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Egholm CL, Helmark C, Rossau HK, Munkehøj P, Brøndum S, Pedersen SS, Zwisler AD. Implementation of systematic screening for anxiety and depression in cardiac rehabilitation: Real world lessons from a longitudinal study. J Psychosom Res 2022; 158:110909. [PMID: 35472687 DOI: 10.1016/j.jpsychores.2022.110909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
AIMS Systematic screening for anxiety and depression is widely recommended as a core component of cardiac rehabilitation in ischemic heart disease, however, recommendation-practice gaps are common and limited knowledge exists about factors hindering and supporting implementation. The study aimed to assess adherence to national clinical guideline recommendations and to gain a greater understanding of the implementation of screening in real-world practice. METHODS An observational, longitudinal mixed-methods design including hospitals and municipalities in Denmark. We retrieved nationwide survey data from 2013, 2015, 2018 and 2021 to assess adherence to screening on programme level, and clinical quality registry data from 2016 to 2020 to assess proportion of patients screened. Data were analysed descriptively. Semi-structured interviews with healthcare professionals were conducted in 2015 (n = 11) and 2020 (n = 11) to explore how screening was conducted and factors supporting implementation. Normalization Process Theory guided interviews and content analysis. RESULTS Screening on programme level increased from 61% to 88% in hospitals and 20% to 89% in municipalities. The individual proportion of patients screened remained relatively stable in both hospitals and municipalities overall, however with considerable inter-site differences. Screening practices became more aligned to guidelines, pushed by formal recommendations and monitoring, and pulled by activities strengthening the knowledge and motivation among staff. CONCLUSION Screening for anxiety and depression improved considerably over the seven-year period, from a scattered practice driven by individuals to a movement where healthcare professionals had a feeling of going with the flow. Nationwide implementation of screening requires national and local supporting activities and a continuous effort.
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Affiliation(s)
- Cecilie Lindström Egholm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital Roskilde, Vestermarksvej 21, 4000 Roskilde, Denmark
| | - Henriette Knold Rossau
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pia Munkehøj
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Københavns Professionshøjskole, Campus Sigurdsgade, Sigurdsgade 26, 2200 Copenhagen N, Denmark
| | | | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000 Odense C, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløwsvej 4, 5000 Odense C, Denmark
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2
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Vaillancourt M, Busseuil D, D'Antono B. Severity of psychological distress over five years differs as a function of sex and presence of coronary artery disease. Aging Ment Health 2022; 26:762-774. [PMID: 33764244 DOI: 10.1080/13607863.2021.1901262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Psychological distress is more prevalent and severe among patients with coronary artery disease (CAD) compared to healthy individuals. Little is known regarding its time course, and whether these differences extend to individuals with non-cardiovascular (CV) illnesses. This study examined the presence, severity, and time course of psychological distress in men and women with CAD and those of similarly aged individuals suffering from non-CV conditions. METHODS 1229 individuals (61% men; meanage = 60.4 ± 7.0 years) with stable CAD or non-CV illnesses reported on social support, hostility, stress, anxiety and depression at baseline as well as 4.8 ± 0.8 years later. Analyses involved mixed (Sex*CAD status*Time) repeated measures analyses (controlling for relevant covariates), as well as Chi-square and McNemar analyses. RESULTS Women with CAD reported more symptoms of depression compared to other participants at both evaluations (p's < 0.01), and reported more symptoms of anxiety and stress compared to others at T1 (p's < 0.05). At T2, perceived stress remained significantly greater among women with CAD compared to men (p's < 0.01), though differences in anxiety were no longer significant. Men reported more hostility than women (p = 0.001). CAD women fell within the clinical range for depression (p < 0.001), anxiety (p = 0.001), and stress (p = 0.030) more frequently compared to others at T1, and for depression (p = 0.009) and stress (p = 0.002) at T2. CONCLUSIONS The evolution of patient distress differed as a function of the measure examined, their sex, and/or CV status. While psychological distress was prevalent among these patients with diverse health conditions, women with CAD were particularly and chronically vulnerable.
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Affiliation(s)
- Monica Vaillancourt
- Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - David Busseuil
- Research Center, Montreal Heart Institute, Montreal, Canada
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
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3
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Kong D, Lu P, Solomon P, Shelley M. Gender-based depression trajectories following heart disease onset: significant predictors and health outcomes. Aging Ment Health 2022; 26:754-761. [PMID: 33663280 DOI: 10.1080/13607863.2021.1891202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period. METHOD Six waves of longitudinal data from the Health and Retirement Study (2006-2016) were used (n = 1787). Heart disease onset was defined as self-reporting no heart disease at baseline but reporting a positive diagnosis in a subsequent wave. Growth Mixture Modelling identified depression trajectories. Multinomial logistic regression models determined significant predictors of depression trajectories. Cox proportional-hazards models examined the associated disability and mortality risks. RESULTS Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women's chronic depression and men's emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92, p < 0.001). Only men's emerging depression was linked to higher mortality risk compared to minimal depression (HR = 2.03, p < 0.001). CONCLUSION Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions.
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Affiliation(s)
- Dexia Kong
- Rutgers University Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA
| | - Peiyi Lu
- Departments of Political Science and Statistics, School of Education, Iowa State University, Ames, IA, USA
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Mack Shelley
- Departments of Political Science and Statistics, School of Education, Iowa State University, Ames, IA, USA
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4
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Freak-Poli R, Hu J, Phyo AZZ, Barker F. Does social isolation, social support or loneliness influence health or well-being after a cardiovascular disease event? A narrative thematic systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e16-e38. [PMID: 34028106 DOI: 10.1111/hsc.13427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
Identification of factors which influence health after a cardiovascular disease (CVD) event will assist with reducing the high health and economic burden of CVD. We undertook a systematic review to investigate the association between social health (lower social isolation, higher social support and lower loneliness) and health and well-being after a CVD event among people living in Australia and New Zealand. Four electronic databases were systematically searched until June 2020. Two reviewers undertook title/abstract screen. One reviewer undertook full-text screen and data extraction. A second author either independently extracted or checked data. Narrative thematic analysis was undertaken. Of the 752 unique records retrieved, 39 papers from 29 studies met our inclusion criteria. Included studies recruited between 10 and 1,455 participants, aged 12-96 years, and the majority were male. Greater social health was consistently associated with better mental health outcomes (lower depressive symptoms, anxiety symptoms and psychological distress). Lower social isolation and higher social support were associated with the extent to which patient needs were being met. Living situation was not associated with mental health outcomes, and being married or living with someone was associated with greater medication adherence. Our systematic review demonstrates that greater social health is associated with better mental health outcomes and met patient needs among cardiac patients. As partner status and living status did not align with social isolation and social support findings in this review, we recommend they not be used as social health proxies when assessing health outcomes among CVD patients. Our review highlights the need for more research focused on women and the importance of gender-disaggregated reporting. Further assessment is required to evaluate whether loneliness is associated with health and well-being outcomes after a CVD event.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jessie Hu
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Aung Zaw Zaw Phyo
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Fiona Barker
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Zuchowski M, Chilcot J. Illness Perceptions in Hypertrophic Cardiomyopathy (HCM) Patients and Their Association With Heart-Focussed Anxiety. Heart Lung Circ 2021; 30:496-506. [DOI: 10.1016/j.hlc.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/18/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
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Deep learning paired with wearable passive sensing data predicts deterioration in anxiety disorder symptoms across 17-18 years. J Affect Disord 2021; 282:104-111. [PMID: 33401123 PMCID: PMC7889722 DOI: 10.1016/j.jad.2020.12.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/01/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent studies have demonstrated that passive smartphone and wearable sensor data collected throughout daily life can predict anxiety symptoms cross-sectionally. However, to date, no research has demonstrated the capacity for these digital biomarkers to predict long-term prognosis. METHODS We utilized deep learning models based on wearable sensor technology to predict long-term (17-18-year) deterioration in generalized anxiety disorder and panic disorder symptoms from actigraphy data on daytime movement and nighttime sleeping patterns. As part of Midlife in the United States (MIDUS), a national longitudinal study of health and well-being, subjects (N = 265) (i) completed a phone-based interview that assessed generalized anxiety disorder and panic disorder symptoms at enrollment, (ii) participated in a one-week actigraphy study 9-14 years later, and (iii) completed a long-term follow-up, phone-based interview to quantify generalized anxiety disorder and panic disorder symptoms 17-18 years from initial enrollment. A deep auto-encoder paired with a multi-layered ensemble deep learning model was leveraged to predict whether participants experienced increased anxiety disorder symptoms across this 17-18 year period. RESULTS Out-of-sample cross-validated results suggested that wearable movement data could significantly predict which individuals would experience symptom deterioration (AUC = 0.696, CI [0.598, 0.793], 84.6% sensitivity, 52.7% specificity, balanced accuracy = 68.7%). CONCLUSIONS Passive wearable actigraphy data could be utilized to predict long-term deterioration of anxiety disorder symptoms. Future studies should examine whether these methods could be implemented to prevent deterioration of anxiety disorder symptoms.
