Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients With Stable Coronary Artery Disease

Department of Psychiatry and School of Nursing, McGill University, Montreal, Quebec, Canada.
Archives of general psychiatry (Impact Factor: 14.48). 01/2008; 65(1):62-71. DOI: 10.1001/archgenpsychiatry.2007.4
Source: PubMed


Anxiety and depression are associated with mechanisms that promote atherosclerosis. Most recent studies of emotional disturbances in coronary artery disease (CAD) have focused on depression only.
To assess the 2-year cardiac prognostic importance of the DSM-IV-based diagnoses of major depressive disorder (MDD) and generalized anxiety disorder (GAD) and self-report measures of anxiety and depression and their co-occurrence.
Two-year follow-up of 804 patients with stable CAD (649 men) assessed using the Beck Depression Inventory II (BDI-II), the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and the Structured Clinical Interview for DSM-IV (masked to self-reports) 2 months after acute coronary syndromes.
Major adverse cardiac events (MACEs) (cardiac death, myocardial infarction, cardiac arrest, or nonelective revascularization) in the 2 years after baseline.
Of the 804 patients, 57 (7.1%) met the criteria for MDD and 43 (5.3%) for GAD (11 [1.4%] had comorbidity); 220 (27.4%) had elevated BDI-II scores (> or = 14), and 333 (41.4%) had elevated HADS-A scores (> or = 8), with 21.1% overlap. MDD (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.62-5.01), GAD (OR, 2.09; 95% CI, 1.08-4.05), elevated BDI-II (OR, 1.75; 95% CI, 1.21-2.54), elevated HADS-A score (OR, 1.67; 95% CI, 1.18-2.37), and continuous standardized scores on the BDI-II (OR, 1.34; 95% CI, 1.11-1.62) and the HADS-A (OR, 1.38; 95% CI, 1.16-1.63) all predicted MACEs. After covariate control, only the P value associated with the continuous BDI-II score increased to above .10. Most of the risk associated with elevated symptoms was in patients with psychiatric disorders. However, patients with comorbid MDD and GAD or elevated anxiety and depression symptoms were not at greater MACE risk than those with only 1 factor.
Anxiety and depression predict greater MACE risk in patients with stable CAD, supporting future research into common genetic, environmental, and pathophysiologic pathways and treatments.

