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Prevalence of Symptoms of Anxiety Disorders and Depression in Cardiac Rehabilitation Patients in an Academic Hospital: a Case Study

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Abstract

The relationship between body and mind is increasingly recognized in the occurrence and prognosis of cardiac disease. Based on reports detailing the potential (and the influence of certain risk factors) of developing depression and anxiety following cardiovascular disease, or a cardiac event, most notably acute coronary syndrome (ACS), we investigated whether such symptoms also existed in patient cases found at the cardiac rehabilitation unit of an academic hospital of Eastern Ontario. We examined data from charts during a 6-year period (2012–2017). The Hospital Anxiety and Depression Scale cumulated data within a retrospective cross-sectional study, was used to estimate the prevalence of anxious and depressive symptoms that might reflect the presence of psychological distress. Overall, our sample included 1178 patient files, 81.3% of which were diagnosed with ACS and 69.6% were male. 63.1% of the patients were between 60 and 79 years old at the time of diagnosis. Most patients were Caucasian (81.1%), married (60.3%), and living with their family (74.3%), and 49.7% were recorded as overweight or obese. We found that 29.3% of patients reported symptoms of psychological distress. Regression analyses revealed strong negative correlations between the proportion of symptoms of psychological distress and factors like age and functional capacity as measured by metabolic equivalents. Significant associations were also established between symptoms of psychological distress and factors such as obesity, sedentary lifestyle, smoking, and sex (female). This study was undertaken as part of a business case to implement a new cardiac rehabilitation programme in an academic hospital of Eastern Ontario and illustrate to the managers and decision-makers, the important factors to consider and to target when developing a stepped-care program for patients in cardiac rehabilitation in order to prevent psychological distress and how such a program was relevant to their institution.

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References

  1. Trotter R, Gallagher R, Donoghue J. Anxiety in patients undergoing percutaneous coronary interventions. Heart Lung. 2011;40(3):185–92.

    PubMed  Google Scholar 

  2. Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, et al. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med. 2006;21(1):30–8.

    PubMed  PubMed Central  Google Scholar 

  3. Kala P, Hudakova N, Jurajda M, Kasparek T, Ustohal L, Parenica J, et al. Depression and anxiety after acute myocardial infarction treated by primary PCI. PLoS One. 2016;11(4):e0152367.

    PubMed  PubMed Central  Google Scholar 

  4. Xia K, Wang LF, Yang XC, Jiang HY, Zhang LJ, Yao DK, et al. Comparing the effects of depression, anxiety, and comorbidity on quality-of-life, adverse outcomes, and medical expenditure in Chinese patients with acute coronary syndrome. Chin Med J. 2019;132(9):1045–52.

    PubMed  PubMed Central  Google Scholar 

  5. de Jager TAJ, Dulfer K, Radhoe S, Bergmann MJ, Daemen J, van Domburg RT, et al. Predictive value of depression and anxiety for long-term mortality: differences in outcome between acute coronary syndrome and stable angina pectoris. Int J Cardiol. 2018;250:43–8.

    PubMed  Google Scholar 

  6. Martin CR, Thompson DR, Chan DS. An examination of the psychometric properties of the hospital anxiety and depression scale in Chinese patients with acute coronary syndrome. Psychiatry Res. 2004;129(3):279–88.

    PubMed  Google Scholar 

  7. Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation. 2014;129(12):1350–69.

    PubMed  Google Scholar 

  8. Murphy BM, Elliott PC, Higgins RO, le Grande MR, Worcester MUC, Goble AJ, et al. Anxiety and depression after coronary artery bypass graft surgery: most get better, some get worse. Eur J Cardiovasc Prev Rehabil. 2008;15(4):434–40.

    PubMed  Google Scholar 

  9. Welin C, Lappas G, Wilhelmsen L. Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med. 2000;247(6):629–39.

    CAS  PubMed  Google Scholar 

  10. 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.

    PubMed  PubMed Central  Google Scholar 

  11. Nabi H, Shipley MJ, Vahtera J, Hall M, Korkeila J, Marmot MG, et al. Effects of depressive symptoms and coronary heart disease and their interactive associations on mortality in middle-aged adults: the Whitehall II cohort study. Heart. 2010;96(20):1645–50.

    PubMed  Google Scholar 

  12. Charlson FJ, Moran AE, Freedman G, Norman RE, Stapelberg NJC, Baxter AJ, et al. The contribution of major depression to the global burden of ischemic heart disease: a comparative risk assessment. BMC Med. 2013;11:250.

    PubMed  PubMed Central  Google Scholar 

  13. Grace SL, Abbey SE, Irvine J, Shnek ZM, Stewart DE. Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events. Psychother Psychosom. 2004;73(6):344–52.

    PubMed  Google Scholar 

  14. Watkins LL, Blumenthal JA, Davidson JRT, Babyak MA, McCants CB Jr, Sketch MH Jr. Phobic anxiety, depression, and risk of ventricular arrhythmias in patients with coronary heart disease. Psychosom Med. 2006;68(5):651–6.

