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Amiri S. Depression symptoms reducing return to work: a meta-analysis of prospective studies. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2023; 29:347-357. [PMID: 35291917 DOI: 10.1080/10803548.2022.2044640] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives. This study was conducted to estimate the risk of return to work for people who experience symptoms of depression based on the pool of prospective data. Methods. All online articles in PubMed and Scopus which were accessible before November 2019 were searched. The odds ratios of each of the studies were pooled together to obtain an overall odds ratio. The pool of studies was with random effects. The analysis was performed based on the depression symptoms scale, type of disease and duration of follow-up. Two other aspects were examined in the analysis, one being the bias in the publication of studies and the other being the level of heterogeneity that was examined. Results. Thirty-five studies were selected for the meta-analysis. The pooled odds ratio indicates that the odds of return to work in people with depressive symptoms is 31% lower than in those without depressive symptoms. The funnel plot shows that there is asymmetry. The Egger test result was significant (p < 0.001) and there is publication bias. Conclusion. Depression symptoms after sick leave due to physical illness is a risk factor for not returning to work.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Kioumourtzoglou MA, Power MC, Hart JE, Okereke OI, Coull BA, Laden F, Weisskopf MG. The Association Between Air Pollution and Onset of Depression Among Middle-Aged and Older Women. Am J Epidemiol 2017; 185:801-809. [PMID: 28369173 DOI: 10.1093/aje/kww163] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/31/2016] [Indexed: 12/20/2022] Open
Abstract
Despite recently reported associations between air pollution and acute psychiatric outcomes, the association with depression onset has not, to our knowledge, been previously examined. We conducted a prospective cohort study among 41,844 women in the Nurses' Health Study, in the United States. The women had an average age of 66.6 (standard deviation, 7.6) years, were depression-free in 1996, and were followed through 2008. May-September ozone exposures were predicted by interpolating concentrations from the 5 nearest monitors. One-, 2-, and 5-year average concentrations of particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5) were predicted at each participant's residence using a spatiotemporal model. We defined depression as report of doctor's diagnosis or use of antidepressant medication. We estimated adjusted hazard ratios with time-varying Cox models. Hazard ratios for both pollutants were elevated (per 10-parts-per-billion increase in ozone, hazard ratio (HR) = 1.06; 95% confidence interval (CI): 1.00, 1.12; per 10-μg/m3 increase in 1-year PM2.5, HR = 1.08; 95% CI: 0.97, 1.20). Associations were stronger when only antidepressant use was used to define cases (for ozone, HR = 1.08; 95% CI: 1.02, 1.14; for PM2.5, HR = 1.12; 95% CI: 1.00, 1.25). To our knowledge, these results represent the first identification of a possible association between both long-term ozone and PM2.5 exposure and depression onset. Although the stronger association specifically with antidepressant use may reflect that this endpoint better captures the onset time and milder cases, our findings should be interpreted with caution.
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Dobbels F, De Geest S, Vanhees L, Schepens K, Fagard R, Vanhaecke J. Depression and the Heart: A Systematic Overview of Definition, Measurement, Consequences and Treatment of Depression in Cardiovascular Disease. Eur J Cardiovasc Nurs 2016; 1:45-55. [PMID: 14622867 DOI: 10.1016/s1474-5151(01)00012-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is an independent risk factor in the pathogenesis of cardiovascular disease and it is a prevalent disorder after cardiovascular disease associated with negative outcome in terms of mortality and morbidity. It is a dangerous condition requiring adequate screening and treatment, however, it often remains undiagnosed and thus untreated. Non-psychiatric healthcare workers, like nurses, general practitioners, physiotherapists and cardiologists are the health providers most closely involved in the management of patients with cardiovascular disease. They can play an important role in screening cardiovascular patients for depressive symptoms and in referring them for treatment. The purpose of this article therefore is to provide an evidence-based framework, aiming to educate non-psychiatric healthcare providers on depressive disorder in the context of chronic cardiovascular disease. In this paper, an overview of the definition, prevalence and consequences of depression will be discussed. Moreover, an overview of measurement methods and treatment modalities for depression will be provided. In addition, a step-by-step guide is provided in order to help non-psychiatric healthcare providers in dealing with depressed patients.
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Affiliation(s)
- Fabienne Dobbels
- Department of Cardiology, Cardiovascular Rehabilitation Unit, University Hospital of Leuven, Leuven, Belgium.
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Jovanova O, Luik AI, Leening MJG, Noordam R, Aarts N, Hofman A, Franco OH, Dehghan A, Tiemeier H. The long-term risk of recognized and unrecognized myocardial infarction for depression in older men. Psychol Med 2016; 46:1951-1960. [PMID: 26996221 DOI: 10.1017/s0033291716000544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between myocardial infarction (MI) and depression is well described. Yet, the underlying mechanisms are unclear and the contribution of psychological factors is uncertain. We aimed to determine the risk of recognized (RMI) and unrecognized (UMI) myocardial infections on depression, as both have a similar impact on cardiovascular health but differ in psychological epiphenomena. METHOD Participants of the Rotterdam Study, 1823 men aged ⩾55 years, were followed for the occurrence of depression. RMI and UMI were ascertained using electrocardiography and medical history at baseline. We determined the strength of the association of RMI and UMI with mortality, and we studied the relationship of RMI and UMI with depressive symptoms and the occurrence of major depression. RESULTS The risk of mortality was similar in men with RMI [adjusted hazard ratio (aHR) 1.71, 95% confidence interval (CI) 1.45-2.03] and UMI (aHR 1.58, 95% CI 1.27-1.97). Men with RMI had on average [unstandardized regression coefficient (B) 1.14, 95% CI 0.07-2.21] higher scores for depressive symptoms. By contrast, we found no clear association between UMI and depressive symptoms (B 0.55, 95% CI -0.51 to 1.62) in men. Analysis including occurrence of major depression as the outcome were consistent with the pattern of association. CONCLUSION The discrepant association of RMI and UMI with mortality compared to depression suggests that the psychological burden of having experienced an MI contributes to the long-term risk of depression.
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Affiliation(s)
- O Jovanova
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A I Luik
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - M J G Leening
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - R Noordam
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - N Aarts
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A Hofman
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - O H Franco
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - A Dehghan
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
| | - H Tiemeier
- Department of Epidemiology,Erasmus MC, University Medical Center Rotterdam,Rotterdam,The Netherlands
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Paul Taggart D, van der Wall EE, Vrints CJ, Luis Zamorano J, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Anton Sirnes P, Luis Tamargo J, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, González-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Dalby Kristensen S, Lancellotti P, Pietro Maggioni A, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Anton Sirnes P, Gabriel Steg P, Timmis A, Wijns W, Windecker S, Yildirir A, Luis Zamorano J. Guía de Práctica Clínica de la ESC 2013 sobre diagnóstico y tratamiento de la cardiopatía isquémica estable. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Systematic review and meta-analysis of the impact of depression on subsequent smoking cessation in patients with coronary heart disease: 1990 to 2013. Psychosom Med 2014; 76:44-57. [PMID: 24367125 DOI: 10.1097/psy.0000000000000020] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Smoking cessation is crucial for patients with coronary heart disease (CHD), yet depression may impede cessation success. We systematically reviewed the prospective association between depression and subsequent smoking cessation in individuals with CHD to quantify this effect. METHODS Electronic databases (PsychInfo, PubMed, CINAHL) were searched for prospective studies of patients with CHD that measured depression at baseline (scales, diagnostic interview, or antidepressant prescription) and reported smoking continuation/cessation at follow-up. Inclusive dates were January 1, 1990, to May 22, 2013. Standardized mean differences (SMDs) and associated 95% confidence intervals were estimated using random-effects meta-analysis. Sensitivity analysis explored the impact of limiting meta-analysis to studies using different depression measures (validated scales, diagnostic interviews, antidepressant prescription), different durations of follow-up, or higher-quality studies. RESULTS From 1185 citations retrieved, 28 relevant articles were identified. Meta-analysis of all available data from 20 unique data sets found that depressed patients with CHD were significantly less likely to quit smoking at follow-up (SMD = -0.39, 95% confidence interval = -0.50 to -0.29; I(2) = 51.2%, p = .005). Estimates remained largely unchanged for each sensitivity analysis, except for two studies that used antidepressants, which showed a much larger effect (SMD = -0.94, -1.38 to -0.51; I(2) = 57.7%, p = .124). CONCLUSIONS Patients with CHD and depressive symptoms are significantly less likely to quit smoking than their nondepressed counterparts. This may have implications for cardiovascular prognosis, and CHD smokers may require aggressive depression treatment to enhance their chances of quitting.