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Celik Y, Thunström E, Strollo PJ, Peker Y. Continuous positive airway pressure treatment and anxiety in adults with coronary artery disease and nonsleepy obstructive sleep apnea in the RICCADSA trial. Sleep Med 2020; 77:96-103. [PMID: 33341644 DOI: 10.1016/j.sleep.2020.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anxiety and obstructive sleep apnea (OSA) coexist among adults with coronary artery disease (CAD) following revascularization. Continuous positive airway pressure (CPAP) is the first line treatment of OSA patients with daytime sleepiness. The current study evaluated the effect of CPAP on anxiety in CAD patients with nonsleepy OSA. METHODS Two hundred forty-four revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥15/h, Epworth Sleepiness Scale score <10) were randomly assigned to CPAP or no-CPAP between 2005 and 2010. Zung Self-rating Anxiety Scale (SAS) was administered at baseline and after 3 and 12 months with higher scores suggesting more anxiety. RESULTS A total of 208 patients with complete SAS scores at baseline and 12-month follow-up were included (CPAP, n = 103; no-CPAP, n = 105). In the intention-to-treat analysis, CPAP had no significant effect on the SAS scores. On-treatment analysis revealed a significant increase in the median of delta SAS score (+3.75) after three months among the participants using the device 2.8 h/day or more while there was a decline in the median of delta SAS score (-1.25) in the non-adherent or no-CPAP group (p = 0.031). The increase in the SAS score (+1.25) in the adherent group, and the decline (-1.25 points) in the non-adherent/no-CPAP group remained significant after one year (p = 0.011). Baseline SAS score predicted non-adherence [adjusted odds ratio 1.11; 95% confidence interval (CI) 1.04-1.18; p = 0.003], and there was an association between the increase in the SAS scores and accumulated CPAP hours/day [standardized β = 0.144 (95% CI 0.005-0.695), p = 0.047]. CONCLUSION Our results suggest that anxiety should be considered in the management of CAD patients with nonsleepy OSA following revascularization. CLINICAL TRIAL REGISTRATION NCT00519597.
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Affiliation(s)
- Yeliz Celik
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Erik Thunström
- Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Patrick J Strollo
- Dept of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Yüksel Peker
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey; Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Dept of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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8
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Tully PJ, Higgins R. Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide,
- Department of Medicine, Flinders Medical Centre and Flinders University of South Australia,
| | - Rosemary Higgins
- Heart Research Centre,
- Department of Physiotherapy, The University of Melbourne,
- Cabrini Health,
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9
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Abstract
Loneliness and social isolation are increasingly being acknowledged as risk factors for both physical and mental health problems. Recent statistics demonstrate that loneliness and isolation are on the rise internationally, to the point of being classed as an epidemic. In this paper, the authors outline some of the recent research linking loneliness and isolation to significant chronic diseases such as cardiovascular disease and type II diabetes; mental health disorders such as anxiety and depression; cognitive disorders and dementia. Isolation has also been shown to compromise recovery after acute cardiac events, being associated with increased hospital readmission and premature death. Indeed, isolation has now been identified as a risk factor equivalent in effect to traditional risk factors such as smoking, hypertension and obesity. While distinguishing between objective and subjective indicators of isolation, the authors highlight the complexity of this phenomenon, both in terms of definition and measurement, as well as the interplay between subjective and objective indicators. Important clinical implications for health professionals working with cardiac patients are also proposed, in terms of screening for isolation, and possible interventions to support patients at risk of isolation. The aim of the current article is to emphasise the importance of acknowledging loneliness and isolation as key risk factors requiring urgent attention, both in research and in clinical practice.
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Affiliation(s)
- Jackson Alun
- Director, Australian Centre for Heart Health, Melbourne, Victoria, Australia; Honorary Professor, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Honorary Professor, Centre on Behavioural Health, University of Hong Kong, Pakfulam, Hong Kong
| | - Barbara Murphy
- Principal Researcher, Australian Centre for Heart Health, Melbourne, Victoria, Australia; Honorary Associate Professor, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Honorary Senior Research Fellow, Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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10
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Faessler L, Brodbeck J, Schuetz P, Haubitz S, Mueller B, Perrig-Chiello P. Medical patients' affective well-being after emergency department admission: The role of personal and social resources and health-related variables. PLoS One 2019; 14:e0212900. [PMID: 30893347 PMCID: PMC6426177 DOI: 10.1371/journal.pone.0212900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/12/2019] [Indexed: 12/20/2022] Open
Abstract
Background Medical emergency admissions are critical life events associated with considerable stress. However, research on patients’ affective well-being after emergency department (ED) admission is scarce. This study investigated the course of affective well-being of medical patients following an ED admission and examined the role of personal and social resources and health-related variables. Methods In this longitudinal survey with a sample of 229 patients with lower respiratory tract infections and cardiac diseases (taken between October 2013 and December 2014), positive and negative affect was measured at ED admission (T1) and at follow-up after 7 days (T2), and 30 days (T3). The role of personal and social resources (emotional stability, trait resilience, affect state, and social support) as well as health-related variables (self-rated health, multimorbidity, and psychological comorbidity) in patients’ affective well-being was examined by controlling for demographic characteristics using regression analyses. Results The strength of the inverse correlation between positive and negative affect decreased over time. In addition to health-related variables, higher negative affect was predicted by higher psychological comorbidity over time (T1–T3). In turn, lower positive affect was predicted by lower self-rated health (T1–T2) and higher multimorbidity (T3). In terms of personal and social resources, lower negative affect was predicted by higher emotional stability (T2), whereas higher positive affect was predicted by stronger social support (T1–T2). Conclusion Knowledge about psychosocial determinants–personal and social resources and health-related variables–of patients’ affective well-being following ED admission is essential for designing more effective routine screening and treatment.
