Annotated Abstracts of Journal Articles
2015, 2nd Quarter
Annotations by Jane Walker, MBChB, MSc, PhD, MRCPsych
ANNOTATION (Jane Walker)
The Finding: Men with high health anxiety scores were more likely to receive a subsequent cancer diagnosis than those with lower scores, but this association was not found for women. There was no association between health anxiety and the presence or absence of metastatic disease at the time of cancer diagnosis (for either gender).
Strengths and Weaknesses: The strengths of this study are its large sample size, use of longitudinal data, and high quality data on cancer diagnoses. Its main limitations are the use of a screening questionnaire to measure health anxiety and the inability of the study to answer why the association between health anxiety and cancer detection is present for men but not for women.
Relevance: This study is relevant to all C-L psychiatrists who see patients with health anxiety.
Objective: Health anxiety is associated with distress and disability, and overutilization of health services, but it is not known whether high levels of health anxiety may lead to increased detection of severe diseases such as cancer. By linking a large population based health study with the national cancer registry, the aim of the study was to investigate a potential prospective association between health anxiety in men and women and later cancer detection and tumour metastasis at the time of diagnosis.
Method: A longitudinal study with a 13.2year follow-up linking the population-based Hordaland Health Study (HUSK) and the Cancer Registry of Norway (CRN) was conducted. Health anxiety was measured with the Whiteley Index. Associations were examined through gender stratified Cox regression analyses adjusted for relevant covariates.
Results: No association was found between baseline health anxiety and cancer detection for women (adjusted HR: 1.21, 95% CI: 0.42-3.50), but a positive association was found between health anxiety at baseline and cancer detection for men (adjusted HR: 1.76, 95% CI: 1.06-2.91). No statistically significant association was demonstrated between health anxiety and cancer metastasis for either gender.
Conclusion: An increased level of health anxiety in men may be advantageous, as it may motivate to self-examination and healthcare seeking when disturbing symptoms arise. Research is needed to investigate whether health anxiety has a protective effect on cancer metastasis at the time of detection, or whether health anxiety increases the risk of over-diagnosis and overtreatment.
ANNOTATION (Jane Walker)
The Finding: Depression scores increased in approximately half of surviving spouses. There was no difference in depression scores between spouses of hospice users and spouses of patients who had not used hospice services.
Strengths and Weaknesses: The strength of this study is its relatively large sample. The main weakness is that depression scores were collected at 2-year intervals that were not related to the timing of the patient’s death.
Relevance: This study is relevant to C-L psychiatrists who work in palliative care settings and suggests that more focused interventions are needed to prevent and treat depressive symptoms in bereaved caregivers.
Importance: Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the effect of hospice use on depressive symptoms among surviving caregivers.
Objective: To determine the association between hospice use and depressive symptoms in surviving spouses.
Design, Setting, and Participants: We linked data from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US adults 50 years or older, to Medicare claims. Participants included a propensity score-matched sample of 1016 Health and Retirement Study decedents with at least 1 serious illness and their surviving spouses interviewed between August 2002 and May 2011. We compared the spouses of individuals enrolled in hospice with the spouses of individuals who did not use hospice, performing our analysis between January 30, 2014, and January 16, 2015.
Exposures: Hospice enrollment for at least 3 days in the year before death.
Main Outcomes and Measures: Spousal depressive symptom scores measured 0 to 2 years after death with the Center for Epidemiologic Studies Depression Scale, which is scored from 0 (no symptoms) to 8 (severe symptoms).
Results: Of the 1016 decedents in the matched sample, 305 patients (30.0%) used hospice services for 3 or more days in the year before death. Of the 1016 spouses, 51.9% had more depressive symptoms over time (mean [SD] change, 2.56 [1.65]), with no significant difference related to hospice use. A minority (28.2%) of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 21.7% of spouses of decedents who did not use hospice, although the difference was not statistically significant (P = .06). Among the 662 spouses who were the primary caregivers, 27.3% of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 20.7% of spouses of decedents who did not use hospice; the difference was not statistically significant (P = .10). In multivariate analysis, the odds ratio for the association of hospice enrollment with improved depressive symptoms after the spouse’s death was 1.63 (95% CI, 1.00-2.65).
Conclusions and Relevance: After bereavement, depression symptoms increased overall for surviving spouses regardless of hospice use. A modest reduction in depressive symptoms was more likely among spouses of hospice users than among spouses of nonhospice users.