ReviewDepression and anxiety and outcomes of coronary artery bypass surgery
Section snippets
Material and methods
The identification of articles in English language peer-reviewed journals was obtained by using PubMed from 1980 to 2001 (www.ncbi.nlm.nih.gov/PubMed), with key words as follow: depression, anxiety, mood disorder, and coronary artery bypass graft surgery. The articles were also identified by searching on any author who had contributed one relevant article and by using the function “related articles” in PubMed.
Overview of epidemiology of depression and anxiety in coronary artery disease
Many studies conducted over the last 10 years have documented that the prevalence of depression is increased among patients with various manifestations of CAD, including those recently hospitalized for an acute myocardial infarction (AMI) 7, 8, unstable angina [9], congestive heart failure [10], and coronary catheterization or angioplasty 11, 12. There is also evidence of an increased prevalence in patients with stable coronary artery disease [13], and at 6 months and 1 year after an AMI [14].
Depression and anxiety before and after bypass surgery
In contrast to the large number of studies documenting relationships between depression and anxiety and cardiovascular disease outcomes, relatively few studies have examined links between psychological symptoms and morbidity and mortality after CABG. Although there is some evidence that surgery may be associated with better psychological and social outcomes after AMI than nonsurgical treatment [25], symptoms of anxiety, depression, or reactive stress are commonly reported among patients with a
Pathophysiology
The factors that link major depression or depressive symptoms, and possibly anxiety, to an increased risk of postsurgical morbidity and mortality remain unclear. In addition to the pathophysiological disturbances postulated to underlie relationships between depression and anxiety and prognosis in CAD patients, several factors specific to cardiac surgery may be involved in CABG patients.
According to several reviews of the current data, symptoms of depression, and to some extent anxiety, may
Interventions before surgery
Evaluation and psychological support specifically designed to reduce the apprehension and emotional tension experienced by CAD patients before cardiac surgery may prevent adverse effects, thus facilitating postoperative recovery and reducing the cost of care [64]. Given that symptoms of anxiety and depression are common in patients scheduled for CABG [26] and can influence the outcome of the procedure, detection of these symptoms during the preoperative evaluation is essential. Structured
Comment
Depression and anxiety are well-recognized cardiovascular risk factors, similar in importance to smoking and hypertension, and must be detected and treated. These psychological disorders can affect the outcomes of cardiovascular disease by numerous pathophysiological mechanisms.
Furthermore, recent studies have confirmed that symptoms of depression or anxiety are associated with worse outcomes after CABG, often with a marked alteration in quality of life. Careful routine evaluation of these
Acknowledgements
We are greatly thankful to Luce Bégin for the preparation of the manuscript.
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