    PubMed  Google Scholar 

  15. Frasure-Smith N, Lesperance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry. 2008;65(1):62–71.

    CAS  PubMed  Google Scholar 

  16. Benjenk I, Chen J. Effective mental health interventions to reduce hospital readmission rates: a systematic review. J Hosp Manag Health Policy. 2018;2.

  17. Dickens CM, et al. The risk factors for depression in first myocardial infarction patients. Psychol Med. 2004;34(6):1083–92.

    CAS  PubMed  Google Scholar 

  18. van Melle JP, de Jonge P, Kuyper AMG, Honig A, Schene AH, Crijns HJGM, et al. Prediction of depressive disorder following myocardial infarction data from the myocardial INfarction and depression-intervention trial (MIND-IT). Int J Cardiol. 2006;109(1):88–94.

    PubMed  Google Scholar 

  19. Doyle F, McGee H, Conroy R, Conradi HJ, Meijer A, Steeds R, et al. Systematic review and individual patient data Meta-analysis of sex differences in depression and prognosis in persons with myocardial infarction: a MINDMAPS study. Psychosom Med. 2015;77(4):419–28.

    PubMed  Google Scholar 

  20. Carney RM, Freedland KE, Steinmeyer B, Blumenthal JA, de Jonge P, Davidson KW, et al. History of depression and survival after acute myocardial infarction. Psychosom Med. 2009;71(3):253–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Steptoe A, Molloy GJ, Messerly-Bürgy N, Wikman A, Randall G, Perkins-Porras L, et al. Emotional triggering and low socio-economic status as determinants of depression following acute coronary syndrome. Psychol Med. 2011;41(9):1857–66.

    CAS  PubMed  Google Scholar 

  22. Spijkerman T, de Jonge P, van den Brink R, Jansen JH, May JF, Crijns HJ, et al. Depression following myocardial infarction: first-ever versus ongoing and recurrent episodes. Gen Hosp Psychiatry. 2005;27(6):411–7.

    PubMed  Google Scholar 

  23. Martens EJ, Smith ORF, Winter J, Denollet J, Pedersen SS. Cardiac history, prior depression and personality predict course of depressive symptoms after myocardial infarction. Psychol Med. 2008;38(2):257–64.

    CAS  PubMed  Google Scholar 

  24. Doyle F, McGee H, Delaney M, Motterlini N, Conroy R. Depressive vulnerabilities predict depression status and trajectories of depression over 1 year in persons with acute coronary syndrome. Gen Hosp Psychiatry. 2011;33(3):224–31.

    PubMed  Google Scholar 

  25. Stafford L, Jackson HJ, Berk M. Cognitive-personality style as vulnerability to depression in patients with coronary artery disease: roles of sociotropy and autonomy. Psychosom Med. 2009;71(1):63–9.

    PubMed  Google Scholar 

  26. Celano CM, Mastromauro CA, Lenihan EC, Januzzi JL, Rollman BL, Huffman JC. Association of baseline anxiety with depression persistence at 6 months in patients with acute cardiac illness. Psychosom Med. 2012;74(1):93–9.

    PubMed  Google Scholar 

  27. Marchesi C, Ossola P, Scagnelli F, Paglia F, Aprile S, Monici A, et al. Type D personality in never-depressed patients and the development of major and minor depression after acute coronary syndrome. J Affect Disord. 2014;155:194–9.

    PubMed  Google Scholar 

  28. Ossola P, Gerra ML, Ferrari M, Marchesi C. Personality and widowhood increase the risk for incident depression in the two years following the first acute coronary syndrome. Aging Ment Health. 2019:1–6.

  29. Kim JM, Kang HJ, Bae KY, Kim SW, Shin IS, Hong YJ, et al. Effect of sleep problems on depressive disorders 1 year after developing acute coronary syndrome: the K-DEPACS study. J Affect Disord. 2017;210:319–22.

    PubMed  Google Scholar 

  30. Roberts SB, et al. Psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) among female cardiac patients. Br J Health Psychol. 2001;6(Part 4):373–83.

    PubMed  Google Scholar 

  31. Stafford L, Berk M, Jackson HJ. Validity of the hospital anxiety and depression scale and patient health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry. 2007;29(5):417–24.

    PubMed  Google Scholar 

  32. Ren Y, Yang H, Browning C, Thomas S, Liu M. Performance of screening tools in detecting major depressive disorder among patients with coronary heart disease: a systematic review. Med Sci Monit. 2015;21:646–53.

    PubMed  PubMed Central  Google Scholar 

  33. Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck depression inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), geriatric depression scale (GDS), hospital anxiety and depression scale (HADS), and patient health Questionnaire-9 (PHQ-9). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S454–66.

    Google Scholar 

  34. Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003;1:29.

    PubMed  PubMed Central  Google Scholar 

  35. Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.

    PubMed  Google Scholar 

  36. Cosco TD, Doyle F, Ward M, McGee H. Latent structure of the hospital anxiety and depression scale: a 10-year systematic review. J Psychosom Res. 2012;72(3):180–4.

