Anxiety and depression in the patients with pulmonary nodules and its related influencing factors: A cross-sectional study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Junhan ^1,2 , ZHUANG Weitao ¹ , XU Haijie ^2,3 , TANG Yong ¹ , DENG Cheng ¹ , WU Hansheng ³ ,  QIAO Guibin ¹

1. Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;
3. Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;

Corresponding author：

QIAO Guibin, Email: guibinqiao@126.com

Keywords：

Pulmonary nodule; anxiety; depression; psychological burden; treatment preference

DOI：

10.7507/1007-4848.202202040

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To identify the potential factors for psychological burdens and to better understand how the patients’ psychological status affect their treatment preferences. Methods A questionnaire survey was conducted among 996 patients with pulmonary nodules who visited the Thoracic Surgery Clinic of Guangdong Provincial People's Hospital from January to November 2021, including 381 males and 615 females, aged 47.26±11.53 years. A self-administrated questionnaire was used to investigate the sociodemographic and clinical characteristics of the patients, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate the psychological status of the patients, with a score>7 points of each subscale indicating potential anxiety or depression. Results Among the 996 patients with pulmonary nodules, the incidence of anxiety was 42.4% and the incidence of depression was 26.4%, while the incidence of both anxiety and depression was 24.7%. There was a significant correlation between anxiety and depression (ρ=0.834, P<0.05). Age, purpose of CT examination, number of pulmonary nodules and symptoms were independent factors for anxiety, while symptoms and number of pulmonary nodules were independent factors for depression (P<0.05). For treatment preferences, there was a statistical difference in educational level, symptoms, nodule size and anxiety level (P<0.05). Conclusion Anxiety and depression are common in patients with pulmonary nodules. Symptoms are associated with anxiety and depression, which also make an impact on treatment preferences.

Citation： WU Junhan, ZHUANG Weitao, XU Haijie, TANG Yong, DENG Cheng, WU Hansheng, QIAO Guibin. Anxiety and depression in the patients with pulmonary nodules and its related influencing factors: A cross-sectional study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 357-363. doi: 10.7507/1007-4848.202202040 Copy

