Association of Anxiety and Depression With All‐Cause Mortality in Individuals With Coronary Heart Disease

Journal of the American Heart Association - Tập 2 Số 2 - 2013
Lana L. Watkins1, Gary G. Koch2, Andrew Sherwood1, James A. Blumenthal1, Jonathan Davidson1, Christopher O’Connor3, Michael H. Sketch3
1Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
2Department of Medicine, Duke University Medical Center, Durham, NC
3Department of Biostatistics, University of North Carolina, Chapel Hill, NC

Tóm tắt

Background Depression has been related to mortality in coronary heart disease ( CHD ) patients, but few studies have evaluated the role of anxiety or the role of the co‐occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD .

Methods and Results The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale ( HADS ) during hospitalization for coronary angiography. Over the 3‐year follow‐up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale ( HADS ‐A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3‐vessel disease, and renal disease (hazard ratio [ HR ], 2.27; 95% CI , 1.55 to 3.33; P <0.001). Elevated scores on the HADS depression subscale ( HADS ‐D≥8) were also associated with increased risk of mortality ( HR , 2.18; 95% CI , 1.47 to 3.22; P <0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR , 1.83; 95% CI , 1.18 to 2.83; P =0.006; depression, HR , 1.66; 95% CI , 1.06 to 2.58; P =0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone ( HR , 3.10; 95% CI , 1.95 to 4.94; P <0.001).

Conclusions Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co‐occurrence of these psychosocial factors as markers of increased mortality risk.

Từ khóa


Tài liệu tham khảo

10.1097/01.psy.0000146294.82810.9c

10.1016/S0002-9149(96)00380-3

10.1161/01.CIR.91.4.999

10.1001/archpsyc.1984.01790230015002

10.1001/archpsyc.62.6.617

10.1192/S0007125000298371

10.1016/S0193-953X(18)30504-5

10.1001/archpsyc.1984.01790190045005

10.1097/01.psy.0000195872.00987.db

10.1016/j.atherosclerosis.2005.06.001

10.1093/eurheartj/ehn326

10.1016/j.bbi.2010.03.003

10.2337/dc08-1979

10.1001/jama.1993.03510200045030

10.1001/archpsyc.64.10.1153

10.1161/01.CIR.0000153813.64165.5D

10.1136/bmj.295.6593.297

10.1161/01.CIR.89.5.1992

10.1161/01.CIR.90.5.2225

10.1097/HJR.0b013e3280142a02

10.1016/j.jpsychores.2007.09.007

10.1037/0278-6133.14.5.388

10.1001/archgenpsychiatry.2007.4

10.1097/PSY.0b013e31814b8c0f

10.1016/j.jacc.2003.07.007

10.1016/j.jacc.2007.03.007

10.1097/PSY.0b013e3181dbff97

10.1016/0002-9149(90)90736-K

10.1001/archpsyc.60.6.627

10.1016/j.jpsychores.2011.04.006

10.1097/00006842-200103000-00005

10.1111/j.1600-0447.1983.tb09716.x

10.1093/oxfordjournals.aje.a114163

10.1016/S0022-3999(01)00296-3

10.1192/bjp.158.2.255

10.1348/014466500163121

10.1348/000711200160255

10.1016/j.jpsychores.2011.01.005

10.1177/014107688808100907

Wilkinson MJ, Barczak P. Psychiatric screening in general practice: comparison of the general health questionnaire and the hospital anxiety depression scale. J R Coll Gen Pract. 1988;38:311–313.

10.1038/bjc.1991.305

10.1001/archpsyc.62.6.593

10.1097/PSY.0b013e3181c64fc0

10.1016/0022-3999(79)90031-X

10.1111/j.2044-8341.1987.tb02753.x

10.1023/A:1010305200087

10.1016/S0887-6185(96)00033-3

10.2337/diacare.21.7.1178

10.1111/j.1600-0447.1998.tb05960.x

10.1002/mpr.128

10.1001/archpsyc.55.9.801

10.1192/bjp.176.3.229

Zajecka JM, Ross JS. Management of comorbid anxiety and depression. J Clin Psychiatry. 1995;56(suppl 2):10–13.

10.1111/j.1399-5618.2008.00639.x

10.1097/PSY.0b013e31819e6706

10.4065/mcp.2011.0148

10.1016/j.ijcard.2009.05.025

10.1016/j.genhosppsych.2006.11.005

10.1001/jama.1990.03450190043026

10.1001/archpsyc.1997.01830160031005

10.1016/j.janxdis.2008.10.011

Thông tin
Thông tin xuất bản

Journal of the American Heart Association

Tập 2 Số 2

Thông tin tác giả