Estimating the weighted prevalence of anxiety disorders in breast cancer patients using a Two-stage approach
Background: A two-stage survey is useful when the actual diagnostic interview is time-consuming and expensive to administer on the general population.
Objective: To compare Schedule for Clinical Assessment in Neuropsychiatry (SCAN) with Hospital Anxiety and Depression Scale (HADS) in the determination of the prevalence of anxiety disorder in patients with breast cancer.
Methods: A cross-sectional study of 200 female patients diagnosed with breast cancer attending the Oncology Out-Patients Clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria was done. The instruments used for the survey included a socio-demographic questionnaire, the HADS and the SCAN.
Results: The mean age of the subjects was 49.6 ± 11.2 years. Majority of the subjects (76.5%) were married. Using HADS with a threshold score of ≥ 8, 53 (26.5%) met the criteria for probable anxiety disorders (herein called ‘cases’). Of the 68 patients (all 53 ‘cases’ plus 15 randomly selected 10% of the non-cases) interviewed with the SCAN instrument, only 38 met the criteria for diagnosis of anxiety disorder.
Conclusions: The prevalence of anxiety disorders can be determined with greater precision using the two-stage design approach. Diagnostic tools like SCAN should therefore be incorporated in the assessment protocols for patients with breast cancer and other illnesses.
2. Leung DHY, Qin J. Semi-parametric prevalence estimation from a two-phase survey. 18th World IMACS/MODSIM Congress: Cairns; 2009.
3. Dunn G, Pickles A, Tansella M, Vazquez-Barquero J. Two-phase epidemiological surveys in psychiatric research. Br J Psy 1999; 174: 95-100.
4. Gao S, Hui SL, Hall KS, Hendrie HC. Estimating disease prevalence from two-phase surveys with non-response at the second phase. Statist Med 2000; 19: 2101-2114.
5. Beckett LA, Scherr PA, Evans DA. Population prevalence estimates from complex samples. J Clin Epidemiol 1992; 45: 393-402.
6. Warszawski J, Messiah A, Lellouch J, Meyer L, Deville JC. Estimating means and percentages in a complex sampling surveys: application to a French national survey on sexual behaviour. Statist Med 1997; 16: 397-423.
7. Chambless LE, Boyle KE. Maximum likelihood methods for complex sample data: logistic regression and discrete proportional hazard models. Communications in Statistics — Theory and Methods. 1985; 14: 1377-1392.
8. McNamee R. Efficiency of two-phase designs for prevalence estimation. Int J Epidemiol 2003; 32: 1072–1078.
9. Kalbfleisch JD, Lawless JF. Likelihood analysis of multi-state models for disease incidence and mortality. Statist Med 1988; 7: 149–160.
10. National Institute of Mental Health (2007). Anxiety disorders. Available at http:www.nimh.gov/healthinformation/anxietymenu.cfm. Accessed on 22nd July 2014.
11. Kilonzo G, Musisi S, Sebit MB, Ndetei DM, Szabo CP. Anxiety and adjustment disorder in the African. Textbook of Clinical Psychiatry and Mental Health. Nairobi: AMREF; 2006: 214-227.
12. Morasso G, Constantini M, Viterbori P, (List the first six authors before “et al”) et al. Predicting mood disorders in breast cancer patients. Eur J Cancer 2001; 37(2): 216-223.
13. Stark JL, Avitsur R, Hunzeker J, Padgett DA, Sheridan JF. Interleukin-6 and the development of social disruption-induced glucocorticoid resistance. J Neuroimmunol 2002; 124: 9–15.
14. Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC. Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust N Z J Psy 2004; 38(5): 320-6.
15. Love AW, Grabsch B, Clarke DM, Bloch S, Kissane DW. Screening for depression in women with metastatic breast cancer: A comparison of the Beck Depression Inventory Short form and the Hospital Anxiety and Depression Scale. Aust N Z J Psy 2004; 38(7): 526-531.
16. Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thai 2007; 90: 2164–2174.
17. Masako O, Shigeto Y, Tatsuo A, Koji T, Yosuke U. Psychiatric disorders following first breast cancer recurrence: Prevalence, associated factors and relationship to quality of life. Japan. J Clin Oncol 2005; 35(6): 302–309.
18. Anja M, Uwe K. Psychological comorbidity and health-related quality of life and its association with awareness, utilization, and need for psychosocial support in a cancer register-based sample of long-term breast cancer survivors. J Psychosom Res 2008; 64(40): 383–391.
19. Osborne RH, Elsworth GR, Hopper JL. Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry. Eur J Cancer 2003; 39: 755–762.
20. Saniah AR, Zainal NZ. Mechanisms of endocrine resistance in breast cancer patients on chemotherapy. Malay J Psych 2010; 19: 1-6.
21. Wong WS, Fielding R. Change in quality of life in Chinese women with breast cancer: changes in psychological distress as a predictor. Supp Care Canc 2007; 15(11): 1223-1230.
22. Lehtonen R, Pahicinen E. Practical Methods for Design and Analysis of Complex Surveys. Chichester: Wiley. 1995.
23. Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin: Nathadex Publishers.2004: 117-120.
24. Ohaeri JU, Campbell OB, Lola OD. The emotional disposition of terminally ill Nigerian patients to their condition. Orient J Med 1993; 5(4): 115-117.
25. Olagunju O. Depression among cancer patients attending oncology clinic in Lagos University Teaching Hospital. [A dissertation submitted to the National Postgraduate Medical College of Nigeria in partial fulfillment of the requirement for the award of Fellowship of the Faculty of Psychiatry.] Lagos: 2010.
26. Popoola AO, Adewuya OA. Prevalence and correlates of depressive disorders in outpatients breast cancer. Psycho-Oncol 2012; 21(6): 675-679.
27. Nuhu FT, Odejide OA, Adebayo KO, Yusuf AJ. Psychological and physical effect of pain on cancer patients in Ibadan, Nigeria. Afr J Psy 2009; 12(1): 65-70.
28. Zigmond AS, Snaith RP. The hospital anxiety and depression scales. Acta Psych Scand 1983; 67: 361-370.
29. Ryde-Brandt B. Anxiety and depression in mothers of children with psychotic disorders and mental retardation. Br J Psych 1990; 156: 118-121.
30. Abiodun OA. A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria. Br J Psych 1994; 165: 669-672.
31. World Health Organization. Schedule for Clinical Assessment in Neuropsychiatry (SCAN). World Health Organization Assessment, Classification and Epidemiology, Geneva. 1999.
32. Prince M. Commentary: Two-phase surveys. A death is announced; no flowers please. Int. J Epidemiol 2003; 32(6): 1078-108
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