1.	Gould MK, Tang T, Liu IL, et al. Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med, 2015, 192(10): 1208-1214.
2.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
3.	Slatore CG, Wiener RS. Pulmonary nodules: A small problem for many, severe distress for some, and how to communicate about it. Chest, 2018, 153(4): 1004-1015.
4.	Li L, Zhao Y, Li H. Assessment of anxiety and depression in patients with incidental pulmonary nodules and analysis of its related impact factors. Thorac Cancer, 2020, 11(6): 1433-1442.
5.	Slatore CG, Wiener RS, Golden SE, et al. Longitudinal assessment of distress among veterans with incidental pulmonary nodules. Ann Am Thorac Soc, 2016, 13(11): 1983-1991.
6.	Freiman MR, Clark JA, Slatore CG, et al. Patients' knowledge, beliefs, and distress associated with detection and evaluation of incidental pulmonary nodules for cancer: Results from a multicenter survey. J Thorac Oncol, 2016, 11(5): 700-708.
7.	Byrne MM, Weissfeld J, Roberts MS. Anxiety, fear of cancer, and perceived risk of cancer following lung cancer screening. Med Decis Making, 2008, 28(6): 917-925.
8.	Kosson D, Malec-Milewska M, Gałązkowski R, et al. Analysis of anxiety, depression and aggression in patients attending pain clinics. Int J Environ Res Public Health, 2018, 15(12): 2898.
9.	Xiao R, Huang Y, Meng S, et al. A cross-sectional study of psychological burden in Chinese patients with pulmonary nodules: Prevalence and impact on the management of nodules. Thorac Cancer, 2021, 12(23): 3150-3156.
10.	Wiener RS, Gould MK, Slatore CG, et al. Resource use and guideline concordance in evaluation of pulmonary nodules for cancer: Too much and too little care. JAMA Intern Med, 2014, 174(6): 871-880.
11.	Tanner NT, Aggarwal J, Gould MK, et al. Management of pulmonary nodules by community pulmonologists: A multicenter observational study. Chest, 2015, 148(6): 1405-1414.
12.	Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-e120S.
13.	Wiener RS, Clark JA, Koppelman E, et al. Patient vs clinician perspectives on communication about results of lung cancer screening: A qualitative study. Chest, 2020, 158(3): 1240-1249.
14.	Leung CM, Wing YK, Kwong PK, et al. Validation of the Chinese-Cantonese version of the Hospital Anxiety and Depression Scale and comparison with the Hamilton Rating Scale of Depression. Acta Psychiatr Scand, 1999, 100(6): 456-461.
15.	Leung CM, Ho S, Kan CS, et al. Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. Int J Psychosom, 1993, 40(1-4): 29-34.
16.	Wu Y, Levis B, Sun Y, et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: Systematic review and individual participant data meta-analysis. BMJ, 2021, 373: n972.
17.	Herrmann C. International experiences with the Hospital Anxiety and Depression Scale—A review of validation data and clinical results. J Psychosom Res, 1997, 42(1): 17-41.
18.	Jiang G, Chen C, Zhu Y, et al. Shanghai pulmonary hospital experts consensus on the management of ground-glass nodules suspected as lung adenocarcinoma (Version 1). Zhongguo Fei Ai Za Zhi, 2018, 21(3): 147-159.
19.	Wood DE, Kazerooni EA, Baum SL, et al. Lung cancer screening, version 3. 2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(4): 412-441.
20.	Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax, 2015, 70 Suppl 2: ii1-ii54.
21.	Andersson E, Dai Ydrefelt Y, Johannesson M, et al. Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): Psychosocial consequences and impact on health-related quality of life—A multicentre prospective cross-sectional study. BMJ Open, 2021, 11(9): e048721.
22.	Smith Z, Barnett SA, Gorelik A, et al. Strategies for the management of solitary pulmonary nodules: A Survey of patient preferences. Ann Thorac Surg, 2022, 113(5): 1670-1675.
23.	Wiener DC, Wiener RS. Patient-centered, guideline-concordant discussion and management of pulmonary nodules. Chest, 2020, 158(1): 416-422.
24.	Han L. Prevalence, risk factors and prognostic role of anxiety and depression in surgical gastric cancer patients. Transl Cancer Res, 2020, 9(3): 1371-1383.
25.	Hinz A, Finck C, Gómez Y, et al. Anxiety and depression in the general population in Colombia: Reference values of the Hospital Anxiety and Depression Scale (HADS). Soc Psychiatry Psychiatr Epidemiol, 2014, 49(1): 41-49.
26.	Hamm AO. Fear, anxiety, and their disorders from the perspective of psychophysiology. Psychophysiology, 2020, 57(2): e13474.
27.	Rosenblat JD, Kurdyak P, Cosci F, et al. Depression in the medically ill. Aust N Z J Psychiatry, 2020, 54(4): 346-366.
28.	Michaelides A, Zis P. Depression, anxiety and acute pain: Links and management challenges. Postgrad Med, 2019, 131(7): 438-444.
29.	Jacobson NC, Newman MG. Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies. Psychol Bull, 2017, 143(11): 1155-1200.
30.	Silva M, Bankier AA, Centra F, et al. Longitudinal evolution of incidentally detected solitary pure ground-glass nodules on CT: Relation to clinical metrics. Diagn Interv Radiol, 2015, 21(5): 385-390.
31.	Leander M, Lampa E, Rask-Andersen A, et al. Impact of anxiety and depression on respiratory symptoms. Respir Med, 2014, 108(11): 1594-1600.
32.	Moseson EM, Wiener RS, Golden SE, et al. Patient and clinician characteristics associated with adherence. A cohort study of Veterans with incidental pulmonary nodules. Ann Am Thorac Soc, 2016, 13(5): 651-659.
33.	Iaccarino JM, Simmons J, Gould MK, et al. Clinical equipoise and shared decision-making in pulmonary nodule management. A survey of American Thoracic Society clinicians. Ann Am Thorac Soc, 2017, 14(6): 968-975.