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Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, Crea F, Cuisset T, Di Mario C, Ferreira JR, Gersh BJ, Gitt AK, Hulot JS, Marx N, Opie LH, Pfisterer M, Prescott E, Ruschitzka F, Sabaté M, Senior R, Taggart DP, van der Wall EE, Vrints CJM, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Knuuti J, Valgimigli M, Bueno H, Claeys MJ, Donner-Banzhoff N, Erol C, Frank H, Funck-Brentano C, Gaemperli O, Gonzalez-Juanatey JR, Hamilos M, Hasdai D, Husted S, James SK, Kervinen K, Kolh P, Kristensen SD, Lancellotti P, Maggioni AP, Piepoli MF, Pries AR, Romeo F, Rydén L, Simoons ML, Sirnes PA, Steg PG, Timmis A, Wijns W, Windecker S, Yildirir A, Zamorano JL. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34:2949-3003. [PMID: 23996286 DOI: 10.1093/eurheartj/eht296] [Citation(s) in RCA: 2878] [Impact Index Per Article: 261.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Indirect costs in patients with coronary artery disease and mental disorders: a systematic review and meta-analysis. Int J Occup Med Environ Health 2012; 25:319-29. [PMID: 23212288 DOI: 10.2478/s13382-012-0042-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/23/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of the present study was to systematically review the association of comorbid mental disorders with indirect health care costs in patients with coronary artery disease (CAD). MATERIALS AND METHODS A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included, which allowed for a comparison of indirect health care costs between CAD patients with comorbid mental disorders and CAD patients without mental disorders. RESULTS The literature search revealed 4962 potentially relevant studies, out of which 13 primary studies met the inclusion criteria. Depression was investigated most often (N = 10), followed by anxiety disorders (N = 3) and any mental disorder not further specified (N = 3). All studies focused on return to work as indirect cost outcome. CAD patients with depression showed diminished odds for return to work, compared to CAD patients without depression (OR = 0.37; 95% CI: 0.27-0.51). The findings for comorbid anxiety and any mental disorder were inconsistent. Indirect health care costs were exclusively assessed by a patient self-report (N = 13). CONCLUSIONS There is strong evidence for diminished odds of return to work in CAD patients with comorbid depression, highlighting the need for integrated CAD and depression care. With regard to other comorbid mental disorders, however, the evidence is sparse and inconclusive.
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Ismail H, Lewin RJ. The role of a new arrhythmia specialist nurse in providing support to patients and caregivers. Eur J Cardiovasc Nurs 2012; 12:177-83. [DOI: 10.1177/1474515112442446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Paradise MB, Naismith SL, Davenport TA, Hickie IB, Glozier NS. The impact of gender on early ill-health retirement in people with heart disease and depression. Aust N Z J Psychiatry 2012; 46:249-56. [PMID: 22391282 DOI: 10.1177/0004867411427807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Depression and heart disease are major causes of early ill-health retirement. The effect of comorbid depression on the award of ill-health retirement in those with heart disease is unclear, however, and may differ by gender. Given the deleterious effects of ill-health retirement, identifying at-risk groups is important for guiding targeted interventions. METHOD We retrospectively analysed baseline data of 20,655 participants from the 45 and Up Study (New South Wales, Australia), who had fully retired between the ages of 45 and 64. We examined the associations of depression and heart disease with ill-health retirement and then adjusted for the presence of common confounders. We then restricted the sample to the 1165 individuals with heart disease prior to retirement, to determine the impact of comorbid depression on IHR and analysed whether there was a differential impact by gender. RESULTS In the complete sample, 3836 out of 20,655 (18.6%) of the participants retired early due to ill health. Prior heart disease and depression were both independently and strongly associated with ill-health retirement. Those who retired due to ill health were also more likely to be men, less educated, report greater physical disability and were younger at retirement. Among the 1165 for whom heart disease predated any form of retirement, 40% retired due to ill health. Comorbid depression prior to ill-health retirement was strongly associated with an increased risk of this IHR in women (odds ratio = 2.85; 95% confidence interval = 1.20-6.77, p = 0.01), but not in men (interaction term, p = 0.045). CONCLUSIONS Ill-health retirement is common in those with heart disease. Women appear to be particularly susceptible to the effects of comorbid depression. Given the policy emphasis on reducing the number of people leaving the workforce early, women with early heart disease may represent a particular group in whom interventions designed to detect and treat comorbid depression should be targeted.
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Affiliation(s)
- Matt B Paradise
- Brain and Mind Research Institute, The University of Sydney, Camperdown, Australia
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Ladwig KH, Emeny RT, Häfner S, Lacruz ME. [Depression. An underestimated risk for the development and progression of coronary heart disease]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:59-65. [PMID: 21246330 DOI: 10.1007/s00103-010-1195-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this article is to provide an overview on depression as a risk factor for the onset and follow-up of cardiovascular disease (CVD). In brief, the current state of psychobiological mechanisms bridging the gap between affective states and somatic consequences are presented. Four meta-analyses dealing with depression as a CVD risk factor in apparently healthy populations with >100,000 participants included, extracted an adjusted effect estimator of 1.60-1.90. Depressed subjects present with an unhealthier lifestyle (nutrition, smoking, physical activity). Three major psychobiological pathways directly acting on the circulatory system are under discussion: (1) hyperregulation of the autonomic nervous system (e.g., increased mean heart rate, increased heart rate responses, impaired heart rate variability), (2) overshooting stress responses of the endocrine system with impaired feedback mechanisms (e.g., for cortisol release), and (3) the immune system with dysregulated release of acute phase proteins and proinflammatory cytokines, all involved in a bidirectional crosstalk with the patient's affective state and leading to platelet activation and flow mediated endothelial (dys-)function. Nonadherence and adverse side effects of medications also contribute to the lethal properties of depression in CVD.
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Affiliation(s)
- K H Ladwig
- Institut für Epidemiologie, Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt, Neuherberg, Ingolstädter Landstr. 1, 85764, Neuherberg.
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Beresnevaitė M, Benetis R, Taylor GJ, Jurėnienė K, Kinduris Š, Barauskienė V. Depression predicts perioperative outcomes following coronary artery bypass graft surgery. SCAND CARDIOVASC J 2011; 44:289-94. [PMID: 21080846 DOI: 10.3109/14017431.2010.490593] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess preoperative depression in middle-aged men undergoing coronary artery bypass graft surgery (CABG) and to determine if depression is related to perioperative outcomes. DESIGN One hundred and nine middle-aged male patients were randomly selected and assessed for depression one day before CABG using the Symptom Checklist-90 Revised (SCL-90R). Perioperative outcomes were: (1) postoperative length of hospital stay, (2) the presence of any early complications (at intensive care unit), and (3) the presence of any late complications (at cardiac surgery unit). RESULTS Twenty-five (23%) patients had a high level of depression. Preoperative depression scores significantly predicted postoperative length of hospital stay (p < 0.001) and the incidence of late perioperative complications (p < 0.05) independently from biomedical and sociodemographic factors. Each increase in depression T score increased the odds of occurrence of late complications by 10% (p = 0.018, CI 95% 1.02-1.19). CONCLUSIONS Depression is common in middle-aged men undergoing CABG and is an independent predictor of postoperative length of hospital stay and late perioperative complications.
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Affiliation(s)
- Margarita Beresnevaitė
- Clinical Cardiology Laboratory, Institute of Cardiology of Kaunas University of Medicine, Kaunas, Lithuania.
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Ma W, Hu D, Liu G, Jiang J, Zhao X, Ma Y. Predictors of quality of life in Chinese patients with acute coronary syndrome. Asian Cardiovasc Thorac Ann 2011; 18:469-75. [PMID: 20947602 DOI: 10.1177/0218492310381291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Predictors of quality of life in Chinese patients with acute coronary syndrome remain unknown. Between January 2006 and March 2009, a prospective cohort study of 782 patients with acute coronary syndrome was carried out, with follow-up 7 months later. Depression and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale. Quality of life was assessed using the 36-Item Short-Form Health Survey. To identify predictors of decreased quality of life, both the physical and mental component summary scores were analyzed using multiple and ordinal logistic regression. In our quality-of-life model, diabetes mellitus was an independent risk factor for a low mental component summary score. Anxiety symptoms and the baseline mental component summary score were significant independent predictors of a low mental component summary score. Acute myocardial infarction was found to be a risk factor for a low physical component summary score. Anxiety symptoms, baseline physical component summary score, and systolic blood pressure on admission were significant independent predictive factors. Among patients with acute coronary syndrome, those with acute myocardial infarction, diabetes, or a low baseline quality of life need more care and effective intervention to improve their quality of life.
