Using path analysis to investigate the relationships between depression, anxiety, and health-related quality of life among patients with coronary artery disease
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Demographic and clinical indicators usually influence depression, anxiety, and health-related quality of life (HRQoL) in patients with coronary artery disease (CAD). The aim of this study was to assess the direct and indirect association that existed among the identified variables, psychosocial status, and HRQoL in CAD patients.
CAD patients with at least one of the main coronary artery and/or branch stenosis over 50% were eligible for inclusion. HRQoL, depression, and anxiety were tested by questionnaires within 3 days after angiography. Mono-factor and multiple linear regression models were used to examine the independent associations of depression, anxiety, and HRQoL. A path analysis was conducted to examine the association among demographic/clinical indicators, depression, anxiety, and HRQoL.
The sample consisted of 414 subject, patients with depression accounted for 40.82%, and patients with anxiety accounted for 25.12%. The direct effects of SAS scores on HRQoL (B = − 0.26, β = − 0.16), of SDS scores on HRQoL (B = − 0.70, β = − 0.47), of gender on HRQoL (B = 4.05, β = 0.17), and of NYHA classification on HRQoL (B = − 3.46, β = − 0.18) were significant (p < 0.001). The indirect effects of gender on HRQoL (B = 2.16, β = 0.09) and of Gensini scores on HRQoL (B = − 0.06, β = − 0.08) were also statistically significant (p < 0.001).
Depression and anxiety were common CAD patients and played an important role in HRQoL. Gender differences were found in determinants of HRQoL and the state of depression and anxiety directly, and women’s anxiety, depression, and quality of life were worse than men’s. NYHA classification and Gensini scores also played direct and indirect role in HRQoL, respectively.
KeywordsCoronary artery disease Health-related quality of life Depression Anxiety Path analysis
Study conception and design: YL; acquisition of data: YJ and LG; analysis and interpretation of data: YL and YJ; drafting of manuscript: YL. All authors have participated in revising the manuscript critically and gave their final approval of the version to be submitted.
The study was supported by the Science and Technology Project of Nantong (MS12016002), and the Science and Technology Project from Nantong University (13180083).
Compliance with ethical standards
Conflict of interest
None of the authors has any conflict of interest to disclose.
The study was approved by the ethics committee of Nantong University.
All subjects signed informed consent forms before participating.
- 5.Westin, L., Carlsson, R., Israelsson, B., Willenheimer, R., Cline, C., & McNeil, T. F. (1997). Quality of life in patients with ischaemic heart disease: A prospective controlled study. Journal of Internal Medicine, 242(3), 239–247.Google Scholar
- 6.Panasewicz, A., Pedersen, S. S., Veenhuis, S. J., Oemrawsingh, R. M., van der Giessen, W. J., van Geuns, R. J., et al. (2013). Health-related quality of life in the elderly three years after percutaneous coronary intervention. EuroIntervention, 9(3), 373–381. https://doi.org/10.4244/EIJV9I3A60.Google Scholar
- 7.De Smedt, D., Clays, E., Doyle, F., Kotseva, K., Prugger, C., Pajak, A., et al. (2013). Validity and reliability of three commonly used quality of life measures in a large European population of coronary heart disease patients. International Journal of Cardiology, 167(5), 2294–2299. https://doi.org/10.1016/j.ijcard.2012.06.025.Google Scholar
- 9.Mommersteeg, P. M., Arts, L., Zijlstra, W., Widdershoven, J. W., Aarnoudse, W., & Denollet, J. (2017). Impaired health status, psychological distress, and personality in women and men with nonobstructive coronary artery disease: Sex and gender differences: The TWIST (Tweesteden Mild Stenosis) Study. Circulation Cardiovascular Quality and Outcomes, 10(2), e003387. https://doi.org/10.1161/CIRCOUTCOMES.116.003387.Google Scholar
- 10.Koltowski, L., Koltowska-Haggstrom, M., Filipiak, K. J., Kochman, J., Golicki, D., Pietrasik, A., et al. (2014). Quality of life in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention–radial versus femoral access (from the OCEAN RACE Trial). American Journal of Cardiology, 114(4), 516–521. https://doi.org/10.1016/j.amjcard.2014.05.030.Google Scholar
