CLINICAL RESEARCH: EFFECT OF DEPRESSION/ANXIETY ON CARDIAC EVENTS
Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction
Jacqueline J. M. H. Strik, MD*,
Johan Denollet, PhD* ,*,
Richel Lousberg, PhD* and
Adriaan Honig, MD, PhD, MRCPsych*
* Department of Psychiatry, Academic Hospital Maastricht/Maastricht University, Maastricht, Netherlands
Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands
Manuscript received November 4, 2002;
revised manuscript received June 30, 2003,
accepted July 29, 2003.
* Reprint requests and correspondence: Dr. Johan Denollet, Department of Psychology and Health, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
denollet{at}uvt.nl
OBJECTIVES: We sought to compare symptoms of depression and anxiety as predictors of incomplete recovery after a first myocardial infarction (MI).
BACKGROUND: Depressive symptoms have been related to post-MI mortality and health care consumption, but little is known about the effect of anxiety. We wanted to examine the effect of emotional distress on health care consumption and whether depressive symptomatology is a better predictor of prognosis than anxiety.
METHODS: Subjects were 318 men (mean age 58 years) who completed the depression, anxiety, and hostility scales from the 90-item symptom check list after they survived a first MI.
RESULTS: After an average follow-up of 3.4 years, there were 25 cardiac events (fatal or non-fatal MI). Symptoms of both depression (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.04 to 5.18; p = 0.039) and anxiety (HR 3.01, 95% CI 1.20 to 7.60; p = 0.019) were associated with cardiac events, adjusting for age, left ventricular ejection fraction, and use of antidepressants. However, a multivariate analysis including all three negative emotions indicated that symptoms of anxiety (HR 2.79, 95% CI 1.11 to 7.03; p = 0.029) explained away the relationship between depressive symptoms and cardiac events. Regarding health care consumption, anxiety (OR 2.00, 95% CI 1.24 to 3.22; p = 0.005), but not depression/hostility, was a predictor of cardiac rehospitalization and frequent visits at the cardiac outpatient clinic.
CONCLUSIONS: Symptoms of depression and anxiety were associated with cardiac events. Anxiety was an independent predictor of both cardiac events and increased health care consumption and accounted for the relationship between depressive symptoms and prognosis. Symptoms of anxiety need to be considered in the risk stratification and treatment of post-MI patients.
|
Abbreviations and Acronyms
| | ASAT | = aspartate aminotransferase | | AZM | = Academic Hospital Maastricht | | CAD | = coronary artery disease | | CHD | = coronary heart disease | | CI | = confidence interval | | HR | = hazard ratio | | LVEF | = left ventricular ejection fraction | | MI | = myocardial infarction | | OR | = odds ratio | | SCL-90 | = 90-item Symptom Check List |
|
This article has been cited by other articles:
|
|
|
|
 
T. Rutledge, S. E. Linke, D. S. Krantz, B. D. Johnson, V. Bittner, J.-A. Eastwood, W. Eteiba, C. J. Pepine, V. Vaccarino, J. Francis, et al.
Comorbid Depression and Anxiety Symptoms as Predictors of Cardiovascular Events: Results From the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study
Psychosom Med,
November 1, 2009;
71(9):
958 - 964.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Lichtman, J. T. Bigger Jr, J. A. Blumenthal, N. Frasure-Smith, P. G. Kaufmann, F. Lesperance, D. B. Mark, D. S. Sheps, C. B. Taylor, and E. S. Froelicher
Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Focus,
July 1, 2009;
7(3):
406 - 413.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. M. M. Licht, E. J. C. de Geus, R. van Dyck, and B. W. J. H. Penninx
Association between Anxiety Disorders and Heart Rate Variability in The Netherlands Study of Depression and Anxiety (NESDA)
Psychosom Med,
June 1, 2009;
71(5):
508 - 518.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Post-Myocardial Infarction Depression Clinical Pra
AAFP Guideline for the Detection and Management of Post-Myocardial Infarction Depression
Ann. Fam. Med,
January 1, 2009;
7(1):
71 - 79.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. S. Pedersen, N. Kupper, and J. Denollet
CHAPTER 35 Psychological Factors and Heart Disease
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Lichtman, J. T. Bigger Jr, J. A. Blumenthal, N. Frasure-Smith, P. G. Kaufmann, F. Lesperance, D. B. Mark, D. S. Sheps, C. B. Taylor, and E. S. Froelicher
Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association
Circulation,
October 21, 2008;
118(17):
1768 - 1775.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. P. Roy-Byrne, K. W. Davidson, R. C. Kessler, G. J.G. Asmundson, R. D. Goodwin, L. Kubzansky, R. B. Lydiard, M. J. Massie, W. Katon, S. K. Laden, et al.