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    • "The use of self-report scales may also be an important factor. These scales tend to give higher estimates of distress [16], which could be particularly important with respect to anxiety. Anxiety can be adaptive in moderate levels, providing motivation to avoid risks and engage in behaviours to prevent negative health outcomes in the future, such as checking for early symptoms and increased treatment seeking. "
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    ABSTRACT: There has been increasing interest in the relationship between cardiac and metabolic conditions with mental illness. Many studies have found associations between these conditions and depression but results with anxiety disorders have been mixed. We explore these relationships in a nationally representative survey using physician diagnoses of physical conditions and DSM-IV psychiatric disorders. Data came from the nationally representative German Health Survey (N=4181, age 18-65). Physician diagnoses of angina, myocardial infarction, congestive heart, hypertension, dyslipidemia, diabetes, and obesity were examined in relation to depression and anxiety disorders, which were assessed through a modified version of the Composite International Diagnostic Interview. Multiple logistic regression analyses were used to examine the associations between these conditions. After adjusting for sociodemographics, psychiatric comorbidity, and substance use, having an anxiety disorder was associated with increased odds of cardiac conditions and metabolic risk factors with odds ratios ranging from 1.3 to 3.3. Depression was not associated with any of the conditions but was associated with poor medical compliance for health conditions on two outcomes measured. Anxiety was also associated with reduced medical compliance for one health behaviour measured. Anxiety disorders, but not depression, were associated with metabolic and cardiac conditions in our sample. Both conditions were related to some aspects of poor self-care for health conditions and therefore may be linked to negative outcomes. Copyright © 2015. Published by Elsevier Inc.
    General hospital psychiatry 04/2015; 37(4). DOI:10.1016/j.genhosppsych.2015.03.022 · 2.61 Impact Factor
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    • "Symptoms of anxiety and depression are commonly experienced by patients with coronary artery diseases (CAD). Depression and anxiety have been previously associated the with increased severity of CAD, the number and length of cardiac-related hospitalizations and all-cause mortality, and can predict greater risk major adverse cardiac events in patients with stable CAD[42]–[44]. Evidence from this systematic review and meta-analysis is therefore in support of conducting a randomized controlled trial of sufficient power and at least 12 months of follow-up to compare the impact associated with the delivery of a regular telephone intervention alongside usual care for monitoring and supporting coronary artery disease patients following an acute cardiac event or revascularization procedure. "
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    ABSTRACT: Cardiac rehabilitation is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness. However, patient participation remains suboptimal and the provision of high quality care to an expanding population of patients with chronic heart conditions is becoming increasingly difficult. A systematic review and meta-analysis was conducted to determine the effect of telephone support interventions compared with standard post-discharge care on coronary artery disease patient outcomes. The Cochrane Library, MEDLINE, EMBASE, and CINAHL were searched and randomized controlled trials that directly compared telephone interventions with standard post-discharge care in adults following a myocardial infarction or a revascularization procedure were included. Study selection, data extraction and quality assessment were completed independently by two reviewers. Where appropriate, outcome data were combined and analyzed using a random effects model. For each dichotomous outcome, odds ratios (OR) and 95% confidence intervals (CI) were derived for each outcome. For continuous outcomes, weighted mean differences (WMD) and standardized mean differences (SMD) and 95% CI were calculated. 26 studies met the inclusion criteria. No difference was observed in mortality between the telephone group and the group receiving standard care OR 1.12 (0.71, 1.77). The intervention was significantly associated with fewer hospitalizations than the comparison group OR 0.62 (0.40, 0.97). Significantly more participants in the telephone group stopped smoking OR 1.32 (1.07, 1.62); had lower systolic blood pressure WMD -0.22 (-0.40, -0.04); lower depression scores SMD -0.10 (-0.21, -0.00); and lower anxiety scores SMD -0.14 (-0.24, -0.04). However, no significant difference was observed for low-density lipoprotein levels WMD -0.10 (-0.23, 0.03). Compared to standard post-discharge care, regular telephone support interventions may help reduce feelings of anxiety and depression as well as, improve systolic blood pressure control and the likelihood of smoking cessation.
    PLoS ONE 05/2014; 9(5):e96581. DOI:10.1371/journal.pone.0096581 · 3.23 Impact Factor
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    • "Cardiac problems, such as coronary heart disease, myocardial infarction (MI), arrhythmias, and hypertension, are associated with acute and with chronic mental stress [1,2]. Depression and anxiety can be generally regarded as factors associated with increased morbidity and mortality of coronary heart disease [3]. "
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    ABSTRACT: Type D personality has been associated with a variety of emotional and social difficulties as well as with poor prognosis in patients with established coronary heart disease (CHD). We examined the psychometric properties and validity of the Type D Scale-14 (DS14) and the prevalence of Type D personality among Greek patients with CHD while taking into account demographic; clinical, such as diabetes mellitus, hypertension, and hypercholesterolemia; as well as psychological variables such as depression, anxiety, and psychological stress. Ninety-six patients with stable coronary heart disease and 80 healthy participants from the general population completed the Greek version of the DS14 and the Hospital Anxiety and Depression Scale (HADS). Cronbach's alpha coefficient for the negative affectivity (NA) and social inhibition (SI) subscales was 0.83 and 0.72 for the CHD and 0.88 and 0.76 for the control group, respectively. Internal-structural validity was assessed by a factor analysis (two-factor solution), and the factor structure of the original DS14 was replicated. Using the standardized cutoff point of NA >=10 and SI >=10, instead of the median scores, in order to have compatible results with the majority of studies, the prevalence of Type D personality was 51% for the CHD patients and 13% for the control group. Higher NA and SI were connected with higher anxiety, depression, and total psychological stress. Finally, more patients with CHD and Type D personality than those without were diagnosed with type 2 diabetes; however, no differences were observed in hypertension or hypercholesterolemia. These results indicate that the Type D construct is reliable and valid in a Greek population. The prevalence of Type D personality was higher in patients with stable coronary heart disease than in people from the general population. The DS14 subscales were positively correlated with higher anxiety, depression, and total psychological stress. Regarding other CHD risk factors, only diabetes mellitus was found more frequently in CHD patients with Type D personality.
    Annals of General Psychiatry 11/2013; 12(1):38. DOI:10.1186/1744-859X-12-38 · 1.40 Impact Factor
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