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).