1. Gould MK, Tang T, Liu IL, et al. Recent trends in the identification of incidental pulmonary nodules. Am J Respir Crit Care Med, 2015, 192(10): 1208-1214.
2. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
3. Slatore CG, Wiener RS. Pulmonary nodules: A small problem for many, severe distress for some, and how to communicate about it. Chest, 2018, 153(4): 1004-1015.
4. Li L, Zhao Y, Li H. Assessment of anxiety and depression in patients with incidental pulmonary nodules and analysis of its related impact factors. Thorac Cancer, 2020, 11(6): 1433-1442.
5. Slatore CG, Wiener RS, Golden SE, et al. Longitudinal assessment of distress among veterans with incidental pulmonary nodules. Ann Am Thorac Soc, 2016, 13(11): 1983-1991.
6. Freiman MR, Clark JA, Slatore CG, et al. Patients' knowledge, beliefs, and distress associated with detection and evaluation of incidental pulmonary nodules for cancer: Results from a multicenter survey. J Thorac Oncol, 2016, 11(5): 700-708.
7. Byrne MM, Weissfeld J, Roberts MS. Anxiety, fear of cancer, and perceived risk of cancer following lung cancer screening. Med Decis Making, 2008, 28(6): 917-925.
8. Kosson D, Malec-Milewska M, Gałązkowski R, et al. Analysis of anxiety, depression and aggression in patients attending pain clinics. Int J Environ Res Public Health, 2018, 15(12): 2898.
9. Xiao R, Huang Y, Meng S, et al. A cross-sectional study of psychological burden in Chinese patients with pulmonary nodules: Prevalence and impact on the management of nodules. Thorac Cancer, 2021, 12(23): 3150-3156.
10. Wiener RS, Gould MK, Slatore CG, et al. Resource use and guideline concordance in evaluation of pulmonary nodules for cancer: Too much and too little care. JAMA Intern Med, 2014, 174(6): 871-880.
11. Tanner NT, Aggarwal J, Gould MK, et al. Management of pulmonary nodules by community pulmonologists: A multicenter observational study. Chest, 2015, 148(6): 1405-1414.
12. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e93S-e120S.
13. Wiener RS, Clark JA, Koppelman E, et al. Patient vs clinician perspectives on communication about results of lung cancer screening: A qualitative study. Chest, 2020, 158(3): 1240-1249.
14. Leung CM, Wing YK, Kwong PK, et al. Validation of the Chinese-Cantonese version of the Hospital Anxiety and Depression Scale and comparison with the Hamilton Rating Scale of Depression. Acta Psychiatr Scand, 1999, 100(6): 456-461.
15. Leung CM, Ho S, Kan CS, et al. Evaluation of the Chinese version of the Hospital Anxiety and Depression Scale. A cross-cultural perspective. Int J Psychosom, 1993, 40(1-4): 29-34.
16. Wu Y, Levis B, Sun Y, et al. Accuracy of the Hospital Anxiety and Depression Scale Depression subscale (HADS-D) to screen for major depression: Systematic review and individual participant data meta-analysis. BMJ, 2021, 373: n972.
17. Herrmann C. International experiences with the Hospital Anxiety and Depression Scale—A review of validation data and clinical results. J Psychosom Res, 1997, 42(1): 17-41.
18. Jiang G, Chen C, Zhu Y, et al. Shanghai pulmonary hospital experts consensus on the management of ground-glass nodules suspected as lung adenocarcinoma (Version 1). Zhongguo Fei Ai Za Zhi, 2018, 21(3): 147-159.
19. Wood DE, Kazerooni EA, Baum SL, et al. Lung cancer screening, version 3. 2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(4): 412-441.
20. Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax, 2015, 70 Suppl 2: ii1-ii54.
21. Andersson E, Dai Ydrefelt Y, Johannesson M, et al. Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): Psychosocial consequences and impact on health-related quality of life—A multicentre prospective cross-sectional study. BMJ Open, 2021, 11(9): e048721.
22. Smith Z, Barnett SA, Gorelik A, et al. Strategies for the management of solitary pulmonary nodules: A Survey of patient preferences. Ann Thorac Surg, 2022, 113(5): 1670-1675.
23. Wiener DC, Wiener RS. Patient-centered, guideline-concordant discussion and management of pulmonary nodules. Chest, 2020, 158(1): 416-422.
24. Han L. Prevalence, risk factors and prognostic role of anxiety and depression in surgical gastric cancer patients. Transl Cancer Res, 2020, 9(3): 1371-1383.
25. Hinz A, Finck C, Gómez Y, et al. Anxiety and depression in the general population in Colombia: Reference values of the Hospital Anxiety and Depression Scale (HADS). Soc Psychiatry Psychiatr Epidemiol, 2014, 49(1): 41-49.
26. Hamm AO. Fear, anxiety, and their disorders from the perspective of psychophysiology. Psychophysiology, 2020, 57(2): e13474.
27. Rosenblat JD, Kurdyak P, Cosci F, et al. Depression in the medically ill. Aust N Z J Psychiatry, 2020, 54(4): 346-366.
28. Michaelides A, Zis P. Depression, anxiety and acute pain: Links and management challenges. Postgrad Med, 2019, 131(7): 438-444.
29. Jacobson NC, Newman MG. Anxiety and depression as bidirectional risk factors for one another: A meta-analysis of longitudinal studies. Psychol Bull, 2017, 143(11): 1155-1200.
30. Silva M, Bankier AA, Centra F, et al. Longitudinal evolution of incidentally detected solitary pure ground-glass nodules on CT: Relation to clinical metrics. Diagn Interv Radiol, 2015, 21(5): 385-390.
31. Leander M, Lampa E, Rask-Andersen A, et al. Impact of anxiety and depression on respiratory symptoms. Respir Med, 2014, 108(11): 1594-1600.
32. Moseson EM, Wiener RS, Golden SE, et al. Patient and clinician characteristics associated with adherence. A cohort study of Veterans with incidental pulmonary nodules. Ann Am Thorac Soc, 2016, 13(5): 651-659.
33. Iaccarino JM, Simmons J, Gould MK, et al. Clinical equipoise and shared decision-making in pulmonary nodule management. A survey of American Thoracic Society clinicians. Ann Am Thorac Soc, 2017, 14(6): 968-975.

Previous Article
The value of breast palpation imaging in breast cancer screening
Next Article
Research progress in the stemness regulation and targeted treatment of microRNA in gastric cancer stem cells

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Anxiety and depression in the patients with pulmonary nodules and its related influencing factors: A cross-sectional study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content