    PubMed  Google Scholar 

  37. Norton S, Cosco T, Doyle F, Done J, Sacker A. The hospital anxiety and depression scale: a meta confirmatory factor analysis. J Psychosom Res. 2013;74(1):74–81.

    PubMed  Google Scholar 

  38. Palacios JE, Khondoker M, Achilla E, Tylee A, Hotopf M. A single, one-off measure of depression and anxiety predicts future symptoms, higher healthcare costs, and lower quality of life in coronary heart disease patients: analysis from a multi-wave. Primary Care Cohort Study PLoS One. 2016;11(7):e0158163.

    PubMed  Google Scholar 

  39. Burns A, Höfer S, Curry P, Sexton E, Doyle F. Revisiting the dimensionality of the hospital anxiety and depression scale in an international sample of patients with ischaemic heart disease. J Psychosom Res. 2014;77(2):116–21.

    PubMed  Google Scholar 

  40. Tesio V, Marra S, Molinaro S, Torta R, Gaita F, Castelli L. Screening of depression in cardiology: a study on 617 cardiovascular patients. Int J Cardiol. 2017;245:49–51.

    PubMed  Google Scholar 

  41. Figueiredo JHC, et al. Major depression and acute coronary syndrome-related factors. Arq Bras Cardiol. 2017;108(3):217–27.

    PubMed  PubMed Central  Google Scholar 

  42. Smolderen KG, Buchanan DM, Amin AA, Gosch K, Nugent K, Riggs L, et al. Real-world lessons from the implementation of a depression screening protocol in acute myocardial infarction patients: implications for the American Heart Association depression screening advisory. Circ Cardiovasc Qual Outcomes. 2011;4(3):283–92.

    PubMed  PubMed Central  Google Scholar 

  43. Sin NL, Yaffe K, Whooley MA. Depressive symptoms, cardiovascular disease severity, and functional status in older adults with coronary heart disease: the heart and soul study. J Am Geriatr Soc. 2015;63(1):8–15.

    PubMed  Google Scholar 

  44. Parker GB, Hilton TM, Walsh WF, Owen CA, Heruc GA, Olley A, et al. Timing is everything: the onset of depression and acute coronary syndrome outcome. Biol Psychiatry. 2008;64(8):660–6.

    PubMed  Google Scholar 

  45. Bjerkeset O, Nordahl HM, Mykletun A, Holmen J, Dahl AA. Anxiety and depression following myocardial infarction: gender differences in a 5-year prospective study. J Psychosom Res. 2005;58(2):153–61.

    PubMed  Google Scholar 

  46. Kronish IM, Rieckmann N, Halm EA, Shimbo D, Vorchheimer D, Haas DC, et al. Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes. J Gen Intern Med. 2006;21(11):1178–83.

    PubMed  PubMed Central  Google Scholar 

  47. Pratt LA, Brody DJ. Depression and obesity in the U.S. adult household population. NCHS Data Brief. 2005-2010;2014(167):1–8.

    Google Scholar 

  48. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67(3):220–9.

    PubMed  Google Scholar 

  49. Parto P, Lavie CJ. Obesity and CardiovascularDiseases. Curr Probl Cardiol. 2017;42(11):376–94.

    PubMed  Google Scholar 

  50. Romero EK, Abdalla M, Thanataveerat A, Alcantara C, Kronish IM, Edmondson D, et al. Short sleep duration after hospital evaluation for acute coronary syndrome is associated with increased risk of 6-month readmission. Psychosom Med. 2020;82(1):57–63.

    PubMed  PubMed Central  Google Scholar 

  51. Tulloch H, Greenman PS, Tasse V. Post-traumatic stress disorder among cardiac patients: prevalence, risk factors, and considerations for assessment and treatment. Behav Sci (Basel). 2014;5(1):27–40.

    Google Scholar 

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Funding

This study was funded by the Association médicale universitaire de l’Hôpital Monfort (AMUHM) – 2018 scholarship.

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Authors and Affiliations

  1. Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada

    Gladys Bruyninx, Jean Grenier, Paul S. Greenman, Vanessa Tassé, Joseph Abdulnour & Marie Hélène Chomienne

  2. Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada

    Gladys Bruyninx & Marie Hélène Chomienne

  3. Université du Québec en Outaouais, 283, boul. Alexandre-Taché, Gatineau, Québec, J8X 3X7, Canada

    Paul S. Greenman

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  1. Gladys Bruyninx
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  2. Jean Grenier
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Correspondence to Gladys Bruyninx.

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This study received approval from the Montfort Hospital Research Ethics Board (project #18–19–07-013).

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Appendix 1. Hospital Anxiety and Depression Scale used at the Montfort Hospital

Appendix 1. Hospital Anxiety and Depression Scale used at the Montfort Hospital

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Bruyninx, G., Grenier, J., Greenman, P.S. et al. Prevalence of Symptoms of Anxiety Disorders and Depression in Cardiac Rehabilitation Patients in an Academic Hospital: a Case Study. Psychiatr Q 92, 273–287 (2021). https://doi.org/10.1007/s11126-020-09791-w

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