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Affiliation(s)
- Lukas Faessler
- Institute of Psychology, University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
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11
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Clarifying the Concept of Depression in Women With Coronary Heart Disease. ANS Adv Nurs Sci 2019; 42:E24-E37. [PMID: 30864985 DOI: 10.1097/ans.0000000000000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The concept of depression in women with coronary heart disease has been poorly defined for several reasons: numerous widely variable instruments that operationalize the concept, divergent proposed instrument cutoff scores, and continued lack of female participants and data analysis by gender in coronary heart disease research. In the forty articles from 1990 to 2018 evaluating depression in women with coronary heart disease, the concept is defined by specific somatic and cognitive symptoms, preceded by particular physiological and psychosocial vulnerabilities, and leads to poorer outcomes. Concept clarification is necessary for accurate diagnosis of depression, leading to more timely and appropriate interventions for women.
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12
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Tran HV, Gore JM, Darling CE, Ash AS, Kiefe CI, Goldberg RJ. Clinically significant ventricular arrhythmias and progression of depression and anxiety following an acute coronary syndrome. J Psychosom Res 2019; 117:54-62. [PMID: 30482494 DOI: 10.1016/j.jpsychores.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and anxiety are common and associated with worse clinical outcomes in patients who experience an acute coronary syndrome (ACS). We investigated the association between major ventricular arrhythmias (VAs) with the progression of depression and anxiety among hospital survivors of an ACS. METHODS Patients were interviewed in hospital and by telephone up to 12 months after hospital discharge. The primary outcome was the presence of moderate/severe symptoms of depression and anxiety defined as a Patient Health Questionnaire (PHQ)-9 score ≥ 10 and a Generalized Anxiety Disorder (GAD)-7 score ≥ 10 at baseline and 1 month and PHQ-2 ≥ 3 and GAD-2 ≥ 3 at 3, 6, and 12 months. We used marginal models to examine the association between major VAs and the symptoms of depression or anxiety over time. RESULTS The average age of the study population (n = 2074) was 61.1 years, 33.5% were women, and 78.3% were white. VAs developed in 105 patients (5.1%). Symptoms of depression and anxiety were present in 22.2% and 23.5% of patients at baseline, respectively, and declined to 14.1% and 12.6%, respectively, at 1-month post-discharge. VAs were not significantly associated with the progression of symptoms of depression (adjusted relative risk [aRR] = 1.29, 95% confidence interval [CI] = 0.94-1.77) and anxiety (aRR = 1.22, 95% CI = 0.86-1.72), or with change in average scores of PHQ-2 and GAD-2 over time, both before and after risk adjustment. CONCLUSION The prevalence of symptoms of depression and anxiety was high after an ACS but declined thereafter and may not be associated with the occurrence of major in-hospital VAs.
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Affiliation(s)
- Hoang V Tran
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States; Department of Medicine, Bridgeport Hospital, Yale New Haven Health, United States.
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, United States
| | - Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, United States
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, United States
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Guertin JR, Pagé MG, Tarride JÉ, Talbot D, Watt-Watson J, Choinière M. Just how much does it cost? A cost study of chronic pain following cardiac surgery. J Pain Res 2018; 11:2741-2759. [PMID: 30519078 PMCID: PMC6235323 DOI: 10.2147/jpr.s175090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The study objective was to determine use of pain-related health care resources and associated direct and indirect costs over a two-year period in cardiac surgery patients who developed chronic post-surgical pain (CPSP). METHODS This multicentric observational prospective study recruited patients prior to cardiac surgery; these patients completed research assistant-administered questionnaires on pain and psychological characteristics at 6, 12 and 24 months post-operatively. Patients reporting CPSP also completed a one-month pain care record (PCR) (self-report diary) at each follow-up. Data were analyzed using descriptive statistics, multivariable logistic regression models, and generalized linear models with log link and gamma family adjusting for sociodemographic and pain intensity. RESULTS Out of 1,247 patients, 18%, 13%, and 9% reported experiencing CPSP at 6, 12, and 24 months, respectively. Between 16% and 28% of CPSP patients reported utilizing health care resources for their pain over the follow-up period. Among all CPSP patients, mean monthly pain-related costs were CAN$207 at 6 months and significantly decreased thereafter. More severe pain and greater levels of pain catastrophizing were the most consistent predictors of health care utilization and costs. DISCUSSION Health care costs associated with early management of CPSP after cardiac surgery seem attributable to a minority of patients and decrease over time for most of them. Results are novel in that they document for the first time the economic burden of CPSP in this population of patients. Longer follow-up time that would capture severe cases of CPSP as well as examination of costs associated with other surgical populations are warranted. SUMMARY Economic burden of chronic post-surgical pain may be substantial but few patients utilize resources. Health utilization and costs are associated with pain and psychological characteristics.
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Affiliation(s)
- Jason Robert Guertin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - M Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada,
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,
| | - Jean-Éric Tarride
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Denis Talbot
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Quebec City, QC, Canada
| | - Judy Watt-Watson
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Manon Choinière
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada,
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada,
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Phelps AJ, Steele Z, Cowlishaw S, Metcalf O, Alkemade N, Elliott P, O'Donnell M, Redston S, Kerr K, Howard A, Nursey J, Cooper J, Armstrong R, Fitzgerald L, Forbes D. Treatment Outcomes for Military Veterans With Posttraumatic Stress Disorder: Response Trajectories by Symptom Cluster. J Trauma Stress 2018; 31:401-409. [PMID: 29958337 DOI: 10.1002/jts.22299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/12/2018] [Accepted: 03/17/2018] [Indexed: 11/11/2022]
Abstract
Although effective posttraumatic stress disorder (PTSD) treatments are available, outcomes for veterans with PTSD are relatively modest. Previous researchers have identified subgroups of veterans with different response trajectories but have not investigated whether PTSD symptom clusters (based on a four-factor model) have different patterns of response to treatment. The importance of this lies in the potential to increase treatment focus on less responsive symptoms. We investigated treatment outcomes by symptom cluster for 2,685 Australian veterans with PTSD. We used Posttraumatic Stress Disorder Checklist scores obtained at treatment intake, posttreatment, and 3- and 9-month follow-ups to define change across symptom clusters. Repeated measures effect sizes indicated that arousal and numbing symptoms exhibited the largest changes between intake and posttreatment, dRM = -0.61 and dRM = -0.52, respectively, whereas avoidance and intrusion symptoms showed more modest reductions, dRM = -0.36 and dRM = -0.30, respectively. However, unlike the other symptom clusters, the intrusions cluster continued to show significant changes between posttreatment and 3-month follow-up, dRM = -0.21. Intrusion and arousal symptoms also showed continued changes between 3- and 9-month follow-ups although these effects were very small, dRM = -0.09. Growth curve model analyses produced consistent findings and indicated modest initial changes in intrusion symptoms that continued posttreatment. These findings may reflect the longer time required for emotional processing, relative to behavioral changes in avoidance, numbing, and arousal, during the program; they also reinforce the importance of prioritizing individual trauma-focused therapy directly targeting intrusions as the core component of programmatic treatment.