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Affiliation(s)
- Wenlin Ma
- Department of Cardiology, Tongji Hospital of Tongji University, Putuo District, Shanghai, China.
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Milani RV, Lavie CJ, Mehra MR, Ventura HO. Impact of exercise training and depression on survival in heart failure due to coronary heart disease. Am J Cardiol 2011; 107:64-8. [PMID: 21146688 DOI: 10.1016/j.amjcard.2010.08.047] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 08/13/2010] [Accepted: 08/13/2010] [Indexed: 01/22/2023]
Abstract
Depression is prevalent in patients with heart failure (HF) and is associated with increased mortality. In patients with coronary heart disease (CHD) without HF, exercise training (ET) can effectively decrease depressive symptoms resulting in improved survival. We evaluated 189 patients with American College of Cardiology/American Heart Association stage C HF due to CHD (mean left ventricular ejection fraction 35 ± 10%) enrolled in a structured ET program from January 2000 to December 2008, including a group of 151 who completed the program and 38 patients with HF who dropped out of rehabilitation without ET. Depressive symptoms were assessed by standard questionnaire at baseline and after ET, and mortality was determined at a mean follow-up of 4.6 ± 2.6 years. Prevalence of depressive symptoms decreased by 40% after ET, from 22% to 13% (p <0.0001). Patients initially classified as depressed who remained depressed after ET had nearly a fourfold higher mortality than patients whose depression resolved after ET (43% vs 11%, p = 0.005). Depressed patients who completed ET had a 59% lower mortality (44% vs 18%, p <0.05) compared to depressed dropout subjects not undergoing ET. Survival benefits after ET were concentrated to those patients with depression who improved exercise capacity. In conclusion, depressive symptoms are prevalent in patients with HF and are associated with increased mortality. Structured ET is effective in decreasing depressive symptoms, a factor that correlates with improved long-term survival.
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Affiliation(s)
- Richard V Milani
- Department of Cardiology, Ochsner Clinic Foundation, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, Louisiana, USA.
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O'Neil A, Sanderson K, Oldenburg B. Depression as a predictor of work resumption following myocardial infarction (MI): a review of recent research evidence. Health Qual Life Outcomes 2010; 8:95. [PMID: 20815937 PMCID: PMC2944344 DOI: 10.1186/1477-7525-8-95] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 09/06/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression often coexists with myocardial infarction (MI) and has been found to impede recovery through reduced functioning in key areas of life such as work. In an era of improved survival rates and extended working lives, we review whether depression remains a predictor of poorer work outcomes following MI by systematically reviewing literature from the past 15 years. METHODS Articles were identified using medical, health, occupational and social science databases, including PubMed, OVID, Medline, Proquest, CINAHL plus, CCOHS, SCOPUS, Web of Knowledge, and the following pre-determined criteria were applied: (i) collection of depression measures (as distinct from 'psychological distress') and work status at baseline, (ii) examination and statistical analysis of predictors of work outcomes, (iii) inclusion of cohorts with patients exhibiting symptoms consistent with Acute Coronary Syndrome (ACS), (iv) follow-up of work-specific and depression specific outcomes at minimum 6 months, (v) published in English over the past 15 years. Results from included articles were then evaluated for quality and analysed by comparing effect size. RESULTS Of the 12 articles meeting criteria, depression significantly predicted reduced likelihood of return to work (RTW) in the majority of studies (n = 7). Further, there was a trend suggesting that increased depression severity was associated with poorer RTW outcomes 6 to 12 months after a cardiac event. Other common significant predictors of RTW were age and patient perceptions of their illness and work performance. CONCLUSION Depression is a predictor of work resumption post-MI. As work is a major component of Quality of Life (QOL), this finding has clinical, social, public health and economic implications in the modern era. Targeted depression interventions could facilitate RTW post-MI.
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Affiliation(s)
- Adrienne O'Neil
- School of Public Health and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne, Victoria 3004, Australia. adrienne.o'
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Ben-Ezra M, Shmotkin D. Physical Versus Mental Predictors of Mortality Among the Old-Old in Israel: The CALAS Study. Res Aging 2010. [DOI: 10.1177/0164027510374283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When risk factors are examined concurrently, they tend to show mixed results in predicting mortality among the old-old. The purpose of this study was to compare a set of physical predictors with a set of mental predictors, all considered as most common and predictive in the literature, to assess their relative dominance in predicting mortality at old-old age. Based on Baltes’s incomplete architecture model and the disablement process, the authors postulated that physical predictors of mortality would diminish the impact of mental predictors of mortality. The database used for this study was the multidimensional survey of the Cross-Sectional and Longitudinal Aging Study conducted from 1989 to 1992 with a follow-up of mortality after 10 years. Participants ( N = 1,369) were drawn from a national sample of the Jewish Israeli population aged 75 to 94. The mean age of the sample was 83.52 ( SD = 5.42). Results of hierarchical Cox regression models showed that besides sociodemographic effects (mainly age, gender, and marital status), physical disability, physician visits, and medication consumption predicted mortality. Mental predictors (cognitive impairment and life evaluation) lost their predictive power when the physical predictors were introduced. Hence, biological and physical risk factors predominated over mental risk factors when examining prediction of mortality among the old-old age population.
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18
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Martin CR, Thompson DR. A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. PSYCHOL HEALTH MED 2010; 5:193-201. [DOI: 10.1080/713690189] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Meinow B, Parker MG, Thorslund M. Complex health problems and mortality among the oldest old in Sweden: decreased risk for men between 1992 and 2002. Eur J Ageing 2010; 7:81-90. [PMID: 28798620 DOI: 10.1007/s10433-010-0145-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Accepted: 03/17/2010] [Indexed: 11/29/2022] Open
Abstract
Although mortality in older ages generally declined in most countries during the past decades less is known about mortality trends among the most vulnerable subset of the oldest old. The aim of this study was to investigate possible changes between 1992 and 2002 in the relation of complex health problems and mortality in two representative samples of the Swedish population aged 77+ (1992: n = 537; 2002: n = 561). Further, it was examined if trends differed by sex, education, and age. Serious problems in three health domains were identified (diseases/symptoms, mobility, cognition/communication). People with serious problems in two or three domains were considered to have complex health problems. Four-year mortality was analyzed using Cox proportional hazard regressions. Controlled for age, sex, education, and health status mortality risk decreased by 20% during the 10-year period. Complex health problems strongly predicted 4-year mortality in both 1992 and 2002. No single dimension explained the decrease. Men with complex health problems accounted for most of the decrease in mortality risk, so much that the gender difference in mortality risk was almost eliminated among elderly people with complex health problems 2002. A considerable decrease in the mortality risk among men with complex health problems has implications for the individual who may face longer periods of complex health problems and dependency. It will also place increasing demands upon medical and social services as well as informal caregivers.
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Affiliation(s)
- Bettina Meinow
- Aging Research Center, Karolinska Institute & Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Marti G Parker
- Aging Research Center, Karolinska Institute & Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden
| | - Mats Thorslund
- Aging Research Center, Karolinska Institute & Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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20
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Ratcliffe S, Younus M, Hauben M, Reich L. Antidepressants that inhibit neuronal norepinephrine reuptake are not associated with increased spontaneous reporting of cardiomyopathy. J Psychopharmacol 2010; 24:503-11. [PMID: 19240086 DOI: 10.1177/0269881108100776] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A recent literature review linked norepinephrinergic stimulation to alterations in cyclic adenosine monophosphate (cAMP)-mediated signaling in cardiac myocytes and suggested that this might contribute to the pathological mechanisms that lead to chamber enlargement and hypocontractility, which are seen in dilated cardiomyopathy. This accompanies a large body of literature linking cardiac sympathetic outflow activation in early heart failure with progressive myocyte deterioration. As the mode of action of a number of antidepressants involves the inhibition of neuronal norepinephrine reuptake to varying degrees, this study was conducted to assess whether such agents might be associated with disproportionate reporting of cardiomyopathy. Limited data exist specifically examining the association between the antidepressant use and the cardiomyopathy. Using a data mining algorithm (DMA), we quantitatively investigated the association between antidepressant agents that predominantly exert their effects through inhibiting neuronal norepinephrine reuptake (rather than serotonin) and cardiomyopathy. We retrospectively applied a Bayesian DMA, the Bayesian Confidence Propagation Neural Network, to the cumulative reports in the Food and Drug Administration Adverse Event Reporting System (through the fourth quarter of 2006) and World Health Organization Vigibase (through the second quarter of 2007) databases. A threshold of the posterior interval 95% lower limit > 0 was used to define a signal of disproportionate reporting with individual or groups of antidepressants and cardiomyopathy-related terms. The analysis suggested that there is no direct relationship between antidepressants with greater norepinephrine reuptake inhibitor activity (affinity for norepinephrine reuptake transporter or selectivity for norepinephrine versus serotonin) and reporting of cardiomyopathy. In contrast, an inverse correlation might exist with a higher number of cases identified with tricyclic antidepressants showing lower norepinephrine reuptake inhibition and the serotonin/norepinephrine reuptake inhibitors as well as with serotonin/ norepinephrine/slight dopamine reuptake inhibitor.
