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Time-dependent depression and anxiety symptoms as risk factors for recurrent cardiac events: findings from the UPBEAT-UK study

Published online by Cambridge University Press:  10 February 2021

Joanna Norton Open the ORCID record for Joanna Norton [Opens in a new window] ,
Manuela Pastore ,
Matthew Hotopf ,
Andre Tylee ,
Anthony Mann ,
Marie-Laure Ancelin  and
Jorge Palacios
Joanna Norton*
Affiliation:
Univ Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
Manuela Pastore
Affiliation:
Univ Montpellier, CNRS, Inserm, Biocampus UAR3426, Montpellier, France
Matthew Hotopf
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK South London and Maudsley NHS Foundation Trust, London, UK
Andre Tylee
Affiliation:
Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Anthony Mann
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Marie-Laure Ancelin
Affiliation:
Univ Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
Jorge Palacios
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
Author for correspondence: Joanna Norton, E-mail: joanna.norton@inserm.fr
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Abstract

Background

Depression is a well-known risk factor for recurrent cardiac events (RCEs) but findings are less consistent for anxiety, not previously reported on using a time-dependent approach. We aimed to study the prognostic effect of anxiety and depression symptom levels on RCEs.

Methods

Data (N = 595) were drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Hospital Anxiety and Depression Scale symptoms were grouped into: agitation (three items), anxiety (four items), and depression (seven items) subscales. We performed two types of multivariate analyses using Cox proportional hazard models with delayed entry: with baseline variables (long-term analysis), and with variables measured 12-to-18 months prior to the event (short-term time-dependent analysis), as RCE risk factors.

Results

In the baseline analysis, both anxiety and depression, but not agitation, were separate RCE risk factors, with a moderating effect when considered jointly. In the short-term time-dependent analysis, elevated scores on the anxiety subscale were associated with increased RCE risk even when adjusted for depression [hazard ratio (95% confidence interval) 1.22 (1.05–1.41), p = 0.009]. Depression was no longer a significant predictor when adjusted for anxiety [1.05 (0.87–1.27), p = 0.61]. For anxiety, individual items associated with RCEs differed between the two approaches: item 5 ‘worrying thoughts’ was the most significant long-term risk factor [1.52 (1.21–1.91), p = 0.0004] whereas item 13 ‘feelings of panic’ was the most significant time-dependent short-term risk factor [1.52 (1.18–1.95), p = 0.001].

Conclusions

Anxiety is an important short-term preventable and potentially causal risk factor for RCEs, to be targeted in secondary cardiac disease prevention programmes.