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Affiliation(s)
- Andrea J Phelps
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Zachary Steele
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sean Cowlishaw
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nathan Alkemade
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Peter Elliott
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Meaghan O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Suzy Redston
- Psychological Trauma Recovery Service, Austin Health, Melbourne, Australia
| | - Katelyn Kerr
- Trauma Recovery Program, Toowong Private Hospital, Brisbane, Australia
| | - Alexandra Howard
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Jane Nursey
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - John Cooper
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Renee Armstrong
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Lea Fitzgerald
- Trauma Recovery Centre, Mater Health Services, Townsville, Australia
| | - David Forbes
- Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Pagé MG, Watt-Watson J, Choinière M. Do depression and anxiety profiles over time predict persistent post-surgical pain? A study in cardiac surgery patients. Eur J Pain 2017; 21:965-976. [DOI: 10.1002/ejp.998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 12/11/2022]
Affiliation(s)
- M. Gabrielle Pagé
- Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM); QC Canada
- Department of Biomedical Sciences; Faculty of Medicine; Université de Montréal; QC Canada
| | - J. Watt-Watson
- Bloomberg Faculty of Nursing; University of Toronto; ON Canada
| | - M. Choinière
- Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM); QC Canada
- Department of Anesthesiology; Faculty of Medicine; Université de Montréal; QC Canada
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16
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Shi X, Zhou Y, Fan F. Longitudinal trajectories and predictors of anxiety symptoms among adolescent survivors exposed to Wenchuan earthquake. J Adolesc 2016; 53:55-63. [DOI: 10.1016/j.adolescence.2016.08.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/27/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
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Saltmarsh N, Murphy B, Bennett P, Higgins R, Macvean M, Le Grande M, Thompson D, Ski C, Worcester M, Jackson A. Distress in partners of cardiac patients: relationship quality and social support. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/bjca.2016.11.8.397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Nadine Saltmarsh
- Research Fellow, Australian Centre for Heart Health; Department of Psychology and Counselling, La Trobe University, Bendigo, Australia
| | - Barbara Murphy
- Associate Professor, Australian Centre for Heart Health, Melbourne; Faculty of Health, Deakin University; Department of Psychology, University of Melbourne; Department of Behavioural Medicine, University of Newcastle, Australia
| | - Pauleen Bennett
- Associate Professor, Department of Psychology and Counselling, La Trobe University, Bendigo, Australia
| | - Rosemary Higgins
- Associate Professor, Australian Centre for Heart Health, Melbourne; Department of Psychology, Deakin University, Melbourne; Department of Physiotherapy, University of Melbourne, Australia
| | - Michelle Macvean
- Former Research Fellow, Heart Research Centre, Melbourne, Australia
| | - Michael Le Grande
- Research Fellow, Australian Centre for Heart Health, Melbourne; Faculty of Health, Deakin University, Melbourne, Australia
| | - David Thompson
- Professor, University of Melbourne, Department of Psychiatry, Melbourne, Australia
| | - Chantal Ski
- Associate Professor, University of Melbourne, Department of Psychiatry, Melbourne, Australia
| | - Marian Worcester
- Former Director, Heart Research Centre, Melbourne; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alun Jackson
- Professor, Australian Centre for Heart Health, Melbourne; Faculty of Health, Deakin University, Melbourne, Australia; Centre on Behavioural Health, Hong Kong University, Hong Kong
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Murphy BM, Higgins RO, Shand L, Page K, Holloway E, Le Grande MR, Jackson AC. Improving health professionals' self-efficacy to support cardiac patients' emotional recovery: the 'Cardiac Blues Project'. Eur J Cardiovasc Nurs 2016; 16:143-149. [PMID: 27071738 DOI: 10.1177/1474515116643869] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients experience the 'cardiac blues' at the time of an acute cardiac event, and one in five go on to develop severe depression. These emotional responses often go undetected and unacknowledged. We initiated the 'Cardiac Blues Project' in order to help support patients' emotional recovery. As part of the project, we developed online training in order to support health professionals in the identification and management of the cardiac blues and depression. The aim of this study was to assess the acceptability of the training and its impacts on health professionals' self-efficacy. METHOD In July 2014, a 'cardiac blues' pack of patient resources, including access to health professional online training, was mailed to 606 centres across Australia. In the first 3 months after distribution, 140 health professionals registered to undertake the online training and participated in the present study. Participants provided information via a six-item pre- and post-training self-efficacy scale and on 10 post-training acceptability items. RESULTS Health professionals' self-efficacy improved significantly after undertaking the online training across the six domains assessed and for the total score. Acceptability of the training was high across all 10 items assessed. Ratings of usefulness of the training in clinical practice were particularly favourable amongst those who worked directly with cardiac patients. CONCLUSIONS The health professional training significantly improves health professionals' confidence in identifying and managing the 'cardiac blues' and depression. Monitoring of uptake is ongoing and future studies will investigate patient outcomes.
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Affiliation(s)
- Barbara M Murphy
- 1 Australian Centre for Heart Health, Australia.,2 Faculty of Health, Deakin University, Australia.,3 Department of Psychology, University of Melbourne, Australia.,4 School of Medicine & Public Health, University of Newcastle, Australia
| | - Rosemary O Higgins
- 1 Australian Centre for Heart Health, Australia.,5 Department of Physiotherapy, University of Melbourne, Australia.,6 Department of Psychology, Deakin University, Australia.,7 Cabrini Health, Malvern, Australia
| | - Lyndel Shand
- 1 Australian Centre for Heart Health, Australia.,2 Faculty of Health, Deakin University, Australia
| | - Karen Page
- 2 Faculty of Health, Deakin University, Australia
| | | | - Michael R Le Grande
- 1 Australian Centre for Heart Health, Australia.,2 Faculty of Health, Deakin University, Australia
| | - Alun C Jackson
- 1 Australian Centre for Heart Health, Australia.,2 Faculty of Health, Deakin University, Australia.,8 Centre on Behavioural Health, Hong Kong University, Hong Kong
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Celano CM, Millstein RA, Bedoya CA, Healy BC, Roest AM, Huffman JC. Association between anxiety and mortality in patients with coronary artery disease: A meta-analysis. Am Heart J 2015; 170:1105-15. [PMID: 26678632 DOI: 10.1016/j.ahj.2015.09.013] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression and anxiety are common in patients with coronary artery disease (CAD). Although depression clearly has been associated with mortality in this population, the relationship between anxiety and mortality is less clear. Accordingly, we performed a series of meta-analyses to (1) examine the relationship between anxiety and mortality in patients with established CAD and (2) determine if this relationship differs in patients with stable CAD compared to those who have just had an acute coronary syndrome (ACS). METHODS AND RESULTS Systematic literature searches identified 44 articles (total N = 30,527) evaluating the prospective relationship between anxiety and mortality in individuals with established CAD. A series of 8 adjusted and unadjusted meta-analyses were performed to examine this relationship across all patients, with sensitivity analyses completed in post-ACS and stable CAD cohorts. In unadjusted analyses, anxiety was associated with a moderate increase in mortality risk (odds ratio 1.21 per SD increase in anxiety). However, when adjusting for covariates, nearly all associations became nonsignificant. In sensitivity analyses, anxiety was associated with an increased risk of poor outcomes in the stable CAD-but not post-ACS-cohort. CONCLUSIONS These analyses confirm that anxiety is associated with increased risk of mortality in patients with CAD; however, this relationship is not as strong as that of depression and may be explained partly by other clinical factors. If anxiety screening is performed, it should be performed during a period of clinical stability and should target anxiety disorders rather than anxiety symptoms alone.
