Using path analysis to investigate the relationships between depression, anxiety, and health-related quality of life among patients with coronary artery disease

  • Yihua LuEmail author
  • Yun Jiang
  • Liang Gu



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.


Coronary artery disease Health-related quality of life Depression Anxiety Path analysis 


Author contributions

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.

Ethical approval

The study was approved by the ethics committee of Nantong University.

Informed consent

All subjects signed informed consent forms before participating.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Health Statistics, School of Public HealthNantong UniversityNantongPeople’s Republic of China
  2. 2.Department of Cardio ThoracicNantong Rich HospitalNantongPeople’s Republic of China
  3. 3.Department of Cardiovascular SurgeryNantong Rich HospitalNantongPeople’s Republic of China

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