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Characterizing anxiety at the first encounter in women presenting to the clinic: the CAFÉ study

      Background

      Clinically based anxiety questionnaires measure 2 forms of anxiety that are known as state anxiety and trait anxiety. State anxiety is temporary and is sensitive to change; trait anxiety is a generalized propensity to be anxious.

      Objective

      Our study aims to characterize the reasons for anxiety among women about the initial consultation for their pelvic floor disorders to measure change in participant state anxiety after the visit and to correlate improvement in anxiety with visit satisfaction.

      Study Design

      All new patients at our tertiary urogynecology clinic were invited to participate. After giving consent, participants completed pre- and postvisit questionnaires. Providers were blinded to pre- and postvisit questionnaire responses. The previsit questionnaires included the Pelvic Floor Distress Inventory, the Generalized Anxiety Disorder-7, and the 6-item short form of the Spielberg State Trait Anxiety Inventory. Participants were also asked to list their previsit anxieties. The postvisit questionnaires comprised of the Spielberg State Trait Anxiety Inventory, patient global impression of improvement of participant anxiety, patient satisfaction, and the participant’s perception of whether her anxiety was addressed during the visit. The anxieties listed by participants were then reviewed independently and categorized by 2 of the authors. A separate panel arbitrated when there were disagreements among anxiety categories.

      Results

      Fifty primarily white (66%) women with a median age of 53 years (interquartile range, 41–66) completed the study. The visit diagnoses included stress urinary incontinence (54%), urge urinary incontinence (46%), myofascial pain (28%), pelvic organ prolapse (20%), and recurrent urinary tract infection (12%). Less than one-quarter of participants (22%) had a history of anxiety diagnosis. The average previsit Spielberg State Trait Anxiety Inventory score was 42.9 (standard deviation, 11.98) which decreased by an average of 12.60 points in the postvisit (95% confidence interval, –16.56 to –8.64; P<.001). Postvisit decreased anxiety was associated with improvements in the patient global impression of improvement anxiety (P<.001) and participants’ perception that their anxiety symptoms had been addressed completely (P=.045). The most reported causes for consultation related anxiety were lack of knowledge of diagnosis and ramifications, personal or social issues, and fear of the physical examination. Participants reported that improvements in anxiety were related to patient education and reassurance, medical staff appreciation, and acceptable treatment plan. Participants who reported complete satisfaction demonstrated a greater decrease in the postvisit Spielberg State Trait Anxiety Inventory scores compared with the participants who did not report complete satisfaction (P=.045). Changes in the Spielberg State Trait Anxiety Inventory score were not associated with the Pelvic Floor Distress Inventory (P=.35) or Generalized Anxiety Disorder-7 scores (P=.78).

      Conclusion

      Women with the highest satisfaction after their initial urogynecology visit also demonstrated the largest decreases in anxiety after the visit. Changes in anxiety scores were not correlated with the Pelvic Floor Distress Inventory or with measures of generalized anxiety (Generalized Anxiety Disorder-7). Recognizing and addressing patient anxiety may help physicians better treat their patients and improve overall patient satisfaction.