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Affiliation(s)
- Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Rachel A Millstein
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - C Andres Bedoya
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brian C Healy
- Harvard Medical School, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Annelieke M Roest
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA
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Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers. J Stroke Cerebrovasc Dis 2015; 25:172-81. [PMID: 26476585 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
GOAL We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories. METHODS Data on 172 stroke survivor-caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates. FINDINGS Three stroke survivor depressive symptom trajectories (low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories (low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement). CONCLUSION Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor-caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor-caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.
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21
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Ski CF, Jelinek M, Jackson AC, Murphy BM, Thompson DR. Psychosocial interventions for patients with coronary heart disease and depression: A systematic review and meta-analysis. Eur J Cardiovasc Nurs 2015; 15:305-16. [PMID: 26475227 DOI: 10.1177/1474515115613204] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/30/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Depression is common in patients with coronary heart disease, and together these conditions significantly affect health outcomes. Impaired social support is also considered an important predictor of coronary heart disease prognosis and, as there is a complex interplay between social isolation and depression, interventions to address both may be required. This review aimed to assess the effectiveness of psychosocial interventions addressing both depression and social support for people with coronary heart disease and depression. METHODS PRISMA guidelines were used to search major health databases to identify randomised controlled trials that evaluated psychosocial interventions compared with usual care in patients with coronary heart disease and depression; the primary outcome was depressive symptoms and secondary outcomes were mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety, social support and quality of life. Data, when suitable, were pooled using a random-effects meta-analysis model. RESULTS Five studies (n=1358 participants) were eligible and included. The psychosocial intervention group had significantly lower levels of depressive symptoms (standardised mean difference (SMD) -0.15, 95% confidence interval (CI) -0.27 to -0.03; P=0.02) and higher levels of social support (SMD 0.17; 95% CI 0.04 to 0.30; P=0.01) but no differences were found for mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety or quality of life. CONCLUSIONS Psychosocial interventions for patients with coronary heart disease and depression result in modest reductions in depressive symptoms and improvements in social support. However, caution is warranted in view of the small number of studies included in the review and potential heterogeneity in outcomes and in differences in treatment.
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Affiliation(s)
- Chantal F Ski
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Michael Jelinek
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Cardiology, St Vincent's Hospital, Melbourne, Australia
| | | | - Barbara M Murphy
- Heart Research Centre, Melbourne, Australia Department of Psychology, University of Melbourne, Melbourne, Australia
| | - David R Thompson
- Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
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22
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Depressive symptom trajectories over a 6-year period following myocardial infarction: predictive function of cognitive appraisal and coping. J Behav Med 2015; 39:181-91. [PMID: 26424444 PMCID: PMC4799799 DOI: 10.1007/s10865-015-9681-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/10/2015] [Indexed: 11/06/2022]
Abstract
The association between distinct patterns of depression and coping variables in myocardial infarction (MI) survivors over the long-term is unclear. The study aims to evaluate depressive trajectories and their covariates, including coping and cognitive appraisal, following MI over a period of 6 years. Depressive symptoms were assessed in 200 patients a few days after the first MI, and 1 month, 6 months and 6 years later. Cognitive appraisal and coping were assessed during the first three time points. Three latent depressive trajectories were identified: chronic (high; increasing then decreasing; n = 49), rising (moderate; decreasing then increasing; n = 121) and low (low; decreasing then stabilizing; n = 30). The chronic trajectory was associated with higher negative appraisal and emotion-focused coping. The findings clarify the long-term longitudinal trajectories of post-MI depressive symptoms and their association with coping variables, revealing the unfavorable impact of negative cognition and palliative coping.
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Wardenaar KJ, Monden R, Conradi HJ, de Jonge P. Symptom-specific course trajectories and their determinants in primary care patients with Major Depressive Disorder: Evidence for two etiologically distinct prototypes. J Affect Disord 2015; 179:38-46. [PMID: 25845748 DOI: 10.1016/j.jad.2015.03.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/16/2015] [Accepted: 03/17/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND The course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains. METHODS In primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly 'mood/cognition' (MC) and 'somatic' (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated. RESULTS PP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up. LIMITATIONS The sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals. CONCLUSIONS The results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms.
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Affiliation(s)
- K J Wardenaar
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - R Monden
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - H J Conradi
- University of Amsterdam, Department of Clinical Psychology, The Netherlands
| | - P de Jonge
- University of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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Versteeg H, Roest AM, Denollet J. Persistent and fluctuating anxiety levels in the 18 months following acute myocardial infarction: the role of personality. Gen Hosp Psychiatry 2015; 37:1-6. [PMID: 25524723 DOI: 10.1016/j.genhosppsych.2014.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the varying courses of anxiety symptoms in the first 18 months after a myocardial infarction (MI) and to examine the importance of personality in determining elevated anxiety. METHODS Four hundred eighty-six MI patients completed the State-Trait Anxiety Inventory during hospitalization and at 2-, 12- and 18-months post-MI. At baseline, patients also completed the DS14 Type D personality scale, Anxiety Sensitivity Index and Beck Depression Inventory, and clinical and sociodemographic information was collected. RESULTS Growth mixture modeling analysis identified four anxiety trajectories. The majority of patients reported stable anxiety scores over time, indicative of either persistent high (17%) or low (71%) anxiety. Patients in the other two smaller groups initially reported moderate levels of anxiety that fluctuated during follow-up. Type D personality [odds ratio (OR)=5.34; 95% confidence interval (CI): 2.26-12.63], negative affectivity (OR=3.24; 95% CI: 1.29-8.14) and anxiety sensitivity (OR=3.35; 95% CI: 1.69-6.62) were the most prominent determinants of persistent high anxiety, independent of depression, sociodemographic and clinical factors. CONCLUSIONS The course of anxiety in the first 18 months after MI is relatively stable for the majority of patients. Patients with Type D personality, negative affectivity and anxiety sensitivity are at an increased risk for persisting elevated anxiety and should be identified and offered appropriate treatment.
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Affiliation(s)
- Henneke Versteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; Department of Cardiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Annelieke M Roest
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Hanzeplein 1, 9173 GZ Groningen, The Netherlands.
| | - Johan Denollet
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
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Wardenaar KJ, Conradi HJ, de Jonge P. Data-driven course trajectories in primary care patients with major depressive disorder. Depress Anxiety 2014; 31:778-86. [PMID: 24390862 DOI: 10.1002/da.22228] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/29/2013] [Accepted: 11/28/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The chronic nature of MDD has been acknowledged as one of the key determinants of the burden associated with depression. Unfortunately, so far described prognostic factors have been inconsistent, possibly due to used course outcomes that are often based on arbitrary criteria/cut-offs. Therefore, the aim of the current study was to use data-driven trajectory groups based on closely spaced weekly severity ratings, as outcomes in prognostic research. METHODS The sample consisted of primary care patients with MDD (n = 153), who were followed up for a year with 52 consecutive weekly ratings of the nine DSM-IV MDD criterion symptoms. Growth Mixture Modeling (GMM) was used to reduce the interpersonal growth variation to an optimal set of clinically interpretable trajectory groups. Next, baseline course predictors were investigated and the prognostic (added) value of course-group membership was investigated for clinical outcomes after 1, 2, and 3 years. RESULTS GMM resulted in four trajectory groups: "early remission" (40.2%), "late remission" (9.8%), "remission and recurrence" (17.0%), and "chronic" (33.0%). Multivariate predictors of "chronic" group membership were a prior suicide attempt, comorbid dysthymia, and lower levels of somatic depressive symptoms. Group membership predicted differences in depression severity and/or quality of life after 1, 2, and 3 years. CONCLUSIONS The used data-driven approach provided a parsimonious and clinically informative way to describe course variation across MDD patients. Using the trajectory groups to investigate prognostic factors of MDD provided insight in potentially useful prognostic factors. Importantly, trajectory-group membership was itself a strong predictor of future mental well-being.