- 11.Staniute, M., Bunevicius, A., Brozaitiene, J., & Bunevicius, R. (2014). Relationship of health-related quality of life with fatigue and exercise capacity in patients with coronary artery disease. European Journal of Cardiovascular Nursing, 13(4), 338–344. https://doi.org/10.1177/1474515113496942.Google Scholar
- 14.Reeder, G. S., Smith, H. C., Elveback, L. R., & Mock, M. B. (1985). The angiographic spectrum of coronary artery disease. Cardiovascular Clinics, 15(1), 17–31.Google Scholar
- 15.Chen, Z., Sun, B., Duan, Q., Xue, Y., & Chen, L. (2018). 3.0T Contrast-enhanced whole-heart coronary magnetic resonance angiography for simultaneous coronary artery angiography and myocardial viability in chronic myocardial infarction: A single-center preliminary study. Medicine (Baltimore), 97(45), e13138. https://doi.org/10.1097/md.0000000000013138.Google Scholar
- 16.Gensini, G. G. (1983). A more meaningful scoring system for determining the severity of coronary heart disease. American Journal of Cardiology, 51(3), 606.Google Scholar
- 18.Zung, W. W. (1974). The measurement of affects: Depression and anxiety. Modern Problems of Pharmacopsychiatry, 7, 170–188.Google Scholar
- 23.Pihl, E., Jacobsson, A., Fridlund, B., Stromberg, A., & Martensson, J. (2005). Depression and health-related quality of life in elderly patients suffering from heart failure and their spouses: A comparative study. European Journal of Heart Failure, 7(4), 583–589. https://doi.org/10.1016/j.ejheart.2004.07.016.Google Scholar
- 24.Ohira, T. (2010). Psychological distress and cardiovascular disease: The Circulatory Risk in Communities Study (CIRCS). Journal of Epidemiology, 20(3), 185–191.Google Scholar
- 27.Blok, I. M., van Riel, A. C., Schuuring, M. J., Duffels, M. G., Vis, J. C., van Dijk, A. P., et al. (2015). Decrease in quality of life predicts mortality in adult patients with pulmonary arterial hypertension due to congenital heart disease. Netherlands Heart Journal, 23(5), 278–284. https://doi.org/10.1007/s12471-015-0666-9.Google Scholar
- 28.Assari, S. (2014). Depression mediates the effect of sexual function on quality of life among men but not women with coronary artery disease. International Journal of Cardiovascular Research, 8(4), 171–177.Google Scholar
- 29.Alonso, J., Ferrer, M., Gandek, B., Ware, J. E., Jr., Aaronson, N. K., Mosconi, P., et al. (2004). Health-related quality of life associated with chronic conditions in eight countries: Results from the International Quality of Life Assessment (IQOLA) Project. Quality of Life Research, 13(2), 283–298. https://doi.org/10.1023/B:QURE.0000018476.11278.35.Google Scholar
- 30.Dowlati, Y., Herrmann, N., Swardfager, W., Thomson, S., Oh, P. I., Van Uum, S., et al. (2010). Relationship between hair cortisol concentrations and depressive symptoms in patients with coronary artery disease. Neuropsychiatric Disease and Treatment, 6, 393.Google Scholar
- 31.Ren, Y., Yang, H., Browning, C., Thomas, S., & Liu, M. (2014). Prevalence of depression in coronary heart disease in China: A systematic review and meta-analysis. Chinese Medical Journal (England), 127(16), 2991–2998.Google Scholar
- 33.Norris, C. M., Johnson, N. L., Hardwicke-Brown, E., McEwan, M., Pelletier, R., & Pilote, L. (2017). The contribution of gender to apparent sex differences in health status among patients with coronary artery disease. Journal of Womens Health, 26(1), 50–57.Google Scholar
- 37.Mieres, J. H., Heller, G. V., Hendel, R. C., Gulati, M., Boden, W. E., Katten, D., et al. (2011). Signs and symptoms of suspected myocardial ischemia in women: Results from the What is the Optimal Method for Ischemia Evaluation in Women? Trial. Journal of Womens Health (Larchmt), 20(9), 1261–1268. https://doi.org/10.1089/jwh.2010.2595.Google Scholar
- 38.van Wijk, C. M., & Kolk, A. M. (1997). Sex differences in physical symptoms: The contribution of symptom perception theory. Social Science and Medicine, 45(2), 231–246.Google Scholar
- 39.Halbach, M., Abraham, W. T., Butter, C., Ducharme, A., Klug, D., Little, W. C., et al. (2018). Baroreflex activation therapy for the treatment of heart failure with reduced ejection fraction in patients with and without coronary artery disease. International Journal of Cardiology, 266, 187–192. https://doi.org/10.1016/j.ijcard.2018.04.075.Google Scholar
- 40.Rostami, R., Najafi, M., Sarami, R., Bozorgi, A., Soltani, M., & Salamati, P. (2017). Gensini scores and well-being states among patients with coronary artery disease: A comparison study. ARYA Atherosclerosis, 13(5), 205–210.Google Scholar