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Affiliation(s)
- S Ratcliffe
- Risk Management Strategy, Pfizer Global Research and Development, Sandwich, UK
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21
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Ablin JN, Beilinson N, Aloush V, Elkayam O, Finkelstein A. Association between fibromyalgia and coronary heart disease and coronary catheterization. Clin Cardiol 2010; 32:E7-11. [PMID: 18727109 DOI: 10.1002/clc.20308] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fibromyalgia (FM) has been associated with physical and emotional trauma including invasive medical procedures. Both FM and ischemic heart disease have been linked with depression. The purpose of this study was to retrospectively investigate the frequency of FM symptoms and physical findings among patients undergoing coronary catheterization. METHODS Consecutive patients who underwent coronary angiography during the previous 6 mo were recruited. Patients with major depression, bi-polar disorder, schizophrenia, or malignancy were excluded. Patients underwent dolorimetry for tender-point assessment and completed the fibromyalgia impact questionnaire (FIQ). Group A included patients with significant coronary pathology (n = 43), group B included patients with normal coronary arteries (n = 50), and group C included patients with normal controls (n = 51). A cardiological score incorporated the number of coronary arteries with significant pathology and left ventricular function. Chi-square or Fisher's exact test was used for categorical data and a one-way analysis of variance for continuous variables; a multivariate linear regression was performed to compare groups. RESULTS Significantly increased levels of tenderness were discovered among patients with coronary pathology compared with healthy controls. Significantly increased levels of depression were also found, as well as higher scores on the FIQ scale. On multivariate analysis, a positive correlation was demonstrated between tenderness/FIQ scores and a composite cardiological score. CONCLUSION Coronary angiography is associated with a significantly increased frequency of pain, tenderness, and depression after 6 mo, apparent in both patients undergoing coronary procedures and patients with normal coronaries. This association may impact the outcome of patients with significant coronary disease.
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Affiliation(s)
- Jacob N Ablin
- Department of Internal Medicine 6, Tel-Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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22
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Marano G, Harnic D, Lotrionte M, Biondi-Zoccai G, Abbate A, Romagnoli E, Mazza M. Depression and the cardiovascular system: increasing evidence of a link and therapeutic implications. Expert Rev Cardiovasc Ther 2009; 7:1123-47. [PMID: 19764865 DOI: 10.1586/erc.09.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This review explores the epidemiological evidence for the relationship between depression and cardiovascular disease from a mechanistic standpoint. It is important to examine the biological, behavioral and social mechanisms to improve outcomes for depressed cardiac patients. A number of plausible biobehavioral mechanisms linking depression and cardiovascular disease have been identified. Tricyclic antidepressants have various effects on the cardiovascular system, while selective serotonin reuptake inhibitors are not associated with adverse cardiac effects and should, therefore, be the preferred choice for the treatment of most patients with comorbid depression and cardiovascular disease.
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Affiliation(s)
- Giuseppe Marano
- Department of Neuroscience, Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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23
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Fosb�l EL, Gislason GH, Poulsen HE, Hansen ML, Folke F, Schramm TK, Olesen JB, Bretler DM, Abildstr�m SZ, S�rensen R, Hvelplund A, K�ber L, Torp-Pedersen C. Prognosis in Heart Failure and the Value of β-Blockers Are Altered by the Use of Antidepressants and Depend on the Type of Antidepressants Used. Circ Heart Fail 2009; 2:582-90. [DOI: 10.1161/circheartfailure.109.851246] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background—
Depression worsens the prognosis in patients with cardiac disease, and treatment with antidepressants may improve survival. Guidelines recommend use of selective serotonin reuptake inhibitors (SSRIs), but knowledge of the prognostic effect of different classes of antidepressants is sparse.
Methods and Results—
We studied 99 335 patients surviving first hospitalization for heart failure (HF) from 1997 to 2005. Use of HF medication and antidepressants (divided into tricyclic antidepressants [TCA] and SSRI) was determined by prescription claims. Risk of overall and cardiovascular death associated with antidepressants, HF medication, and coadministration of these 2 drug classes was estimated by Cox proportional hazard analyses. Propensity adjusted models were performed as sensitivity analysis. During the study period, there were 53 988 deaths, of which 83.0% were due to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of β-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and β-blockers was associated with a higher risk of overall and cardiovascular death compared with coadministration of β-blockers and TCA (
P
for interaction <0.01).
Conclusions—
Use of antidepressants in patients with HF was associated with worse prognosis. Coadministration of SSRIs and β-blockers was associated with increased risk of overall death and cardiovascular death compared with coadministration of TCAs and β-blockers. To further clarify this, clinical trials testing the optimal antidepressant strategy in patients with HF are warranted.
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Affiliation(s)
- Emil Loldrup Fosb�l
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Gunnar H. Gislason
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Henrik Enghusen Poulsen
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Morten Lock Hansen
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Fredrik Folke
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Tina Ken Schramm
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Jonas Bjerring Olesen
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Ditte-Marie Bretler
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Steen Z. Abildstr�m
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Rikke S�rensen
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Anders Hvelplund
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Lars K�ber
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
| | - Christian Torp-Pedersen
- From the Department of Cardiology (E.L.F., M.L.H., F.F., T.K.S., J.B.O., D.M.B., R.S., A.H., C.T.P.), Gentofte University Hospital, Hellerup, Denmark; The Heart Centre, Department of Cardiology (G.H.G., L.K.), University Hospital of Copenhagen; Department of Clinical Pharmacology (H.E.P.), University Hospital of Copenhagen, Rigshospitalet, Denmark; Faculty of Health Sciences (H.E.P., L.K., C.T.P.), University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, Department of Internal
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Abstract
Approximately 20% of patients with coronary heart disease (CHD) have major depression and 20% have minor depression at any given point in the course of their illness. Depression causes significant psychological and social morbidity, and is a risk factor for further cardiac morbidity and mortality. Although there are many possible biological and behavioral mechanisms, the causal pathways through which depression increases the risk for cardiac events and death are not well understood. Despite the morbidity associated with depression, and the devastating impact it has on the quality of life of patients with CHD, it is underdiagnosed and often left untreated. This article describes screening techniques for use in primary care and cardiology settings, and discusses the safety and efficacy of available treatments for depression in patients with CHD.
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Affiliation(s)
- Robert M Carney
- Behavioral Medicine Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
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25
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Schlienger RG, Meier CR. Effect of selective serotonin reuptake inhibitors on platelet activation: can they prevent acute myocardial infarction? Am J Cardiovasc Drugs 2008; 3:149-62. [PMID: 14727927 DOI: 10.2165/00129784-200303030-00001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years a large body of evidence from several longitudinal studies has emerged suggesting that depression is an independent risk factor for cardiovascular disease (CVD) and that the association between depression and increased CVD risk is not merely due to negative mood-driven behavior related with depression. Even though the underlying mechanisms are not well understood, several hypotheses and explanations have been proposed such as increased activation of the hypothalamic-pituitary-adrenal axis, abnormalities in the sympathoadrenal system, or abnormalities in platelet function. Platelet function abnormalities, including increased platelet reactivity, may predispose patients with depressive disorders to clotting diatheses and may explain their vulnerability to CVD. Serotonin secreted by platelets induces both platelet aggregation and coronary vasoconstriction. Even though serotonin itself is only a weak platelet agonist, it markedly enhances platelet reactions to a variety of other agonists. Several studies have shown that selective serotonin reuptake inhibitors (SSRIs) reduce platelet and whole blood serotonin concentrations after repeated doses, and could therefore exert an inhibitory effect on platelet activation. For that reason, it was hypothesized that SSRIs could have a protective effect against myocardial infarction (MI). Results from three currently available epidemiological studies assessing the risk of MI in patients treated with antidepressants, including SSRIs, are controversial with respect to a potential beneficial effect of SSRIs on CVD risk in depressed patients. However, there is evidence that exposure to SSRIs does not substantially increase the risk of CVD in patients. A recent randomized, double-blind, placebo-controlled, multicenter trial that evaluated the safety and efficacy of the SSRI sertraline in patients with major depression and acute MI or unstable angina suggested that sertraline is well tolerated and effective. Further epidemiological studies or longer-term clinical trials may shed more light on this issue, and answer the question conclusively, whether the effect of SSRIs on platelets or another mechanism translates into a decreased risk of CVD in depressed patients.