Anxiety Disorders and Comorbid Medical Illness
Focus,
October 1, 2008;
6(4):
467 - 485.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. C. Huffman, F. A. Smith, M. A. Blais, A. M. Taylor, J. L. Januzzi, and G. L. Fricchione
Pre-Existing Major Depression Predicts In-Hospital Cardiac Complications After Acute Myocardial Infarction
Psychosomatics,
July 1, 2008;
49(4):
309 - 316.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Frasure-Smith and F. Lesperance
Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients With Stable Coronary Artery Disease
Arch Gen Psychiatry,
January 1, 2008;
65(1):
62 - 71.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Szekely, P. Balog, E. Benko, T. Breuer, J. Szekely, M. D. Kertai, F. Horkay, M. S. Kopp, and J. F. Thayer
Anxiety Predicts Mortality and Morbidity After Coronary Artery and Valve Surgery A 4-Year Follow-Up Study
Psychosom Med,
September 1, 2007;
69(7):
625 - 631.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. A Schiffer, J. Denollet, J. W Widdershoven, E. H Hendriks, and O. R F Smith
Failure to consult for symptoms of heart failure in patients with a type-D personality
Heart,
July 1, 2007;
93(7):
814 - 818.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Piotrowicz, K. Noyes, J. M. Lyness, S. McNitt, M. L. Andrews, A. Dick, W. J. Hall, A. J. Moss, and W. Zareba
Physical functioning and mental well-being in association with health outcome in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II
Eur. Heart J.,
March 1, 2007;
28(5):
601 - 607.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. de Jonge, R. H.S. van den Brink, T. A. Spijkerman, and J. Ormel
Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events
J. Am. Coll. Cardiol.,
December 5, 2006;
48(11):
2204 - 2208.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. L. Watkins, J. A. Blumenthal, J. R. T. Davidson, M. A. Babyak, C. B. McCants Jr, and M. H. Sketch Jr
Phobic anxiety, depression, and risk of ventricular arrhythmias in patients with coronary heart disease.
Psychosom Med,
September 1, 2006;
68(5):
651 - 656.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Shemesh, M. Koren-Michowitz, R. Yehuda, O. Milo-Cotter, E. Murdock, Z. Vered, B. L. Shneider, J. M. Gorman, and G. Cotter
Symptoms of Posttraumatic Stress Disorder in Patients Who Have Had a Myocardial Infarction
Psychosomatics,
June 1, 2006;
47(3):
231 - 239.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Aina and J. L. Susman
Understanding Comorbidity With Depression and Anxiety Disorders
J Am Osteopath Assoc,
May 1, 2006;
106(5_suppl_2):
S9 - S14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Hilton, G. Parker, S. McDonald, G. A. Heruc, A. Olley, H. Brotchie, C. Friend, and W. F. Walsh
A Validation Study of Two Brief Measures of Depression in the Cardiac Population: The DMI-10 and DMI-18.
Psychosomatics,
March 1, 2006;
47(2):
129 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Denollet, S. S. Pedersen, A. T.L. Ong, R. A.M. Erdman, P. W. Serruys, and R. T. van Domburg
Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era
Eur. Heart J.,
January 2, 2006;
27(2):
171 - 177.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. de Jonge, J. Ormel, R. H.S. van den Brink, J. P. van Melle, T. A. Spijkerman, A. Kuijper, D. J. van Veldhuisen, M. P. van den Berg, A. Honig, H. J.G.M. Crijns, et al.
Symptom Dimensions of Depression Following Myocardial Infarction and Their Relationship With Somatic Health Status and Cardiovascular Prognosis
Am J Psychiatry,
January 1, 2006;
163(1):
138 - 144.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. van Melle, P. de Jonge, J. Ormel, H. J.G.M. Crijns, D. J. van Veldhuisen, A. Honig, A. H. Schene, M. P. van den Berg, and for the MIND-IT investigators
Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT
Eur. Heart J.,
December 2, 2005;
26(24):
2650 - 2656.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. C. Ziegelstein and B. D. Thombs
The brain and the heart: the twain meet
Eur. Heart J.,
December 2, 2005;
26(24):
2607 - 2608.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Frasure-Smith and F. Lesperance
Reflections on Depression as a Cardiac Risk Factor
Psychosom Med,
May 1, 2005;
67(Supplement_1):
S19 - S25.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Schulman, P. R. Muskin, and P. A. Shapiro
Psychiatry and Cardiovascular Disease
Focus,
April 1, 2005;
3(2):
208 - 224.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Steptoe and D L Whitehead
Depression, stress, and coronary heart disease: the need for more complex models
Heart,
April 1, 2005;
91(4):
419 - 420.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Denollet
DS14: Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality
Psychosom Med,
January 1, 2005;
67(1):
89 - 97.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. van Melle, P. de Jonge, T. A. Spijkerman, J. G. P. Tijssen, J. Ormel, D. J. van Veldhuisen, R. H. S. van den Brink, and M. P. van den Berg
Prognostic Association of Depression Following Myocardial Infarction With Mortality and Cardiovascular Events: A Meta-analysis
Psychosom Med,
November 1, 2004;
66(6):
814 - 822.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Burg, R. Lampert, T. Joska, W. Batsford, and D. Jain
Psychological Traits and Emotion-Triggering of ICD Shock-Terminated Arrhythmias
Psychosom Med,
November 1, 2004;
66(6):
898 - 902.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Krumholz
The year in health care delivery and outcomes research
J. Am. Coll. Cardiol.,
September 1, 2004;
44(5):
1130 - 1136.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Carney, K. E. Freedland, A. S. Jaffe, N. Frasure-Smith, F. Lesperance, D. S. Sheps, A. H. Glassman, C. M. O'Connor, J. A. Blumenthal, P. G. Kaufmann, et al.
Depression as a risk factor for post-MI mortality
J. Am. Coll. Cardiol.,
July 21, 2004;
44(2):
472 - 472.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Other articles noted: 14 Nov 2003 to 30 Jan 2004
Evid. Based Nurs.,
April 1, 2004;
7(2):
e2 - e2.
[Full Text]
[PDF]
|
|
|
|
