2.1 | Patient Data
Our study was prospectively conducted on the relatives of the patients
who were admitted to the tertiary pandemic intensive care units of
Ankara City Hospital between May 15th and July 15th, 2020 after the
approval of the ethics committee (Ethics committee number: E1-20-526).
This study included the native Turkish speaking relatives aged 18 and
over of 120 patients with clinical or radiological suspicion of COVID-19
on admission to ICU, half of whom received positive PCR results (n=60)
while the other half got negative PCR results (n=60). The consents of
the participants were obtained verbally during the phone call, due to
the pandemic and the Ministry of Health’s restriction of the hospital
visits of the patient’s relatives. The “Hospital Anxiety and Depression
Scale (HADS)” questionnaire was applied to the relative of the ICU
patient twice on phone by the intensive care doctor who followed the
patient and gave information. Before HADS questionnaire, 7 different
questions with 4-point scale ranging from 0 to 3 were asked to the
participants in order to determine the causes of anxiety and depression
(Table 1). HADS was first applied while the diagnosis of COVID-19 was
not yet clear, and then repeated when the PCR test results were
confirmed as positive or negative. Participants with previous or ongoing
psychiatric illness as well as the ones who refused to participate in
the study or cannot communicate and cooperate enough to complete the
questionnaires during phone call were excluded from the study. Patients
without confirmed PCR results were also excluded.
Gender, age, education (primary school, high school, university,
illiterate), marital status (married, single, divorced, widow) of the
patients and the participants were recorded. The patients were divided
into two groups according to the Acute Physiology and Chronic Health
Evaluation II (APACHE- II) score of the patient in the ICU as low
mortality risk (≤20) and high mortality risk (≥21) groups. Expected
mortality risks and PCR results were told to the participants on the
phone, before the second questionnaire was applied. According to World
Health Organization age classification, patients were divided into three
groups as 18-65 years, 66-80 years, 81-99 years.8 The
degree of kinship was evaluated in four groups including spouse, child,
relative or sibling. The occupations of the participants were classified
as private employee, civil servant, unemployed or student.
HADS questionnaire, found by Zigmond and Snaith and translated and
validated for the Turkish society by Aydemir et.al. was used to evaluate
the degree of anxiety and depression of the
participants.9,10 HADS consists of 14 questions with a
4-point scale ranging between 0-3 points. The general HADS score is the
total score of all the 14 questions asked (0-42 points) while anxiety
score (HADS-A) is calculated by adding up the 7 odd-numbered questions
(0-21 points) and the depression score (HADS-D) by adding up the 7
even-numbered questions (0-21 points). The HADS questionnaire was
administered to the participants on the phone and the score was
calculated using the answers recorded. According to the validation of
the HADS survey for the Turkish society, the values >10 and
>7 were considered as cut-off values for anxiety and
depression respectively (10). Participants were evaluated in 3 subgroups
for anxiety and depression as normal (0-10 for HADS-A and 0-7 for
HADS-D), moderate (11-15 for HADS-A and 8-10 for HADS-D) and high (16-21
for HADS-A and 11-21 for HADS-D).