Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease

Henneke Versteeg; Madelein T Hoogwegt; Tina B Hansen; Susanne S Pedersen; Ann-Dorthe Zwisler; Lau C Thygesen

doi:10.1016/j.jpsychores.2013.10.005

Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease

J Psychosom Res. 2013 Dec;75(6):518-25. doi: 10.1016/j.jpsychores.2013.10.005. Epub 2013 Oct 17.

Authors

Henneke Versteeg¹, Madelein T Hoogwegt, Tina B Hansen, Susanne S Pedersen, Ann-Dorthe Zwisler, Lau C Thygesen

Affiliation

¹ Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, The Netherlands. Electronic address: h.versteeg@uvt.nl.

PMID: 24290040
DOI: 10.1016/j.jpsychores.2013.10.005

Abstract

Objective: The objective of the current study was to examine whether depression and anxiety are independently associated with 5-year cardiac-related hospitalizations and all-cause mortality in patients with ischemic heart disease (IHD).

Methods: Patients treated for MI, angina, or ischemic heart failure (N=610) were recruited from Holbæk Hospital, Denmark. All patients completed the Hospital Anxiety and Depression Scale (HADS) in December 2005. Data regarding patient characteristics at baseline, and hospitalizations and deaths during follow-up were collected from Danish population-based registers. Cox and negative binomial regression analyses were performed to examine the relationship between depression, anxiety and the endpoints.

Results: At baseline, 71 (11.6%) patients reported depression and 120 (19.7%) reported anxiety. Models including both depression and anxiety showed that depression was independently associated with time to first cardiac-related hospitalization, cumulative number and length of cardiac-related hospitalizations, and all-cause mortality, while anxiety was only associated with the total length of hospitalizations (all p-values <.05). After adding sociodemographic and clinical factors, depression remained associated with the number (incidence rate ratio (IRR)=2.00, 95% confidence interval (CI): 1.44-2.77) and length of cardiac-related hospitalizations (IRR=3.69, 95% CI: 2.75-4.96), and all-cause mortality (hazard ratio (HR)=2.12, 95% CI: 1.13-3.96). The associations between depression and time to first hospitalization and between anxiety and length of stay were eliminated.

Conclusions: The current study showed that depression, and not anxiety, is associated with the number and length of cardiac-related hospitalizations and all-cause mortality in IHD patients, independent of traditional risk factors. In order to improve health outcomes, better awareness and treatment of depression in IHD patients are crucial.

Keywords: Anxiety; Depression; Hospitalization; Ischemic heart disease; Mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anxiety / epidemiology
Anxiety Disorders / complications
Anxiety Disorders / epidemiology
Coronary Artery Disease / mortality
Coronary Artery Disease / psychology
Denmark / epidemiology
Depression / complications*
Depression / epidemiology*
Depressive Disorder / complications*
Depressive Disorder / epidemiology*
Female
Heart Failure / mortality
Heart Failure / psychology
Hospitalization / statistics & numerical data*
Humans
Incidence
Male
Middle Aged
Myocardial Ischemia / mortality*
Myocardial Ischemia / psychology*
Risk Factors
Time Factors