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Affiliation(s)
- Raymond G Schlienger
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology, University Hospital, Basel, Switzerland.
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26
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Worcester MU, Le Grande MR. The role of cardiac rehabilitation in influencing psychological outcomes. Stress Health 2008. [DOI: 10.1002/smi.1206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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27
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Martin CR, Thompson DR, Barth J. Factor structure of the Hospital Anxiety and Depression Scale in coronary heart disease patients in three countries. J Eval Clin Pract 2008; 14:281-7. [PMID: 18284516 DOI: 10.1111/j.1365-2753.2007.00850.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression and anxiety in patients with coronary heart disease (CHD) is associated with a poorer prognosis. Therefore, the screening for psychological distress is strongly recommended in cardiac care and rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. The factor structure of the HADS was investigated in CHD populations across three countries (Germany, Hong Kong, United Kingdom). METHODS In total, HADS data from 1793 patients with CHD were explored using confirmatory factor analysis to establish the underlying factor structure of the instrument. RESULTS Three-factor models were found to offer a superior fit to the data compared with two-factor (anxiety and depression) models in all countries. The anxiety items can be separated in a factor labelled autonomic anxiety and negative affectivity. CONCLUSIONS The HADS offers good possibilities to detect distressed patients with somatic illnesses, but the construct validity of the originally proposed two factors (depression, anxiety) remains unclear. In outcome studies, more precise scales should be used to reduce measurement errors based on the scales used.
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Affiliation(s)
- Colin R Martin
- Faculty of Health, Leeds Metropolitan University, Leeds, UK
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28
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Azevedo A, Bettencourt P, Friões F, Alvelos M, Abreu-Lima C, Hense HW, Barros H. Depressive symptoms and heart failure stages. PSYCHOSOMATICS 2008; 49:42-8. [PMID: 18212175 DOI: 10.1176/appi.psy.49.1.42] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors measured depressive symptoms cross-sectionally, across evolving stages of heart failure as defined by the American College of Cardiology, from low risk, through high risk for heart failure (Stage A), asymptomatic cardiac dysfunction (Stage B), up to symptomatic heart failure (Stage C), in a community sample of 338 noninstitutionalized adults age >or=45 years. Depressive symptoms were measured with the Beck Depression Inventory (BDI). Women scored significantly higher on the BDI. Adjusted BDI scores increased linearly with heart failure stages in women, whereas, in men, only Stage C was associated with a significantly higher score.
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Affiliation(s)
- Ana Azevedo
- Dept. of Hygiene and Epidemiology, University of Porto Medical School, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
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29
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Martens EJ, Nyklícek I, Szabó BM, Kupper N. Depression and anxiety as predictors of heart rate variability after myocardial infarction. Psychol Med 2008; 38:375-383. [PMID: 17988419 DOI: 10.1017/s0033291707002097] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Reduced heart rate variability (HRV) is a prognostic factor for cardiac mortality. Both depression and anxiety have been associated with increased risk for mortality in cardiac patients. Low HRV may act as an intermediary in this association. The present study examined to what extent depression and anxiety differently predict 24-h HRV indices recorded post-myocardial infarction (MI). METHOD Ninety-three patients were recruited during hospitalization for MI and assessed on self-reported symptoms of depression and anxiety. Two months post-MI, patients were assessed on clinical diagnoses of lifetime depressive and anxiety disorder. Adequate 24-h ambulatory electrocardiography data were obtained from 82 patients on average 78 days post-MI. RESULTS In unadjusted analyses, lifetime diagnoses of major depressive disorder was predictive of lower SDNN [standard deviation of all normal-to-normal (NN) intervals; beta=-0.26, p=0.022] and SDANN (standard deviation of all 5-min mean NN intervals; beta=0.25, p=0.023), and lifetime anxiety disorder of lower RMSSD (root mean square of successive differences; beta=-0.23, p=0.039). Depression and anxiety symptoms did not significantly predict HRV. After adjustment for age, sex, cardiac history and multi-vessel disease, lifetime depressive disorder was no longer predictive of HRV. Lifetime anxiety disorder predicted reduced high-frequency spectral power (beta=-0.22, p=0.039) and RMSSD (beta=-0.25, p=0.019), even after additional adjustment of anxiety symptoms. CONCLUSIONS Clinical anxiety, but not depression, negatively influenced parasympathetic modulation of heart rate in post-MI patients. These findings elucidate the physiological mechanisms underlying anxiety as a risk factor for adverse outcomes, but also raise questions about the potential role of HRV as an intermediary between depression and post-MI prognosis.
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Affiliation(s)
- E J Martens
- CoRPS-Centre of Research on Psychology in Somatic Diseases, Tilburg University, and Department of Cardiology, St Elisabeth Hospital Tilburg, Tilburg, The Netherlands.
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30
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Cardiac Rehabilitation Programs Markedly Improve High-Risk Profiles in Coronary Patients with High Psychological Distress. South Med J 2008; 101:262-7. [DOI: 10.1097/smj.0b013e318164dfa8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Abstract
PURPOSE OF REVIEW Discuss the interplay of depression and ischemic heart disease. Studies demonstrate high prevalence of depression and its negative impact among patients with ischemic heart disease. RECENT FINDINGS Results extend previous findings among men, demonstrating a significant increase in mortality and cardiovascular events among depressed women. Sertraline, citalopram and mitrazapine have been shown to be safe and well tolerated in patients with ischemic heart disease. Sertraline and citalopram have demonstrated efficacy for treating depression in such patients. Mirtazapine did not have significant efficacy on post-myocardial infarction depression. Cognitive-behavioral therapy and interpersonal therapy have not been found to have a significant treatment effect. Treating depression may have an impact on cardiovascular morbidity and mortality, but this has not yet been adequately studied. Studies to date lack sufficient statistical power to fully examine the impact of interventions for depression on cardiovascular outcomes. SUMMARY Cardiologists encounter depression among 25-30% of their patients with ischemic heart disease. Depression is an independent risk factor for poor prognosis among ischemic heart disease patients, at a level comparable to several conventional cardiac risk factors. Adequate treatment of depression may improve the poor prognosis of depressed patients with ischemic heart disease.
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Affiliation(s)
- Sarah Rivelli
- Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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Martens EJ, Smith ORF, Winter J, Denollet J, Pedersen SS. Cardiac history, prior depression and personality predict course of depressive symptoms after myocardial infarction. Psychol Med 2008; 38:257-264. [PMID: 17868502 DOI: 10.1017/s0033291707001377] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although many studies have focused on post-myocardial infarction (MI) depression, there is limited information about the evolution and determinants of depressive symptoms in the first year post-MI. Therefore we examined (1) the course of depressive symptoms during the first year post-MI and (2) the predictors of these symptom trajectories. METHOD To assess depressive symptoms, 287 patients completed the Beck Depression Inventory during hospitalization for MI, and 2, and 12 months post-MI. Personality was assessed with the Type-D scale during hospitalization. We used latent class analysis to examine the evolution of depressive symptoms over a 1-year period and multinomial logit regression analyses to examine predictors of these symptom trajectories. RESULTS The course of depressive symptoms was stable during the first year post-MI. Four groups were identified and classified as non-depressed [40%, intercept (IC) 2.52], mildly depressed (42%, IC 6.91), moderately depressed (14%, IC 13.73) or severely depressed (4%, IC 24.54). In multivariate analysis, cardiac history (log OR(severe) 2.93, p=0.02; log OR(moderate) 1.81, p=0.02; log OR(mild) 1.46, p=0.01), history of depression (log OR(severe) 4.40, p<0.001; log OR(moderate) 1.97, p=0.03) and Type-D personality (log OR(severe) 4.22, p<0.001; log OR(moderate) = 4.17, p<0.001; log OR(mild) 1.66, p=0.02) were the most prominent risk factors for persistence of depressive symptoms during the first year post-MI. CONCLUSIONS Symptoms of depression tend to persist during the first year post-MI. Cardiac history, prior depression and Type-D personality were identified as independent risk factors for persistence of depressive symptoms. The results of this study strongly argue for routine psychological screening during hospitalization for acute MI in order to identify patients who are at risk for chronicity of depressive symptoms and its deleterious effects on prognosis.
