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.