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Affiliation(s)
- Klaas J Wardenaar
- Department of Psychiatry, University Medical Center Groningen (UMCG), Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, Groningen, The Netherlands
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Don BP, Chong A, Biehle SN, Gordon A, Mickelson KD. Anxiety across the transition to parenthood: change trajectories among low-risk parents. ANXIETY STRESS AND COPING 2014; 27:633-49. [DOI: 10.1080/10615806.2014.903473] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Murphy B, Ludeman D, Elliott P, Judd F, Humphreys J, Edington J, Jackson A, Worcester M. Red flags for persistent or worsening anxiety and depression after an acute cardiac event: a 6-month longitudinal study in regional and rural Australia. Eur J Prev Cardiol 2013; 21:1079-89. [DOI: 10.1177/2047487313493058] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barbara Murphy
- Heart Research Centre, Melbourne, VIC, Australia
- University of Melbourne, VIC, Australia
| | | | - Peter Elliott
- Heart Research Centre, Melbourne, VIC, Australia
- University of Melbourne, VIC, Australia
| | | | | | | | - Anthony Jackson
- Bendigo Health, VIC, Australia
- St John of God Hospital, Bendigo, VIC, Australia
| | - Marian Worcester
- Heart Research Centre, Melbourne, VIC, Australia
- University of Melbourne, VIC, Australia
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Turner A, Hambridge J, Baker A, Bowman J, McElduff P. Randomised controlled trial of group cognitive behaviour therapy versus brief intervention for depression in cardiac patients. Aust N Z J Psychiatry 2013; 47:235-43. [PMID: 23015750 DOI: 10.1177/0004867412460592] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine whether a six-session group cognitive behaviour therapy (CBT) programme results in a greater reduction in depression symptoms than a brief intervention alone in cardiac patients with clinically significant symptoms of depression. METHOD Fifty-seven community dwelling cardiac patients scoring >13 on the Beck Depression Inventory-II (BDI-II) received a single-session brief intervention. They were then block randomised to either six sessions of group CBT (n = 25) or no further intervention (BI; n = 32). All were re-assessed at 2, 6 and 12 months. Differences between treatment groups in the primary (BDI-II) and secondary [rates of depression; anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale-Anxiety (HADS-A)] outcomes were examined using generalised linear mixed models with a random intercept term for the individual. RESULTS Significant improvements were seen for the total group from baseline to 12 months on BDI-II and HADS-A scores. However, no differences were found between the CBT and BI conditions on change in BDI-II score, rates of major depressive episode or HADS-A score. Post hoc analysis on the total group found 12-month symptom non-remission was associated with higher baseline BDI-II score (p = 0.03), more visits to health professionals 12 months prior to baseline (p = 0.05) and a greater likelihood of either drinking alcohol over recommended levels or smoking at baseline (p = 0.01). CONCLUSIONS Group CBT of up to six sessions did not result in greater reductions in depression or anxiety symptoms compared with a single-session brief intervention. Further work should focus on the efficacy and role of brief interventions, and addressing smoking and alcohol misuse in cardiac patients with depression.
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Affiliation(s)
- Alyna Turner
- Liaison Psychiatry Department, John Hunter Hospital, Newcastle, Australia.
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Turner A, Murphy BM, Higgins RO, Elliott PC, Le Grande MR, Goble AJ, Worcester MUC. An integrated secondary prevention group programme reduces depression in cardiac patients. Eur J Prev Cardiol 2012; 21:153-62. [DOI: 10.1177/2047487312467747] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Alyna Turner
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Barbara M Murphy
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | | | - Peter C Elliott
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | | | | | - Marian UC Worcester
- Heart Research Centre, Victoria, Australia
- The University of Melbourne, Victoria, Australia
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van Beek MHCT, Mingels M, Voshaar RCO, van Balkom AJLM, Lappenschaar M, Pop G, Speckens AEM. One-year follow up of cardiac anxiety after a myocardial infarction: a latent class analysis. J Psychosom Res 2012; 73:362-8. [PMID: 23062810 DOI: 10.1016/j.jpsychores.2012.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/06/2012] [Accepted: 09/10/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Longitudinal elevated depressive symptom scores are associated with a less favorable cardiac outcome. Although anxiety has received less attention, meta-analysis suggests that high baseline levels of general anxiety might worsen cardiac outcome. The objective of this study was to explore the longitudinal course of cardiac anxiety after a myocardial infarction (MI). METHODS The Cardiac Anxiety Questionnaire (CAQ) was administered to 194 patients hospitalized for MI after admission, and one, three, six and twelve months after discharge. Latent class growth analysis (LCGA) was performed to identify groups based on cardiac anxiety course. Between group differences were checked on relevant socio-demographic, cardiac and psychiatric variables. RESULTS LCGA identified three groups with stable CAQ levels over time, indicative of high (7.7%), intermediate (45.4%) and low (30.4%) levels of cardiac anxiety, respectively. A fourth group (16.5%) reported high levels of cardiac anxiety that decreased over time. Between group differences were of particular interest for the two subgroups that started high in cardiac anxiety, since these may differentiate patients with spontaneous remission from those who might be in need of treatment. Patients in whom cardiac anxiety persisted were less often employed, had more diabetes mellitus, a history of acute coronary syndrome, depressive symptoms, anxiety and avoidance at baseline and a lower quality of life at follow-up. CONCLUSION This first study addressing cardiac anxiety after an MI identified four trajectories. Future studies should focus on cardiac outcome and treatment strategies for cardiac anxiety in the subgroup with persistent high anxiety levels.
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Affiliation(s)
- M H C T van Beek
- Radboud University Nijmegen Medical Centre, Department of Psychiatry, Nijmegen, The Netherlands.
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White JH, Magin P, Attia J, Sturm J, Carter G, Pollack M. Trajectories of psychological distress after stroke. Ann Fam Med 2012; 10:435-42. [PMID: 22966107 PMCID: PMC3438211 DOI: 10.1370/afm.1374] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE There has been little exploration of the distinct trajectories of psychological distress after stroke and the factors that predict recovery from distress. These trajectories may assist primary care physicians by providing insight into disease onset, progression, and resolution and may be a useful way to conceptualize and understand the pattern of psychological morbidity in stroke over time. We undertook a longitudinal qualitative study to explore poststroke psychological trajectories METHODS The primary data collection method was semistructured interviews with community-dwelling stroke survivors in metropolitan Newcastle, New South Wales, Australia. Our sample included 23 participants (12 men, 10 women; age range 37 to 94 years) discharged from a tertiary referral hospital after a stroke; these participants subsequently participated in a total of 106 interviews over 12 months. Qualitative outcomes were participants' perceptions at baseline, 3, 6, 9, and 12 months. Thematic saturation was achieved. RESULTS Most participants were male (54%) and had a partial anterior circulation infarction stroke subtype (57%). Four different longitudinal trajectories were identified: resilience (n = 5); ongoing crisis (n = 5), emergent mood disturbance (n = 3), and recovery from mood disturbance (n = 10). Recovery from mood disturbance was facilitated by gains in independence and self-esteem and by having an internal health locus of control. CONCLUSIONS Stroke survivors experienced a variety of psychological trajectories. Identifying distinct trajectories of psychological morbidity may help primary care physicians develop appropriately timed interventions to promote better mental health. Interventions require implementation over a longer duration than the current outpatient services that, in Australia, are typically provided in the first few months after stroke.