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Affiliation(s)
- E J Martens
- CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands.
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Martens EJ, Smith ORF, Denollet J. Psychological symptom clusters, psychiatric comorbidity and poor self-reported health status following myocardial infarction. Ann Behav Med 2008; 34:87-94. [PMID: 17688400 DOI: 10.1007/bf02879924] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Depression is a risk factor for adverse outcomes following myocardial infarction (MI). However, the importance of various other psychological factors is less well established. PURPOSE The purpose is (a) explore the degree to which self-reported psychological symptoms in post-MI patients represent one or more underlying dimensions and (b) examine whether psychological symptom profiles based on these dimensions are differentially associated with major depressive disorder (MDD) and anxiety disorder (AD), and impaired health status. METHODS Two months post-MI, the Beck Depression Inventory, State-Trait Anxiety Inventory, and Global Mood Scale were used to measure symptoms of depression, anxiety, and mood status in 324 patients. The Composite International Diagnostic Interview was administered to diagnose DSM-IV MDD and AD. Health status was assessed by the Seattle Angina Questionnaire. RESULTS Principal component analysis revealed 4 essential features of post-MI distress: depressed affect, anxious apprehension, positive affect, and emotional exhaustion. Cluster analysis using these components identified 3 subgroups with different symptom profiles: A no distress subgroup (high positive affect, low on the remaining components), a first increased distress subgroup (ID1; elevated anxious apprehension/emotional exhaustion scores and decreased positive affect, p<.001, but absence of depressed affect, p=.56), and a second increased distress subgroup (ID2; decreased positive affect and elevated scores on the other components, all p<.001). Both increased distress subgroups were more likely to have psychiatric disorder (ID1: odds ratio [OR]=5.4, 95% confidence interval [CI]=1.3-22.1, p=.018; ID2: OR=27.1, 95% CI=6.4-114.7, p<.0001) and worse health status (ID1: -.38<B<-.12; all p<.05; ID2: -.48<B<-.20; all p<.05). CONCLUSIONS In addition to standard depressive symptoms, other affective components are important in understanding emotional adjustment in post-MI patients. These components are closely related to psychiatric comorbidity and poor health status post-MI.
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Affiliation(s)
- Elisabeth J Martens
- CoRPS-Center of Research on Psychology in Somatic Diseases Tilburg University, The Netherlands.
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Predictors of depressive symptoms post-acute coronary syndrome. ACTA ACUST UNITED AC 2007; 4:339-51. [DOI: 10.1016/s1550-8579(07)80063-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2007] [Indexed: 11/20/2022]
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Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med 2007; 120:799-806. [PMID: 17765050 DOI: 10.1016/j.amjmed.2007.03.026] [Citation(s) in RCA: 230] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 02/01/2007] [Accepted: 03/06/2007] [Indexed: 01/22/2023]
Abstract
PURPOSE Depression following major cardiac events is associated with higher mortality, but little is known about whether this can be reduced through treatment including cardiac rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients. PATIENTS AND METHODS We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64+/-10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a control group of 179 patients not completing rehabilitation. Depressive symptoms were assessed by questionnaire at baseline and following rehabilitation, and mortality was evaluated after a mean follow-up of 1296+/-551 days. RESULTS Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality than nondepressed patients (22% vs 5%, P=.0004). Depressed patients who completed rehabilitation had a 73% lower mortality (8% vs 30%; P=.0005) compared with control depressed subjects who did not complete rehabilitation. Reductions in depressive symptoms and its associated mortality were related to improvements in fitness; however, similar reductions were noted in those with either modest or marked increases in exercise capacity. CONCLUSION In patients following major coronary events, cardiac rehabilitation is associated with both reductions in depressive symptoms and the excess mortality associated with it. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depressive symptoms and its associated mortality.
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Affiliation(s)
- Richard V Milani
- Department of Cardiology, Ochsner Medical Center, New Orleans, La 70121, USA.
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Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 2007; 29:417-24. [PMID: 17888808 DOI: 10.1016/j.genhosppsych.2007.06.005] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 06/17/2007] [Accepted: 06/19/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD. METHOD Three months post-discharge for a cardiac admission, 193 CAD patients completed the HADS and PHQ-9. The Mini International Neuropsychiatric Interview (MINI) was the criterion standard. Scale reliability was calculated using Cronbach's alpha. Convergent validity was computed using Pearson's intercorrelations. Sensitivity and specificity for various cut-off scores for both measures and for the PHQ-9 categorical algorithm were calculated using receiver operating characteristics (ROC). For analyses, participants were assigned to two groups, 'major depressive disorder' or 'any depressive disorder'. RESULTS For all calculations, alpha was 0.05 and tests were two-tailed. Internal consistencies for the two measures were excellent. Criterion validity for the PHQ-9 and HADS was good. We found no statistical differences between the PHQ-9 and HADS for detecting either group; however, the categorical algorithm of the PHQ-9 for diagnosing major depression had a superior LR+ when compared with the summed HADS or PHQ-9. The operating characteristics of the screening instruments for 'any depressive disorder' were slightly lower than for 'major depressive disorder'. Some optimum cut-off scores were lower than the generally recommended cut-off scores, particularly when screening for major depression (e.g., > or = 5/6 vs. > or = 10 and > or = 8 for PHQ-9 and HADS, respectively). Lowering the cut off scores substantially improved the sensitivity of these instruments while retaining specificity, thereby improving their usefulness to screen for CAD patients with depression. CONCLUSIONS Both instruments have acceptable properties for detecting depression in recently hospitalized cardiac patients, and neither scale is statistically superior when summed scores are used. The categorical algorithm of the PHQ-9 for diagnosing major depression has a superior LR+ compared to the summed PHQ-9 and HADS scores. Use of the generally recommended cut-off scores should be cautious. In light of the aversive outcomes associated with depression in CAD, screening for depression is a clinical priority.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, University of Melbourne, Victoria 3010, Australia.
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Chan DS, Chau JP, Chang AM. Psychosocial outcomes of Hong Kong Chinese diagnosed with acute coronary syndromes: A prospective repeated measures study. Int J Nurs Stud 2007; 44:945-52. [DOI: 10.1016/j.ijnurstu.2006.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 02/15/2006] [Accepted: 03/25/2006] [Indexed: 10/24/2022]
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van Melle JP, de Jonge P, Honig A, Schene AH, Kuyper AMG, Crijns HJGM, Schins A, Tulner D, van den Berg MP, Ormel J. Effects of antidepressant treatment following myocardial infarction. Br J Psychiatry 2007; 190:460-6. [PMID: 17541103 DOI: 10.1192/bjp.bp.106.028647] [Citation(s) in RCA: 287] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression following myocardial infarction is associated with poor cardiac prognosis. It is unclear whether antidepressant treatment improves long-term depression status and cardiac prognosis. AIMS To evaluate the effects of antidepressant treatment compared with usual care in an effectiveness study. METHOD In a multicentre randomised controlled trial, 2177 myocardial infarction patients were evaluated for ICD-10 depression and randomised to intervention (n=209) or care as usual (n=122). Both arms were evaluated at 18 months post-myocardial infarction for long-term depression status and new cardiac events. RESULTS No differences were observed between intervention and control groups in mean scores on the Beck Depression Inventory (11.0, s.d.=7.5 v.10.2, s.d.=5.1, P=0.45) or presence of ICD-10 depression (30.5 v. 32.1%, P=0.68). The cardiac event rate was 14% among the intervention group and 13% among controls (OR=1.07, 95% CI 0.57-2.00). CONCLUSIONS Antidepressant treatment did not alter long-term depression post-myocardial infarction status or improve cardiac prognosis.
