectively than the interviewing physician. The study results showed a low incidence of false positive (1.8 percent) and false negative (2.8 percent) responses to questionnaire items.

Adult↗
PubMed1978

Contrasting demographic patterns of minor psychiatric morbidity in general practice and the community.

The 60-item General Health Questionnaire was completed by 90% of 4798 patients aged 15--69 years who consulted, on one day, the general practitioners of 97% of practices in the Perth Statistical Division. A point prevalence rate of minor psychiatric morbidity in various demographic groups was calculated in terms of the population at risk. The demographic pattern of morbidity was compared with that found in a probability sample of 2324 community residents drawn from the same population at risk, and surveyed at the same time using the same time using the same screening instrument. Widowed persons, British-born men who had recently migrated to Australia, and lower-social-class men with minor psychiatric morbidity were under-represented in general practice. Elderly men and women in upper-class occupations with minor psychiatric morbidity were over-represented in general practice. These differences, unlike others that were found, could not be explained by differing consulting habits or by differing completion rates of the screening instrument.

Adolescent↗
PubMed1977

Psychological disturbance in a general practice setting.

One hundred consecutive patients who consulted a general practitioner in Sydney with a new complaint completed the General Health Questionnaire (GHQ), a self-administered instrument designed to assess psychological dysfunction. Although all patients presented somatic symptoms as their principal complaint, 39 per cent scored positively on the GHQ. A direct relationship between severity of psychological disturbance as clinically assessed and GHQ score was observed, while the relationship between the clinically assessed severity of physical dysfunction and GHQ score was an inverse one. At the 10 week follow-up, psychological morbidity had fallen to 23 per cent, a figure akin to a Sydney general population norm. Some implications of these findings are discussed.

Adolescent↗
PubMed1979

Health hazard appraisal counseling--continuing evaluation.

A program of annual health examinations was expanded to include counseling based on a computerized appraisal of individual patients' specific health risk factors. Data obtained from a specially designed questionnaire, laboratory tests and a physical examination yielded a health hazard appraisal showing a number of weighted risk factors and their relation to ten leading causes of death as determined for that patient. From all of this information, a "risk age" was developed which could then be compared with the patient's "true age." The results were reviewed with each patient, and methods of correcting health hazards were stressed. The first annual retesting of a group of 107 examinees showed a net risk age reduction of 1.4 years (formerly reported in this journal). The longer term follow-up reported in this paper showed a net risk reduction of 2.38 years in a group of 26 examinees. The net risk age reduction in the two groups represented 32 and 40 percent, respectively, of the achievable risk age reduction when patients comply with suggestions made during risk reduction counseling. These findings indicate that health hazard appraisal counseling is an effective method of altering priorities of health practices.

Adult↗
PubMed1976

The role of new health practitioners in a prepaid group practice: provider differences in process and outcomes of medical care.

Practice patterns and patient-reported outcomes of care are compared in detail for ten physicians and 12 new health practitioners delivering ambulatory care in two departments of a prepaid group practice, the Columbia Medical Plan (CMP). All providers completed questionnaires for a 50 per cent random sample of patients seen during a two-week period. Patients completed questionnaires prior to receiving care and were interviewed one week and one month after their clinic visits. New health practitioners deliver approximately 75 per cent of well-person care, 56 per cent of problem-oriented care in adult medicine, and 29 per cent of problem care in pediatrics. They have become increasingly involved over time in the treatment of acute conditions and injuries while physicians have retained their predominant role in treating patients with chronic conditions. Thirty-two per cent of visits with new healh providers involved a physician in one or more of the following: decision-making, direct supervision, consultation, or seeing the patient as a second provider of care. Degree of autonomy varied by type of task performed, category of problem treated, and specialty. The following outcomes of care were examined by type of provider: patient-reported change in problem status,including frequency and intensity of pain or discomfort, level of anxiety, and degree of activity limitation; the degree to which physician-specified criteria for the most commonly occurring conditions were met with respect to change in problem status; and patient satisfaction with a number of dimensions of the clinic visit. The analysis suggests that the new health practitioners at the CMP are providing care, within their areas of responsibility, of comparable quality to that delivered by physicians.

Acute Disease↗