Brief reportIntra-individual changes in anxiety and depression during 12-month follow-up in percutaneous coronary intervention patients
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.
References (23)
- et al.
Depression as a risk factor for mortality after coronary artery bypass surgery
Lancet
(2003) - et al.
The course of anxiety and depression in patients undergoing coronary artery bypass graft surgery
J. Psychosom. Res.
(1998) - et al.
Comparison of prevalence of symptoms of depression, anxiety, and hostility in elderly patients with heart failure, myocardial infarction, and a coronary artery bypass graft
Heart Lung
(2010) - et al.
Type-D personality predicts chronic anxiety following percutaneous coronary intervention in the drug-eluting stent era
J. Affect. Disord.
(2007) - et al.
Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction
J. Am. Coll. Cardiol.
(2003) - et al.
Aspects of social support associated with depression at hospitalization and follow-up assessment among cardiac patients
J. Cardpulm. Rehabil.
(2003) - et al.
Social support, depression, and mortality during the first year after myocardial infarction
Circulation
(2000) - et al.
Type-D personality and depressive symptoms predict anxiety 12 months post-percutaneous coronary intervention
J. Affect. Disord.
(2007) - et al.
The Declaration of Helsinki
Br. Med. J.
(2007) - et al.
Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events
Psychother. Psychosom.
(2004)
Up to one third of individual cardiac patients have a decline in quality of life post-intervention
Scand. Cardiovasc. J.
Cited by (19)
Indication for percutaneous coronary intervention is not associated with symptoms of anxiety and depression
2013, International Journal of CardiologyIn reply to the letter to the editor of Dr. Kawada: "Depression and 7-year mortality for patients treated with percutaneous coronary intervention"
2013, International Journal of CardiologyDepression is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: Results from the RESEARCH registry
2013, International Journal of CardiologyCitation Excerpt :Recent meta-analyses have confirmed the prognostic association between depression and mortality in cardiac patients [15–18]. As depression tends to be stable over time [14,19,20] it is possible that depression is also predictive of long-term mortality (> 5 years). To date, only a paucity of studies in post-MI patients [4,21], CABG patients [5,14], and patients referred for exercise testing [22] have examined the impact of depression on long-term mortality.
Changes in the Anxiety Levels of Patients Undergoing Percutaneous Coronary Intervention
2023, Dimensions of Critical Care Nursing