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Affiliation(s)
- Joost P van Melle
- Department of Cardiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, The Netherlands
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Stafford L, Berk M, Reddy P, Jackson HJ. Comorbid depression and health-related quality of life in patients with coronary artery disease. J Psychosom Res 2007; 62:401-10. [PMID: 17383491 DOI: 10.1016/j.jpsychores.2006.12.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD). METHODS Articles for the primary review were identified via MEDLINE and PsycINFO (1995-2006). RESULTS Evidence suggests that depression has an aversive impact on the HRQOL of patients with stable CAD as well as on patients hospitalized for acute myocardial infarction and coronary artery bypass graft surgery. Unfortunately, there are few depression treatment studies in patients with CAD that make use of standardized HRQOL measures, but the limited evidence suggests that successful treatment has positive implications for HRQOL in these patients. The mechanisms through which depression impacts on HRQOL require further study but are likely to be behavioral. CONCLUSIONS Depressive symptoms significantly undermine HRQOL in patients with CAD despite successful medical and surgical management. Although successful treatment of depression has not been shown to reduce mortality rates in patients with CAD, further study may find that the HRQOL benefits of such treatment are equally valuable.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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Barry LC, Lichtman JH, Spertus JA, Rumsfeld JS, Vaccarino V, Jones PG, Plomondon ME, Parashar S, Krumholz HM. Patient satisfaction with treatment after acute myocardial infarction: role of psychosocial factors. Psychosom Med 2007; 69:115-23. [PMID: 17289828 DOI: 10.1097/psy.0b013e31802f2785] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine if psychosocial status influences treatment satisfaction, a quality-of-care indicator, of patients who were hospitalized for acute myocardial infarction (AMI). METHODS Psychosocial variables (social support, dispositional optimism, and depression) were assessed in 1847 AMI patients who completed a 1-month assessment in Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER), a multicenter, prospective cohort study. Patients' treatment satisfaction was determined using the Treatment Satisfaction scale of the Seattle Angina Questionnaire. The association between psychosocial variables and treatment satisfaction-adjusted for site, sociodemographics, medical history, clinical presentation, and treatment procedures-was evaluated using a censored normal model. RESULTS Study participants were primarily white (77.6%) and male (68.8%), with a mean age of 60.6 +/- 12.7 (SD) years. Satisfaction with posthospitalization treatment following AMI increased as social support (Wald chi(2) = 35.02, p < .001) and dispositional optimism (beta = 1.42; 95% CI 0.24, 2.60) increased. Participants with mild (-3.10, 95% CI -5.77, -0.44), moderate (-4.77, 95% CI -8.16, -1.38), moderately severe (-8.49, 95% CI -13.47, -3.52), and severe (-11.65, 95% CI -18.77, -4.53) depression had significantly worse treatment satisfaction compared with the nondepressed participants. CONCLUSION Assessing psychosocial variables, such as social support, dispositional optimism, and depression severity before hospital discharge, may indicate who is likely to be more satisfied with posthospitalization cardiac care 1 month following AMI. Without controlling for psychosocial status, treatment satisfaction may be a biased indicator of quality. Future studies should evaluate whether psychosocial intervention after AMI can improve satisfaction.
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Affiliation(s)
- Lisa C Barry
- Department of Internal Medicine/Geriatrics, Yale University School of Medicine, New Haven, CT 06511, USA.
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Rauch B, Schiele R, Schneider S, Gohlke H, Diller F, Gottwik M, Steinbeck G, Heer T, Katus H, Zimmer R, Erdogan A, Pfafferott C, Senges J. Highly Purified Omega-3 Fatty Acids for Secondary Prevention of Sudden Cardiac Death After Myocardial Infarction—Aims and Methods of the OMEGA-Study. Cardiovasc Drugs Ther 2006; 20:365-75. [PMID: 17124558 DOI: 10.1007/s10557-006-0495-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION During the last decades a large body of data has been accumulated indicating omega-3 fatty acids to exert beneficial effects on the prognosis of patients with cardiovascular disease. Especially, omega-3 fatty acids are regarded to be effective in reducing the risk of sudden cardiac death after acute myocardial infarction. However, treatment of acute myocardial infarction and secondary prevention considerably have been improved within the past years including early revascularization by PCI, the routine use of beta-blockers, statins and ACE-inhibitors as well as cardiac rehabilitation for improving life style measures. To date, there exists no controlled randomized trial testing the prognostic effect of omega-3 fatty acids after acute myocardial infarction in a double blind regimen under the conditions of modern treatment of myocardial infarction. MATERIALS AND METHODS The present study therefore evaluates the effect of highly purified omega-3 fatty acid ethylesters (omega-3-acid ethyl esters 90=Zodin) on the rate of sudden cardiac death within 1 year after acute myocardial infarction. Secondary endpoints are total mortality, non-fatal cardiovascular events, rhythm abnormalities in holter monitoring and depression score. RESULT AND CONCLUSION The recruitment-period started in October 2003 and is expected to last until December 2006. The results of the study are therefore expected for the beginning of 2008, when all patients will have completed the 12-months follow up-period.
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Affiliation(s)
- Bernhard Rauch
- Herzzentrum, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
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Sullivan MD, Newton K, Hecht J, Russo JE, Spertus JA. Depression and health status in elderly patients with heart failure: a 6-month prospective study in primary care. ACTA ACUST UNITED AC 2006; 13:252-60. [PMID: 15365288 DOI: 10.1111/j.1076-7460.2004.03072.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To determine the prevalence and effects of depression on health status among elderly outpatients with heart failure, the authors conducted a 6-month prospective cohort study of 139 older outpatients with heart failure managed in primary care and 80 of their spouses. Primary care heart failure diagnosis was confirmed through chart review. The Primary Care Evaluation of Mental Disorders psychiatric diagnostic interview and Hamilton Depression Rating Scale were administered by phone. EQ-5D feeling thermometer, Medical Outcomes Study Short Form 36-Item Questionnaire, Kansas City Cardiomyopathy Questionnaire, and heart failure symptom severity questionnaires were administered by self-report. Depression diagnoses at baseline were: major depression and/or dysthymia (n=12, 9%), minor depression (n=14, 10%), and no depression (n=113, 81%). After adjusting for age, gender, and medical comorbidity, these depression groups differed by repeated measures analysis of covariance on most health status measures including the EQ-5D feeling thermometer; Medical Outcomes Study Short Form 36-Item Questionnaire general health and physical role function subscales; Kansas City Cardiomyopathy Questionnaire total score, symptom total, physical limitations, and quality of life subscales; as well as severity of chest pain and fatigue. Depression has significant and persistent effects on health status of elderly patients with heart failure, including heart failure symptoms, physical and role function, and quality of life. This may help explain why depression has been associated with increased health care utilization and costs in this population.
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Affiliation(s)
- Mark D Sullivan
- Department of Psychiatry and Behavioral Studies, University of Washington, Seattle, WA 98195, USA.
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Feinstein RE, Blumenfield M, Orlowski B, Frishman WH, Ovanessian S. A national survey of cardiovascular physicians' beliefs and clinical care practices when diagnosing and treating depression in patients with cardiovascular disease. Cardiol Rev 2006; 14:164-9. [PMID: 16788327 DOI: 10.1097/01.crd.0000200977.41695.43] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A national survey was administered to determine 1) cardiovascular physicians' beliefs about the association between depression and cardiovascular disease (CVD), 2) the methods used to diagnose depression, 3) referral patterns for treatment of depression, and 4) frequency of use and preferred choice of antidepressant. A national survey of 50% of randomly selected U.S. cardiovascular physicians belonging to the American College of Cardiology was conducted; 796 of 8854 physicians who received the questionnaires responded. Cardiovascular physicians were aware of indirect associations between depression and coronary artery disease (CAD). However, 49.9% were unaware of depression as an independent cardiac risk factor; 71.2% asked less than half their patients with CAD about depression; 79% used no standard screening method to diagnose depression. Among cardiovascular physicians, 84.8% reported that between 1% and 50% of their patients have depression, and 49.2% indicated that they treat the symptoms of depression in their patients with CAD. Cardiovascular physicians often refer depressed patients with CAD to mental health professionals and recommend exercise, relaxation training, stress management, psychotherapy, and diaries for their patients. Among cardiovascular physicians, 55.5% treat depression/CAD with antidepressant medication: sertraline (28%), paroxetine (16.1%), fluoxetine (10.8%), escitalopram (8.7%), citalopram (7.9%), bupropion (4.4%), tricyclic antidepressants (3.8%), and venlafaxine 2.9%.
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Affiliation(s)
- Robert E Feinstein
- Department of Psychiatry, New York Medical College, Valhalla, New York, USA.