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Affiliation(s)
- Jennifer H White
- Hunter Stroke Service, Hunter New England Area Health Service, Australia
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Murphy BM, Grande MRL, Navaratnam HS, Higgins RO, Elliott PC, Turner A, Rogerson MC, Worcester MUC, Goble AJ. Are poor health behaviours in anxious and depressed cardiac patients explained by sociodemographic factors? Eur J Prev Cardiol 2012; 20:995-1003. [DOI: 10.1177/2047487312449593] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Barbara M Murphy
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | | | | | | | - Peter C Elliott
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | - Alyna Turner
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
| | | | - Marian UC Worcester
- Heart Research Centre, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Australia
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Type D personality and persistence of depressive symptoms in a German cohort of cardiac patients. J Affect Disord 2012; 136:1183-7. [PMID: 22226380 DOI: 10.1016/j.jad.2011.11.044] [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] [Received: 07/26/2011] [Revised: 11/30/2011] [Accepted: 11/30/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depression is associated with a negative prognosis in coronary heart disease and heart failure patients. Type D personality has been shown to predict the persistence of depressive symptoms over 12 months. Data on longer follow-up periods and on the effectiveness of Type D as a screening tool compared to established measures of depressive symptoms are missing. METHODS Type D personality and depressive mood were assessed with the DS14 and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) in 679 consecutive cardiac patients (22.2% female, mean age 62.4±10.2 years) over a period of 6 years. Latent class and growth mixture models with Type D, comorbidity, age, and sex as covariates were used to model individual depression trajectory classes and to predict trajectories and class membership. Estimates of specificity and sensitivity were calculated for Type D and the HADS-D baseline cut-off point. RESULTS In a model with four latent classes (mild symptoms, moderate and increasing symptoms, significant but decreasing symptoms, and significant and increasing symptoms), Type D predicted the membership in the class with significant and increasing symptoms (OR=10.94, 4.93, and 3.15). Sensitivity and specificity were 59% and 78% for Type D and 47% and 80% for the HADS-D. LIMITATIONS Some possible confounders might be missing. With just two measurement points only linear trajectories could be modeled. CONCLUSIONS Type D personality is a stronger predictor for persistent depressive symptoms than the baseline HADS-D score, but the predictive power seems low for clinical practice.
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Damen NL, Pelle AJ, van Geuns RJM, van Domburg RT, Boersma E, Pedersen SS. Intra-individual changes in anxiety and depression during 12-month follow-up in percutaneous coronary intervention patients. J Affect Disord 2011; 134:464-7. [PMID: 21676467 DOI: 10.1016/j.jad.2011.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Only a paucity of studies focused on intra-individual changes in anxiety and depression over time and its correlates in cardiac patients, which may contribute to the identification of high-risk patients and point to targets for intervention. We examined changes in anxiety and depression over a 12-month period and the demographic and clinical correlates of change scores using an intra-individual approach in patients treated with percutaneous coronary intervention (PCI). METHODS Consecutive PCI patients (N=715) completed the Hospital Anxiety and Depression Scale (HADS) at baseline and at 12 months post-PCI. Individual change scores were calculated and in secondary analysis, three categories of change were identified (i.e., stable, improved, and deteriorated anxiety or depression). RESULTS The mean individual change was -.16 (± 3.0) for anxiety and -.02 (± 2.8) for depression. In linear regression analysis, baseline anxiety levels (B = -.25, 95%CI[-.30 to -.20], p = <.001) and baseline depression levels (B = -.28, 95%CI[-.33 to -.22], p =< .001) were significant correlates of individual change scores. Secondary analysis showed that anxiety remained stable in 76.4% (546/715) of patients, while depression remained stable in 81.4% (582/715) of patients. CONCLUSIONS The findings of the current study showed that levels of anxiety and depression remained stable in the majority of PCI patients from the index PCI to 12 months post-PCI. Future studies using an intra-individual approach are warranted to further examine individual changes in anxiety and depression over time in CAD, and PCI in particular, as a means to bridge the gap between research and clinical practice.
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Affiliation(s)
- Nikki L Damen
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
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Lewis KN, Heckman BD, Himawan L. Multinomial logistic regression analysis for differentiating 3 treatment outcome trajectory groups for Headache-associated Disability. Pain 2011; 152:1718-1726. [DOI: 10.1016/j.pain.2011.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 12/12/2010] [Accepted: 02/01/2011] [Indexed: 11/27/2022]
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Hasnain M, Vieweg WVR, Lesnefsky EJ, Pandurangi AK. Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines. J Psychosom Res 2011; 71:6-12. [PMID: 21665006 DOI: 10.1016/j.jpsychores.2010.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We lack evidence that routine screening for depression in patients with coronary heart disease (CHD) improves patient outcome. This lack has challenged the advisory issued by the American Heart Association (AHA) to routinely screen for depression in CHD patients. We assess the AHA advisory in the context of well-established criteria of screening for diseases. METHODS Using principles and criteria for screening developed by the World Health Organization and the United Kingdom National Screening Committee, we generated criteria pertinent to screening for depression in CHD patients. To find publications relevant to these criteria and clinical setting, we performed a broadly based literature search on "depression and CHD," supplemented by more focused literature searches. RESULTS Evidence for an association between depression and CHD is strong. Despite this, the AHA advisory has several limitations. It did not account for the complexity of the association between depression and CHD. It acknowledged there was no evidence that screening for depression leads to improved outcomes in cardiovascular populations but still recommended routine screening without providing an alternative evidence-based explanation. It ignored the paucity of literature about the safety and cost-effectiveness of routine screening for depression in CHD and failed to define the nature and extent of resources needed to implement such a program effectively. CONCLUSION We conclude that the AHA advisory is premature. We must first demonstrate the efficacy, safety, and cost-effectiveness of screening and define the resources necessary for its implementation and monitoring. Meanwhile, organizations representing cardiologists, psychiatrists, and general practitioners must coordinate efforts to manage depression and CHD through collaborative care, and work with the policy makers to develop the necessary infrastructure and services delivery system needed to optimize the outcome of depressed and at-risk-for-depression patients suffering from CHD.
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Affiliation(s)
- Mehrul Hasnain
- Department of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
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Chan WCH, Chan CLW. Acceptance of spousal death: the factor of time in bereaved older adults' search for meaning. DEATH STUDIES 2011; 35:147-162. [PMID: 24501833 DOI: 10.1080/07481187.2010.535387] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Response to the death of a spouse was examined by focusing on acceptance, which was conceptualized as both a process and an outcome. Grounded theory was applied to analyze the experience of 15 bereaved Hong Kong Chinese older adults. The main theme that emerged was time. Acceptance of spousal death was found to be related to the search for meaning in 2 time-related themes: timing of spousal death and paradoxical time perception. For paradoxical time perception, 2 subthemes were identified: truncation and daily isolation in time. For bereaved older adults, time-related meaning seeking may be best fostered by self-transcendence, (e.g., participation in volunteer work and social activities).