      Key words

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      References

        • Nygaard I.
        • Barber M.D.
        • Burgio K.L.
        • et al.
        Prevalence of symptomatic pelvic floor disorders in US women.
        JAMA. 2008; 300: 1311-1316
        • Minassian V.A.
        • Yan X.
        • Lichtenfeld M.J.
        • Sun H.
        • Stewart W.F.
        The iceberg of health care utilization in women with urinary incontinence.
        Int Urogynecol J. 2012; 23: 1087-1093
        • Rogers G.R.
        • Villarreal A.
        • Kammerer-Doak D.
        • Qualls C.
        Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse.
        Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12: 361-365
        • Lowder J.L.
        • Ghetti C.
        • Nikolajski C.
        • Oliphant S.S.
        • Zyczynski H.M.
        Body image perceptions in women with pelvic organ prolapse: a qualitative study.
        Am J Obstet Gynecol. 2011; 204: 441.e1-441.e5
        • Ghetti C.
        • Skoczylas L.C.
        • Oliphant S.S.
        • Nikolajski C.
        • Lowder J.L.
        The emotional burden of pelvic organ prolapse in women seeking treatment: a qualitative study.
        Female Pelvic Med Reconstr Surg. 2015; 21: 332-338
        • Spielberger C.
        • Gorsuch R.
        • Lushene R.
        • Spirnak J.
        • Vagg P.
        • Jacobs G.
        Manual for the state-trait anxiety inventory.
        Consulting Psychologists Press, Palo Alto (CA)1983
        • Spielberger C.
        State-trait anxiety inventory (preliminary test manual, form B).
        Florida State Univeristy, Tallahassee (FL)1967
        • Smith R.C.
        • Lay C.D.
        State and trait: an annotated bibliography.
        Psychol Rep. 1974; 34: 519-594
        • Kessler R.C.
        • Gruber M.
        • Hettema J.M.
        • Hwang I.
        • Sampson N.
        • Yonkers K.A.
        Co-morbid major depression and generalized anxiety disorders in the national comorbidity survey follow-up.
        Psychol Med. 2008; 38: 365-374
        • Wittchen H.U.
        • Zhao S.
        • Kessler R.C.
        • Eaton W.W.
        DSM-III-R generalized anxiety disorder in the national comorbidity survey.
        Arch Gen Psychiatry. 1994; 51: 355-364
        • Lenze E.
        Anxiety disorders in the elderly.
        in: Stein D. Hollander E. Rothbaum B. Textbook of anxiety disorders. 2nd ed. American Psychiatric Publishing, Inc, Washington (DC)2010: 651
        • Vrijens D.
        • Berghmans B.
        • Nieman F.
        • van Os J.
        • van Koeveringe G.
        • Leue C.
        Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions: Aa cross sectional cohort study at a pelvic care centre.
        Neurourol Urodyn. 2017; 36: 1816-1823
        • Yazdany T.
        • Bhatia N.
        • Reina A.
        Association of depression and anxiety in underserved women with and without urinary incontinence.
        Female Pelvic Med Reconstr Surg. 2014; 20: 349-353
        • Ai F.
        • Deng M.
        • Mao M.
        • Xu T.
        • Zhu L.
        Screening for general anxiety disorders in postmenopausal women with symptomatic pelvic organ prolapse.
        Climacteric. 2018; 21: 35-39
        • Barber M.D.
        • Walters M.D.
        • Bump R.C.
        Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7).
        Am J Obstet Gynecol. 2005; 193: 103-113
        • Marteau T.M.
        • Bekker H.
        The development of a six-item short-form of the state scale of the Spielberger state-trait anxiety inventory (STAI).
        Br J Clin Psychol. 1992; 31: 301-306
        • Spitzer R.L.
        • Kroenke K.
        • Williams J.B.
        • Lowe B.
        A brief measure for assessing generalized anxiety disorder: the GAD-7.
        Arch Intern Med. 2006; 166: 1092-1097
        • Yalcin I.
        • Bump R.C.
        Validation of two global impression questionnaires for incontinence.
        Am J Obstet Gynecol. 2003; 189: 98-101
        • Kenton K.
        • Pham T.
        • Mueller E.
        • Brubaker L.
        Patient preparedness: an important predictor of surgical outcome.
        Am J Obstet Gynecol. 2007; 197: 654.e1-654.e6
        • Pham T.
        • Kenton K.
        • Mueller E.
        • Brubaker L.
        New pelvic symptoms are common after reconstructive pelvic surgery.
        Am J Obstet Gynecol. 2009; 200: 88.e1-88.e5
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Tarazona B.
        • Tarazona-Alvarez P.
        • Penarrocha-Oltra D.
        • Rojo-Moreno J.
        • Penarrocha-Diago M.
        Anxiety before extraction of impacted lower third molars.
        Med Oral Patol Oral Cir Bucal. 2015; 20: e246-e250
        • Mackintosh J.
        • Cone G.
        • Harland K.
        • Sriram K.B.
        Music reduces state anxiety scores in patients undergoing pleural procedures: a randomised controlled trial.
        Intern Med J. 2018; 48: 1041-1048
        • Ai F.F.
        • Mao M.
        • Zhang Y.
        • Kang J.
        • Zhu L.
        Effect of generalized anxiety disorders on the success of pessary treatment for pelvic organ prolapse.
        Int Urogynecol J. 2018; 29: 1147-1153
        • Molinuevo B.
        • Batista-Miranda J.E.
        Under the tip of the iceberg: psychological factors in incontinence.
        Neurourol Urodyn. 2012; 31: 669-671
        • Billquist E.J.
        • Michelfelder A.
        • Brincat C.
        • Brubaker L.
        • Fitzgerald C.M.
        • Mueller E.R.
        Preoperative guided imagery in female pelvic medicine and reconstructive surgery: a randomized trial.
        Int Urogynecol J. 2018; 29: 1117-1122
        • Wood C.
        • Conner M.
        • Miles E.
        • et al.
        The impact of asking intention or self-prediction questions on subsequent behavior: a meta-analysis.
        Pers Soc Psychol Rev. 2016; 20: 245-268
        • Conner M.
        • Godin G.
        • Norman P.
        • Sheeran P.
        Using the question-behavior effect to promote disease prevention behaviors: two randomized controlled trials.
        Health Psychol. 2011; 30: 300-309
        • Sandberg T.
        • Conner M.
        A mere measurement effect for anticipated regret: Impacts on cervical screening attendance.
        Br J Soc Psychol. 2009; 48: 221-236
        • Rodrigues A.M.
        • O’Brien N.
        • French D.P.
        • Glidewell L.
        • Sniehotta F.F.
        The question-behavior effect: genuine effect or spurious phenomenon? A systematic review of randomized controlled trials with meta-analyses.
        Health Psychol. 2015; 34: 61-78
        • Elkadry E.A.
        • Kenton K.S.
        • FitzGerald M.P.
        • Shott S.
        • Brubaker L.
        Patient-selected goals: a new perspective on surgical outcome.
        Am J Obstet Gynecol. 2003; 189: 1551-1558
        • Mahajan S.T.
        • Elkadry E.A.
        • Kenton K.S.
        • Shott S.
        • Brubaker L.
        Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery.
        Am J Obstet Gynecol. 2006; 194: 722-728
        • Lowenstein L.
        • Kenton K.
        • Pierce K.
        • Fitzgerald M.P.
        • Mueller E.R.
        • Brubaker L.
        Patients’ pelvic goals change after initial urogynecologic consultation.
        Am J Obstet Gynecol. 2007; 197: 640.e1-640.e3