title: Level of psychosocial impairment predicts early response to treatment in vasovagal syncope.
abstract: OBJECTIVE
  To investigate whether levels of psychosocial impairment and psychological distress at diagnosis in those with vasovagal syncope (VVS) predict subsequent response to conventional treatment.
  
  
  RESULTS
  This is a prospective, observational new patient cohort study, which includes consecutive patients with head-up tilt-confirmed VVS (September 2004-March 2006). Subjects completed the Hospital Anxiety and Depression Scale, State and trait anxiety inventory, and an Adapted Syncope Functional Status Questionnaire at diagnosis and at 3 months. A total of 108 participants [mean (SD) age 52 (21) years, 70.4% were female] completed baseline assessments. Response status was ascertained for 103 individuals; 70 were responders and 33 non-responders. Eighty-three of 103 participants (81%) completed the follow-up questionnaires. At follow-up, compared with responders, non-responders reported higher levels of Impairment (P = 0.001), negative cognitions (P = 0.01), and depression scores (P = 0.006). At diagnosis those who ultimately did not respond to treatment reported significantly higher levels of Impairment (P < 0.001) and negative cognitions (P = 0.03). Those who did not respond to treatment were significantly more depressed (P = 0.001) with higher Trait anxiety scores (P = 0.007). Multivariate analysis confirmed increased impairment predicted poor response status (z = 9.82, P = 0.002) with participants being 3% more likely to be a non-responder with each 1% increase in self-reported level of impairment.
  
  
  CONCLUSIONS
  Higher levels of psychosocial impairment reliably predict non-response to treatment, suggesting that psychological factors have an important role in VVS. Screening individuals at diagnosis may enable identification of those at risk of non-response and delivery of targeted psychological interventions to reduce the impact of VVS and its sequelae.
authors.affiliation: Department of Clinical Health Psychology, Royal Victoria Infirmary, Newcastle, UK.
authors.forename: Bev
authors.initials: B
authors.lastname: Flint
authors.forename: Christine
authors.initials: C
authors.lastname: Baker
authors.forename: Mark
authors.initials: M
authors.lastname: Freeston
authors.forename: Julia L
authors.initials: JL
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D003863:Depression / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011584:Psychology; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000503:physiopathology*; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D018667:Tilt-Table Test; D016896:Treatment Outcome; D055815:Young Adult