3 | RESULTS:
The results of 120 out of 160 patients’ relatives were included in the
statistical evaluation. Twenty two of the participants were excluded
because their patients were transferred to the ward from the ICU, before
the second test, 10 were excluded because their patients died before the
second test was performed, 7 were excluded because of unavailability
through phone, and 1 participant was excluded because the patient was
coming from a nursing home and the survey was taken by a staff, not a
relative.
When all patients evaluated, the average age was 70.22. Sixty (50%)
patients were male with an average age of 66.48 and sixty (50%) were
female with an average age of 73.95. Ninety two (76.7%) of the patients
were married and 72 (60%) of them were graduated from the primary
school. The average APACHE-II score was 17 and 34 (28%) patients
required mechanical ventilator (Table 2).
When all participants were evaluated, the average age was 43.88. 72
(60%) were male, 94 (78.3%) were married, 54 (45%) were graduated
from the university, 83 (69.2%) were children of the patients, 53
(44.2%) were private employee (Table 3).
While there was no difference in the averages of HADS, HADS-A and HADS-D
between the first and second surveys (p=0.572, p=0.974, p=0.190
respectively). Participants with HADS-A and HADS-D anxiety and
depression scale above the cut-off values were 45.8% and 67.5% for the
first test and 46.7% and 62.5% for the second test respectively (Table
4).
Although there was no statistically significant difference between the
averages of the first questionnaire according to the PCR results of the
patients (p=0.315), and the ratio of participants with PCR positive
patients who have higher survey scores then the cut-off values for
anxiety and depression were higher than the PCR negative patients both
in HADS-A (51.6% for PCR positive, n=31 and 40% for PCR negative,
n=24) and HADS-D (70 % for PCR positive, n=41 and 65% for PCR
negative, n=39) for the first questionnaire. When the results of the
second questionnaire were evaluated, HADS, HADS-A and HADS-D averages
were significantly higher (p=0.001, p<0.001, p=0.012
respectively), also the ratio of participants with PCR positive patients
who have higher survey scores then the cut-off values for anxiety and
depression were significantly higher than the PCR negative patients
(p<0.001 for HADS-A and p=0.034 for HADS-D) (Table 5).
When compared according to gender, the HADS and HADS-A scores of the
first questionnaire and the HADS-D scores of the first and second survey
were significantly higher in female then male participants (p=0.014,
0.046, 0.009, 0.049 respectively) (Table 6).
When HADS results were compared according to kinship, the HADS and
HADS-A results of the first questionnaire were significantly higher
among spouses of the patients than the other relatives (p=0.05 and
p=0.020 respectively) (Table 7).
When the first and second questionnaire HADS results were compared in
terms of APACHE-II score, there was no statistical difference (p=
0.919), but the HADS-D results of the second questionnaire were
significantly higher for patients with an APACHE-II score ≥21 (p= 0.042)
(Table 8).
The average HADS values of participants did not change according to age
of the patients, but the HADS average of the participants increased as
the age of the patients decreased and, although not statistically
significant, as the age of the patients increased, anxiety and
depression scales of the participants decreased (Table 9).
No significant relation was found between the education of the
participants and the HADS results (Table 10).
Logistic regression analysis was used to evaluate whether the answers to
the questions asked to the participants were independent risk factors
for anxiety and depression which showed patients’ hospitalization in the
intensive care unit due to pandemic to be an independent risk factor for
anxiety among the participants while restrictions to visit patients in
the intensive care unit to be an independent risk factor for depression
(Table 11, Table 12). ROC curves were drawn. For anxiety in the
participants, AUC=0.746 for question 1 and for depression, AUC=0.703 for
question 3 (Figure 1, Figure 2).
Twenty five of the participants stated 10 different reasons for anxiety
and depression. Five of them feared death of their patient, 4 feared
infecting their families, 3 feared infecting other people, 3 feared the
length of time to recovery, 3 feared loss of their jobs or had financial
issues, 2 were upset about not getting convenient information through
regular calls, 1 was anxious about the education of his child, 1 was
anxious because he started working and could get infected, 1 expressed
concern about the general spread of the disease and the increasing
number of patients, while another expressed concern about the
insufficiency and unreliability of the data announced by the Ministry of
Health.