Keywords

Anxietycardiac diseasedepressionrecurrent cardiac eventtime-dependent analysis
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3442 - 3450
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Barley, E. A., Walters, P., Haddad, M., Phillips, R., Achilla, E., McCrone, P., … Tylee, A. (2014). The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: A randomised controlled pilot study. PLoS One, 9, e98704.CrossRefGoogle ScholarPubMed
Barth, J., & Martin, C. R. (2005). Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients. Health and Quality of Life Outcomes, 3, 15.CrossRefGoogle ScholarPubMed
Benninghoven, D., Kaduk, A., Wiegand, U., Specht, T., Kunzendorf, S., & Jantschek, G. (2006). Influence of anxiety on the course of heart disease after acute myocardial infarction – Risk factor or protective function? Psychotherapy and Psychosomatics, 75, 56–61.CrossRefGoogle ScholarPubMed
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52, 69–77.CrossRefGoogle ScholarPubMed
Bonnet, F., Irving, K., Terra, J. L., Nony, P., Berthezene, F., & Moulin, P. (2005). Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis, 178, 339–344.CrossRefGoogle ScholarPubMed
Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews: Endocrinology, 5, 374–381.Google ScholarPubMed
Corney, R. H., & Clare, A. W. (1985). The construction, development and testing of a self-report questionnaire to identify social problems. Psychological Medicine, 15, 637–649.CrossRefGoogle ScholarPubMed
Cosco, T. D., Doyle, F., Ward, M., & McGee, H. (2012). Latent structure of the Hospital Anxiety and Depression Scale: A 10-year systematic review. Journal of Psychosomatic Research, 72, 180–184.CrossRefGoogle ScholarPubMed
de Heer, E. W., Palacios, J. E., Ader, H. J., van Marwijk, H. W. J., Tylee, A., & van der Feltz-Cornelis, C. M. (2020). Chest pain, depression and anxiety in coronary heart disease: Consequence or cause? A prospective clinical study in primary care. Journal of Psychosomatic Research, 129, 109891.CrossRefGoogle ScholarPubMed
Dunbar, M., Ford, G., Hunt, K., & Der, G. (2000). A confirmatory factor analysis of the Hospital Anxiety and Depression scale: Comparing empirically and theoretically derived structures. British Journal of Clinical Psychology, 39, 79–94.CrossRefGoogle ScholarPubMed
Fisher, A. J., & Newman, M. G. (2013). Heart rate and autonomic response to stress after experimental induction of worry versus relaxation in healthy, high-worry, and generalized anxiety disorder individuals. Biological Psychology, 93, 65–74.CrossRefGoogle ScholarPubMed
Frasure-Smith, N., & Lesperance, F. (2003). Depression and other psychological risks following myocardial infarction. Archives of General Psychiatry, 60, 627–636.CrossRefGoogle ScholarPubMed
Frasure-Smith, N., & Lesperance, F. (2008). Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Archives of General Psychiatry, 65, 62–71.CrossRefGoogle ScholarPubMed
Freedland, K. E., & Carney, R. M. (2013). Depression as a risk factor for adverse outcomes in coronary heart disease. BMC Medicine, 11, 131.CrossRefGoogle ScholarPubMed
Friedman, S., Samuelian, J. C., Lancrenon, S., Even, C., & Chiarelli, P. (2001). Three-dimensional structure of the Hospital Anxiety and Depression Scale in a large French primary care population suffering from major depression. Psychiatry Research, 104, 247–257.CrossRefGoogle Scholar
Hill, A. B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58, 295–300.CrossRefGoogle ScholarPubMed
Hunt-Shanks, T., Blanchard, C., Reid, R., Fortier, M., & Cappelli, M. (2010). A psychometric evaluation of the Hospital Anxiety and Depression Scale in cardiac patients: Addressing factor structure and gender invariance. British Journal of Health Psychology, 15, 97–114.CrossRefGoogle ScholarPubMed
Khan, M. A., Hashim, M. J., Mustafa, H., Baniyas, M. Y., Al Suwaidi, S., AlKatheeri, R., … Lootah, S. (2020). Global epidemiology of ischemic heart disease: Results from the global burden of disease study. Cureus, 12, e9349.Google ScholarPubMed
Kornerup, H., Zwisler, A. D., Prescott, E., & Danrehab Group, C. D. (2011). No association between anxiety and depression and adverse clinical outcome among patients with cardiovascular disease: Findings from the DANREHAB trial. Journal of Psychosomatic Research, 71, 207–214.CrossRefGoogle ScholarPubMed
Lamarca, R., Alonso, J., Gomez, G., & Munoz, A. (1998). Left-truncated data with age as time scale: An alternative for survival analysis in the elderly population. Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 53, M337–M343.CrossRefGoogle ScholarPubMed
Lane, D., Carroll, D., Ring, C., Beevers, D. G., & Lip, G. Y. (2001). Mortality and quality of life 12 months after myocardial infarction: Effects of depression and anxiety. Psychosomatic Medicine, 63, 221–230.CrossRefGoogle ScholarPubMed
Li, H., Van Halm-Lutterodt, N., Zheng, D., Liu, Y., Guo, J., Feng, W., … Guo, X. (2018). Time-dependent depressive symptoms and risk of cardiovascular and all-cause mortality among the Chinese elderly: The Beijing longitudinal study of aging. Journal of Cardiology, 72, 356–362.CrossRefGoogle ScholarPubMed
Martens, E. J., de Jonge, P., Na, B., Cohen, B. E., Lett, H., & Whooley, M. A. (2010). Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The heart and soul study. Archives of General Psychiatry, 67, 750–758.CrossRefGoogle ScholarPubMed
Martin, C. R., Lewin, R. J., & Thompson, D. R. (2003). A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychiatry Research, 120, 85–94.CrossRefGoogle ScholarPubMed
Martin, C. R., & Thompson, D. R. (2000). A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychology, Health & Medicine, 5, 193–201.CrossRefGoogle ScholarPubMed
Martin, C. R., Thompson, D. R., & Barth, J. (2008). Factor structure of the Hospital Anxiety and Depression Scale in coronary heart disease patients in three countries. Journal of Evaluation in Clinical Practice, 14, 281–287.CrossRefGoogle ScholarPubMed