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Earle A, Ayanian JZ, Heymann J. Work Resumption after Newly Diagnosed Coronary Heart Disease: Findings on the Importance of Paid Leave. J Womens Health (Larchmt) 2006; 15:430-41. [PMID: 16724890 DOI: 10.1089/jwh.2006.15.430] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Studies have demonstrated the health benefits of work resumption for adults experiencing health problems, but there are important gaps in the research examining the factors that would help these individuals return to work. This study examines if working conditions predict whether women who experience angina or a myocardial infarction (MI) return to work. METHODS A sample of 289 employed women from the Nurses' Health Study was analyzed. Bivariate chi-square and logistic regression analyses were conducted to examine the relationship between working conditions and the likelihood of returning to work after experiencing an MI or angina. RESULTS Seventy-nine percent of women returned to work after experiencing an MI or angina. Women who had paid leave were substantially more likely to return to work after an MI or angina episode than women without this benefit (adjusted odds ratio [OR] 2.7, p = 0.04). CONCLUSIONS Public and corporate policies to promote paid leave for female workers who experience a serious health condition are likely to help these workers return to their jobs, thereby providing important health and economic benefits for both workers and society.
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Affiliation(s)
- Alison Earle
- Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Jiang W, Davidson JRT. Antidepressant therapy in patients with ischemic heart disease. Am Heart J 2005; 150:871-81. [PMID: 16290952 DOI: 10.1016/j.ahj.2005.01.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 01/22/2005] [Indexed: 10/25/2022]
Abstract
Depressive disorders are common in patients with ischemic heart disease and have serious consequences in terms of the risk of further cardiac events and cardiac mortality. Among survivors of acute myocardial infarction, up to one fifth meet diagnostic criteria for major depression, and the presence of major depression carries a >5-fold increased risk for cardiac mortality within 6 months. This article reviews clinical trial data on the cardiac safety profiles of antidepressant agents with the aim of discussing clinical considerations in selecting the most appropriate treatment of comorbid depression in patients with ischemic heart disease. Tricyclic antidepressants are effective against depression but are associated with cardiovascular side effects including orthostatic hypotension, slowed cardiac conduction, antiarrhythmic activity, and increased heart rate. Selective serotonin reuptake inhibitors, by contrast, have benign cardiovascular profiles and are well tolerated in patients with cardiac disease. The safety of dual-acting serotonin and noradrenaline reuptake inhibitors has not been well studied. Intervention with a selective serotonin reuptake inhibitors has the potential to provide the depressed patient with ischemic heart disease relief from their depressive symptoms and may offer a potential improvement in their cardiovascular risk profile.
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Affiliation(s)
- Wei Jiang
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Jiang W, Glassman A, Krishnan R, O'Connor CM, Califf RM. Depression and ischemic heart disease: what have we learned so far and what must we do in the future? Am Heart J 2005; 150:54-78. [PMID: 16084151 DOI: 10.1016/j.ahj.2005.04.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 04/18/2005] [Indexed: 01/19/2023]
Affiliation(s)
- Wei Jiang
- Department of Internal Medicine and Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
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Rosén M, Haglund B. From healthy survivors to sick survivors--implications for the twenty-first century. Scand J Public Health 2005; 33:151-5. [PMID: 15823977 DOI: 10.1080/14034940510032121] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypotheses concerning compression of morbidity have gained support, particularly due to improved lifestyles from 1950 to date, but now the increase is largely due to improvements in healthcare. METHODS Survey data from Sweden were used to test whether the older population aged 65-84 years during 1995-2002 had more longstanding illnesses than the older population of 1980-87 or 1988-94. RESULTS There was an increased prevalence of many longstanding illnesses among the elderly in Sweden between 1988-94 and 1995-2002. The increase was especially pronounced among those with at least three longstanding illnesses. For diabetes, heart disease, and hypertension, the prevalence among elderly men increased by over 20%. However, those reporting these kinds of longstanding illnesses perceive improved health and are less restricted in their daily activities. CONCLUSIONS Results from Sweden indicate that many countries approaching Sweden's life expectancy will have an increased need for care for the oldest population in the future. The compression-of-morbidity hypothesis is being challenged, probably due to improvements in healthcare.
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Affiliation(s)
- Måns Rosén
- Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden.
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Barth J, Martin CR. Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients. Health Qual Life Outcomes 2005; 3:15. [PMID: 15771778 PMCID: PMC555847 DOI: 10.1186/1477-7525-3-15] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 03/16/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety in patients with coronary heart disease (CHD) are associated with a poorer prognosis. Therefore the screening for psychological distress is strongly recommended in cardiac rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. METHODS We assessed mental distress in in-patient cardiac rehabilitation in Germany. The factor structure of the German language version of the HADS was investigated in 1320 patients with CHD. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. RESULTS Three-factor models were found to offer a superior fit to the data compared to two-factor (anxiety and depression) models. The German language HADS performs similarly to the English language version of the instrument in CHD patients. The German language HADS fundamentally comprises a tri-dimensional underlying factor structure (labelled by Friedman et al. as psychomotor agitation, psychic anxiety and depression). CONCLUSION Despite of clinical usefulness in screening for mental disturbances the construct validity of the HADS is not clear. The resulting scores of the tri-dimensional model can be interpreted as psychomotor agitation, psychic anxiety, and depression in individual patient data or clinical investigations.
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Affiliation(s)
- Jürgen Barth
- University of Freiburg – Institute of Psychology, Department of Rehabilitation Psychology, 79085 Freiburg, Germany
| | - Colin R Martin
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Chung Chi College, Shatin, New Territories, Hong Kong, China
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van Jaarsveld CHM, Ranchor AV, Sanderman R, Ormel J, Kempen GIJM. The role of premorbid psychological attributes in short- and long-term adjustment after cardiac disease. A prospective study in the elderly in The Netherlands. Soc Sci Med 2005; 60:1035-45. [PMID: 15589672 DOI: 10.1016/j.socscimed.2004.06.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of mastery, self-efficacy expectancies and neuroticism in explaining individual differences in physical and psychological adjustment to cardiac disease was studied in 208 patients. Premorbid data were available from a community-based survey in the Netherlands. Hierarchical linear regression analyses showed that self-efficacy expectancies at baseline were significantly related to adjustment in terms of physical functioning in the short- and long-term and depressive symptoms in the short-term (six weeks after diagnosis). Mastery was significantly related to depressive symptoms and anxiety in the long-term (1 year after diagnosis). Neuroticism was a predictor for depressive symptoms and anxiety both in the short- and long-term. The results of this longitudinal study showed that premorbidly assessed psychological attributes do have a role in explaining individual differences in vulnerability to negative consequences of cardiac disease.
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Affiliation(s)
- Cornelia H M van Jaarsveld
- Department of Public Health and Health Psychology, Northern Centre for Healthcare Research, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands.
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Schins A, Annique S, Tulner D, Dorien T, Lousberg R, Richel L, Kenis G, Gunter K, Delanghe J, Joris D, Crijns HJ, Crijns Harry J, Grauls G, Gert G, Stassen F, Frank S, Maes M, Michael M, Honig A, Adriaan H. Inflammatory markers in depressed post-myocardial infarction patients. J Psychiatr Res 2005; 39:137-44. [PMID: 15589561 DOI: 10.1016/j.jpsychires.2004.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 05/11/2004] [Accepted: 05/28/2004] [Indexed: 01/08/2023]
Abstract
BACKGROUND Depressive disorder in the post-myocardial infarction (MI) period has been associated with increased cardiac morbidity and mortality. Possible pathophysiological mechanisms behind this association are not clear. Major depression in physically healthy subjects has been related to immune abnormalities including increased plasma levels of interleukin-6 (IL-6), tumor necrosis factor alfa (TNF-alpha) and C-reactive protein (CRP). In patients with MI, increased inflammatory markers, such as CRP and TNF-alpha, have been associated with increased cardiovascular events. It was the aim of this study to test the hypothesis that depression in post-MI patients is associated with increased inflammation as compared to non-depressed post-MI patients. METHODS The cytokines IL-6 and TNF-alpha ; the soluble cytokine receptors sIL-6R, sTNF-RI and sTNF-RII; neopterin; and the inflammation-sensitive plasma proteins (ISPs) CRP and haptoglobin were assessed in a group of 57 patients with a diagnosis of depression post-MI and in a control group of 46 non-depressed post-MI patients, matched for age, gender and time elapsed since MI. RESULTS Cytokine, neopterin and ISP levels were not statistically different in the depressed post-MI group as compared to the non-depressed post-MI group. Several inflammatory markers were however elevated in both cohorts when compared with levels reported in healthy subjects, indicating persistent inflammation several months after MI. CONCLUSIONS There was no indication of increased inflammation in depressed post-MI patients as compared to non-depressed post-MI patients.
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Affiliation(s)
- Annique Schins
- Department of Psychiatry, University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
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