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Affiliation(s)
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, Centre on Behavioral Health, University of Hong Kong
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Turner A, Phillips L, Hambridge JA, Baker AL, Bowman J, Colyvas K. Clinical outcomes associated with depression, anxiety and social support among cardiac rehabilitation attendees. Aust N Z J Psychiatry 2010; 44:658-66. [PMID: 20560853 DOI: 10.3109/00048671003646751] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To utilize existing medical record information in order to examine the relationship between depression, anxiety, levels of social support and clinical outcomes in cardiac rehabilitation attendees. METHOD In a tertiary care centre 389 records for cardiac rehabilitation outpatients were analysed. Hospital Anxiety and Depression Scales scores collected at week 4 of their cardiac rehabilitation programme were linked with medical record information on demographic, lifestyle, medical and other coronary heart disease risk factors, as well as follow-up cardiovascular events and readmissions for an average of 2.6 years. Variables of interest were anxiety and depression scores and proxy measures of social support. Clinical outcome measures were number of hospital admissions, length of stay and mortality. RESULTS Multiple variable analysis revealed higher anxiety scores were associated with more hospital admissions and higher depression scores were associated with longer length of stay after controlling for other established prognostic risk factors. Depression, anxiety and social support were not associated with mortality, however there was a low mortality rate in the present study. CONCLUSION A comprehensive summary of the characteristics of cardiac rehabilitation patients was gathered through the linkage and examination of existing clinical databases. The results of this study provide some support for a prognostic role of depressive and anxiety symptoms and highlight the need for screening for psychological distress and provision of appropriate interventions when indicated.
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Affiliation(s)
- Alyna Turner
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia.
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Huffman JC, Celano CM, Januzzi JL. The relationship between depression, anxiety, and cardiovascular outcomes in patients with acute coronary syndromes. Neuropsychiatr Dis Treat 2010; 6:123-36. [PMID: 20505844 PMCID: PMC2874336 DOI: 10.2147/ndt.s6880] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Depression and anxiety occur at high rates among patients suffering an acute coronary syndrome (ACS). Both depressive symptoms and anxiety appear to adversely affect in-hospital and long term cardiac outcomes of post-ACS patients, independent of traditional risk factors. Despite their high prevalence and serious impact, mood and anxiety symptoms go unrecognized and untreated in most ACS patients and such symptoms (rather than being transient reactions to ACS) persist for months and beyond. The mechanisms by which depression and anxiety are linked to these negative medical outcomes are likely a combination of the effects of these conditions on inflammation, catecholamines, heart rate variability, and endothelial function, along with effects on health-promoting behavior. Fortunately, standard treatments for these disorders appear to be safe, well-tolerated and efficacious in this population; indeed, selective serotonin reuptake inhibitors may actually improve cardiac outcomes. Future research goals include gaining a better understanding of the combined effects of depression and anxiety, as well as definitive prospective studies of the impact of treatment on cardiac outcomes. Clinically, protocols that allow for efficient and systematic screening, evaluation, and treatment for depression and anxiety in cardiac patients are critical to help patients avoid the devastating effects of these illnesses on quality of life and cardiac health.
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Affiliation(s)
- Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street/Blake 11, Boston, MA, USA.
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Neigh GN, Karelina K, Zhang N, Glasper ER, Owens MJ, Plotsky PM, Nemeroff CB, Devries AC. Cardiac arrest and cardiopulmonary resuscitation dysregulates the hypothalamic-pituitary-adrenal axis. J Cereb Blood Flow Metab 2009; 29:1673-82. [PMID: 19553908 PMCID: PMC3815600 DOI: 10.1038/jcbfm.2009.85] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cardiac arrest and cardiopulmonary resuscitation (CA/CPR) increase the risk for affective disorders in human survivors. Postischemic anxiety- and depressive-like behaviors have been documented in animal models of CA/CPR; however, the stability of post-CA/CPR anxiety-like behavior over time and the underlying physiologic mechanisms remain unknown. The hypothalamic-pituitary-adrenal (HPA) axis and the corticotropin releasing factor (CRF) system may mediate the pathophysiology of anxiety and depression; therefore, this study measured CA/CPR-induced changes in CRF receptor binding and HPA axis negative feedback. Mice were exposed to CA/CPR or SHAM surgery and assessed 7 or 21 days later. Consistent with earlier demonstrations of anxiety-like behavior 7 days after CA/CPR, increased anxiety-like behavior in the open field was also present 21 days after CA/CPR. On postoperative day 7, CA/CPR was associated with an increase in basal serum corticosterone concentration relative to SHAM, but this difference resolved by postoperative day 21. The Dexamethasone Suppression Test showed that the CA/CPR group had enhanced negative feedback compared with SHAM controls at postoperative day 21. Furthermore, there was a gradual increase in CRF(1) receptor binding in the paraventricular nucleus of the hypothalamus and bed nucleus of the stria terminalis, as well as a transient decrease of both CRF(1) and CRF(2A) receptors in the dorsal hippocampus. Therefore, sustained changes in activity of the HPA axis and the CRF system after CA/CPR may contribute to the postischemic increase in affective disorders.
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Affiliation(s)
- Gretchen N Neigh
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia 30322, USA.
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Gravely-Witte S, Stewart DE, Suskin N, Grace SL. The association among depressive symptoms, smoking status and antidepressant use in cardiac outpatients. J Behav Med 2009; 32:478-90. [PMID: 19504177 DOI: 10.1007/s10865-009-9218-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 05/14/2009] [Indexed: 01/20/2023]
Abstract
Both depression and smoking are highly prevalent and related to poorer outcomes in cardiac patients. In this study, the authors examined the association between depressive symptoms and smoking status, described the frequency and type of antidepressant use, and prospectively tested the effects of antidepressant use in smokers on smoking status and psychosocial outcomes. Participants comprised 1,498 coronary artery disease (CAD) outpatients who completed a baseline survey which assessed depressive symptoms, current medications, and smoking status. A second survey was mailed 9 months later that assessed depressive symptoms, anxiety, insomnia and smoking status. Results showed that current and former-smokers had significantly greater depressive symptoms than non-smokers. Ten percent of patients were taking antidepressants, most frequently SSRIs, with significantly more smokers on antidepressants than former and non-smokers. At follow-up, smokers on antidepressants were less likely to have quit, had greater anxiety, depressive symptoms and insomnia than smokers not using antidepressants. This study demonstrated that smokers and quitters with CAD had greater depressive symptoms and use of antidepressants than non-smokers, but that the antidepressants utilized may not be optimizing outcomes.
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Affiliation(s)
- Shannon Gravely-Witte
- Faculty of Health, York University, Norman Bethune 222B, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
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43
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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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Murphy BM, Elliott PC, Higgins RO, Le Grande MR, Worcester MU, Goble AJ, Tatoulis J. Anxiety and depression after coronary artery bypass graft surgery: most get better, some get worse. ACTA ACUST UNITED AC 2008; 15:434-40. [DOI: 10.1097/hjr.0b013e3282fbc945] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Barbara M. Murphy
- Heart Research Centre, Melbourne
- Department of Psychiatry, The
University of Melbourne
| | - Peter C. Elliott
- Heart Research Centre, Melbourne
- Australian Centre for Posttraumatic
Mental Health, The University of Melbourne
| | | | | | - Marian U.C. Worcester
- Heart Research Centre, Melbourne
- Department of Psychology, The
University of Melbourne
| | | | - James Tatoulis
- Department of Cardiothoracic
Surgery, The Royal Melbourne Hospital, Victoria, Australia
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