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

ArticleinArchives of general psychiatry 65(1):62-71 · January 2008with19 Reads
DOI: 10.1001/archgenpsychiatry.2007.4 · Source: PubMed
Abstract
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.
    • "We used the Italian version of the Hospital Anxiety and Depression Scale (HADS), a 14-item self-report measure developed to screen for emotional distress in medical patients [113, 114]. The HADS has been shown to be a reliable and well-validated scale in various studies of patients with CVD [115, 116]. The participants reported their feelings and moods on a 4-point Likert scale; an example item is " I've lost interest in caring for my physical appearance " , and the possible answers are 1 = " completely " , 2 = " I don't care for it as much as I should " , 3 = " I care for it a bit less than I should " , 4 = " I don't care for it like before " . "
    [Show abstract] [Hide abstract] ABSTRACT: Many studies have focused on Type A and Type D personality types in the context of cardiovascular diseases (CVDs), but nothing is known about how these personality types combine to create new profiles. The present study aimed to develop a typology of Type A and Type D personality in two groups of patients affected by and at risk for coronary disease. The study involved 711 patients: 51.6% with acute coronary syndrome, 48.4% with essential hypertension (mean age = 56.4 years; SD = 9.7 years; 70.7% men). Cluster analysis was applied. External variables, such as socio-demographic, psychological, lifestyle, and clinical parameters, were assessed. Six groups, each with its own unique combined personality profile scores, were identified: Type D, Type A-Negatively Affected, Not Type A-Negatively Affected, Socially Inhibited-Positively Affected, Not Socially Inhibited, and Not Type A-Not Type D. The Type A-Negatively Affected cluster and, to a lesser extent, the Type D cluster, displayed the worst profile: namely higher total cardiovascular risk index, physical inactivity, higher anxiety and depression, and lower self-esteem, optimism, and health status. Identifying combined personality profiles is important in clinical research and practice in cardiovascular diseases. Practical implications are discussed.
    Full-text · Article · Sep 2016
    • "[25] A 2-year follow-up study found that of 804 patients, 7.1% and 5.3%met the criteria for major depressive disorder and generalized anxiety disorders, respectively. [26] The discrepancy between these findings is likely attributable to the following reasons. First, most previous studies have identified depressive or anxiety symptoms and depressive or anxiety disorders by using rating scales, such as the Hospital Anxiety and Depression Scale (HADS), rather than clinical diagnosis by psychiatrists. "
    Full-text · Article · Aug 2016
    • "Stress, anxiety and depression are core symptoms of affective disorders. The spectrum of affective and anxious symptomatology is quite prevalent in the general population [9, 10] and college students [11]. Attempts to subtype anxiety and depression symptoms have resulted in minimal success and have revealed mixed classes [12] . "
    [Show abstract] [Hide abstract] ABSTRACT: Anxious-depression symptomatology is frequently encountered among Latina/o individuals. There is a dearth of studies that examine this mixed class of anxiety and depression symptomatology, especially among Latina/o college students by the US-Mexico border. A total of 505 participants from rural institutions of higher education completed the DASS21. Psychometric properties were measured by means of confirmatory and exploratory factor analysis (EFA). A multivariate analysis of variance (MANOVA) was conducted to determine gender differences in depression, anxiety and stress. Among women, 18 % reported at least moderate levels of depressive symptoms, 33.1 % reported at least moderate levels of anxiety symptoms, and 16.4 % reported at least moderate levels of stress. In men, 15.9 % reported at least moderate levels of depressive symptoms, 34.1 % reported at least moderate levels of anxiety symptoms, and 12.9 % reported at least moderate levels of stress. The EFA supported a one dimension factor (anxious/stress-depression) among this sample of Latina/o college students (Bartlett's test = 4960.9; df = 210; p ≤ 0.01; Kaiser-Meyer-Olkin = 0.95). The MANOVA found no significant gender differences in depression, anxiety symptomatology and stress [Wilks'Λ = 0.99; F = (3, 500) = 2.41; p = 0.07]. The DASS-21 showed a one dimensional construct of anxious/stress-depression symptomatology in a Latina/o rural undergraduate sample, raising awareness to the need to screen and monitor this constellation of symptoms.
    Full-text · Article · Apr 2016
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