Brief report
Intra-individual changes in anxiety and depression during 12-month follow-up in percutaneous coronary intervention patients

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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.

Introduction

Anxiety and depression are common in patients with established coronary artery disease (CAD) (Moser et al., 2010), with prevalence rates ranging from 20 to 50% for anxiety (Musselman et al., 1998, Thombs et al., 2006) and 30 to 60% for depression (Barefoot et al., 2003, Grace et al., 2004), respectively. Both anxiety and depression have been associated with increased cardiovascular morbidity and mortality (Blumenthal et al., 2003, Frasure-Smith et al., 2000, Kaptein et al., 2006), increased health care consumption (Grace et al., 2004, Strik et al., 2003), and impaired health-related quality of life (Lane et al., 2001). Generally, anxiety and depression in CAD have been examined by means of incidence and prevalence rates (Blumenthal et al., 2003, Grace et al., 2004), or changes in overall mean scores over time (Duits et al., 1998, Gestel et al., 2007). However, these approaches mask intra-individual changes over time and, consequently, potentially differential risks of adverse health outcomes may be overlooked (Duits et al., 1998, Hawkes and Mortensen, 2006, Kaptein et al., 2006, Murphy et al., 2008b).

Given that anxiety and depression are associated with poor prognosis in CAD (Blumenthal et al., 2003, Frasure-Smith et al., 2000, Kaptein et al., 2006), knowledge of the correlates of changes in anxiety and depression may contribute to the identification of high-risk patients (Pedersen et al., 2008) and point to targets for intervention (Spindler et al., 2007). Only a paucity of studies have focused on intra-individual changes in anxiety and depression over time and its correlates in cardiac patients using different statistical approaches, with these studies focusing on implantable cardioverter defibrillator (ICD) patients (Pedersen et al., 2009, Pedersen et al., 2010), post myocardial infarction (MI) patients, (Kaptein et al., 2006, Murphy et al., 2008b), patients admitted for elective coronary artery bypass grafting (CABG) surgery (Blumenthal et al., 2003, Duits et al., 1998, Murphy et al., 2008b), and a specific subsample of exhausted patients treated with percutaneous coronary intervention (PCI) (Pedersen et al., 2008). Hence, the aims of the current study in patients treated with PCI were 1) to examine changes in anxiety and depression over time using an intra-individual approach, and 2) to examine the demographic and clinical correlates of changes in anxiety and depression over a 12-month period.

Section snippets

Methods

Our sample comprised 715 consecutive patients (75.8% men; mean age 63.6 ± 10.8 years, range [30–87] years) treated with PCI at the Erasmus Medical Center, Rotterdam, the Netherlands. The Dutch version of the 14-item Hospital Anxiety and Depression Scale (HADS) was used to assess levels of anxiety and depression at baseline (i.e., 4 weeks post-PCI) and at 12 months post-PCI (Spinhoven et al., 1997). The HADS anxiety and depression subscale scores range from 0 to 21, with a high score indicating

Results

The mean anxiety and depression scores at baseline for the total sample were 5.3 (± 3.7) and 4.4 (± 3.8), while 12-month mean scores were 5.1 (± 4.0) and 4.4 (± 3.8). The mean individual change in anxiety scores was − .16 (± 3.0), while the mean individual change in depression scores was − .02 (± 2.8). Overall, univariable and multivariable analyses yielded similar results. In multivariable linear regression analysis, only baseline anxiety levels (B =  .25 95% CI[− .30 to − .20], p = <.001) and baseline

Discussion

Our study demonstrated that the majority of patients did not experience significant changes in levels of anxiety and depression from the index PCI to 12-month follow-up (i.e., 76.4% for anxiety and 81.4% for depression, respectively). A stable pattern of anxiety and depression was demonstrated previously in ICD patients (Pedersen et al., 2009, Pedersen et al., 2010), post-MI patients (Kaptein et al., 2006), patients admitted for elective CABG surgery (Blumenthal et al., 2003), and exhausted PCI

Role of funding source

The current study was funded by a VICI-grant from the Netherlands Organisation for Scientific Research (NWO) to J. Denollet (#453-04-004). The NWO had no further role in study design, collection, analysis and interpretation of the data, writing of the report, and the decision to submit the paper for publication.

Conflict of interest

None declared.

Acknowledgements

This research was in part supported with a VIDI grant (91710393) to Dr. Susanne S. Pedersen from the Netherlands Organisation for Health Research and Development (ZonMw), The Hague, The Netherlands.

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