Meijer, A., Conradi, H. J., Bos, E. H., Thombs, B. D., van Melle, J. P., & de Jonge, P. (2011). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A meta-analysis of 25 years of research. General Hospital Psychiatry, 33, 203–216.CrossRefGoogle ScholarPubMed
Meyer, T., Buss, U., & Herrmann-Lingen, C. (2010). Role of cardiac disease severity in the predictive value of anxiety for all-cause mortality. Psychosomatic Medicine, 72, 9–15.CrossRefGoogle ScholarPubMed
Meyer, T., Hussein, S., Lange, H. W., & Herrmann-Lingen, C. (2015). Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. European Journal of Preventive Cardiology, 22, 75–82.CrossRefGoogle ScholarPubMed
Moser, D. K., McKinley, S., Riegel, B., Doering, L. V., Meischke, H., Pelter, M., … Dracup, K. (2011). Relationship of persistent symptoms of anxiety to morbidity and mortality outcomes in patients with coronary heart disease. Psychosomatic Medicine, 73, 803–809.CrossRefGoogle ScholarPubMed
Nicholson, A., Kuper, H., & Hemingway, H. (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal, 27, 2763–2774.CrossRefGoogle ScholarPubMed
Norton, S., Cosco, T., Doyle, F., Done, J., & Sacker, A. (2013). The hospital anxiety and depression scale: A meta confirmatory factor analysis. Journal of Psychosomatic Research, 74, 74–81.CrossRefGoogle ScholarPubMed
Norton, J., Pastore, M., Ancelin, M., Hotopf, M., Tylee, A., Mann, A., … Palacios, J. (2020). Time-dependent cognitive and somatic symptoms of depression as predictors of new cardiac-related events in at-risk patients: The UPBEAT-UK cohort. Psychological Medicine, Jan 30:1–8.Google Scholar
Palacios, J., Khondoker, M., Mann, A., Tylee, A., & Hotopf, M. (2018). Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. Journal of Psychosomatic Research, 104, 1–8.CrossRefGoogle ScholarPubMed
Pequignot, R., Dufouil, C., Prugger, C., Peres, K., Artero, S., Tzourio, C., & Empana, J. P. (2016). High level of depressive symptoms at repeated study visits and risk of coronary heart disease and stroke over 10 years in older adults: The three-city study. Journal of the American Geriatrics Society, 64, 118–125.CrossRefGoogle ScholarPubMed
Pereira, V. H., Cerqueira, J. J., Palha, J. A., & Sousa, N. (2013). Stressed brain, diseased heart: A review on the pathophysiologic mechanisms of neurocardiology. International Journal of Cardiology, 166, 30–37.CrossRefGoogle Scholar
Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol group. Annals of Medicine, 33, 337–343.CrossRefGoogle ScholarPubMed
Roest, A. M., Heideveld, A., Martens, E. J., de Jonge, P., & Denollet, J. (2014). Symptom dimensions of anxiety following myocardial infarction: Associations with depressive symptoms and prognosis. Health Psychology, 33, 1468–1476.CrossRefGoogle ScholarPubMed
Roest, A. M., Martens, E. J., Denollet, J., & de Jonge, P. (2010). Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: A meta-analysis. Psychosomatic Medicine, 72, 563–569.CrossRefGoogle ScholarPubMed
Rose, G. A. (1962). The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bulletin of the World Health Organization, 27, 645–658.Google ScholarPubMed
Shibeshi, W. A., Young-Xu, Y., & Blatt, C. M. (2007). Anxiety worsens prognosis in patients with coronary artery disease. Journal of the American College of Cardiology, 49, 2021–2027.CrossRefGoogle ScholarPubMed
Straat, J. H., van der Ark, L. A., & Sijtsma, K. (2013). Methodological artifacts in dimensionality assessment of the Hospital Anxiety and Depression Scale (HADS). Journal of Psychosomatic Research, 74, 116–121.CrossRefGoogle ScholarPubMed
Strik, J. J., Denollet, J., Lousberg, R., & Honig, A. (2003). Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. Journal of the American College of Cardiology, 42, 1801–1807.CrossRefGoogle ScholarPubMed
Tully, P. J., Cosh, S. M., & Baumeister, H. (2014). The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. Journal of Psychosomatic Research, 77, 439–448.CrossRefGoogle ScholarPubMed
Tully, P. J., Winefield, H. R., Baker, R. A., Denollet, J., Pedersen, S. S., Wittert, G. A., & Turnbull, D. A. (2015). Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: A five year longitudinal cohort study. Biopsychosocial Medicine, 9, 14.CrossRefGoogle ScholarPubMed
Tylee, A., Ashworth, M., Barley, E., Brown, J., Chambers, J., Farmer, A., … Walters, P. (2011). Up-beat UK: A programme of research into the relationship between coronary heart disease and depression in primary care patients. BMC Family Practice, 12, 38.CrossRefGoogle Scholar
Van Beek, M. H., Zuidersma, M., Lappenschaar, M., Pop, G., Roest, A. M., Van Balkom, A. J., … Voshaar, R. C. (2016). Prognostic association of cardiac anxiety with new cardiac events and mortality following myocardial infarction. British Journal of Psychiatry, 209, 400–406.CrossRefGoogle ScholarPubMed
Versteeg, H., Hoogwegt, M. T., Hansen, T. B., Pedersen, S. S., Zwisler, A. D., & Thygesen, L. C. (2013). Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease. Journal of Psychosomatic Research, 75, 518–525.CrossRefGoogle Scholar
Walters, P., Barley, E. A., Mann, A., Phillips, R., & Tylee, A. (2014). Depression in primary care patients with coronary heart disease: Baseline findings from the UPBEAT UK study. PLoS One, 9, e98342.CrossRefGoogle ScholarPubMed
Watkins, L. L., Koch, G. G., Sherwood, A., Blumenthal, J. A., Davidson, J. R., O'Connor, C., & Sketch, M. H. (2013). Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. Journal of the American Heart Association, 2, e000068.CrossRefGoogle ScholarPubMed
Whalley, B., Thompson, D. R., & Taylor, R. S. (2014). Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. International Journal of Behavioral Medicine, 21, 109–121.CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361–370.CrossRefGoogle ScholarPubMed