Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention

Abstract

Background: Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial. Objectives: This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI). Methods: All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed. Results: Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p<0.001); (t(333) = 5.13, p<0.001); and (t(333) = 2.79, p=0.042), respectively. Conclusion: This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

Prevalence of Anxiety, Depression, and Distress in SCAD and Non-SCAD AMI Patients

“…Importantly, SCAD-AMI remained as a unique predictor of these psychological states even after controlling for previously identified red flags for poor post-event mental health status, namely female sex, younger age, mental health history, social isolation, socioeconomic disadvantage, diabetes, and nonattendance at CR using logistic regression. 22,23,[25][26][27][28][30][31][32][33] Therefore, the current findings confirm that the emotional difficulty associated with SCAD cannot be attributed simply to the fact that most patients with SCAD are younger females, or to their increased likelihood of having a mental health history. Of note, though, the findings regarding post-SCAD depression were not retained after multivariate adjustment using ANCOVA.…”

“…The findings of the present study suggest that survivors of SCAD-AMI are more likely than their counterparts without SCAD to experience anxiety, depression, distress, and cardiac distress in the 6 mo after their acute event. Importantly, SCAD-AMI remained as a unique predictor of these psychological states even after controlling for previously identified red flags for poor post-event mental health status, namely female sex, younger age, mental health history, social isolation, socioeconomic disadvantage, diabetes, and nonattendance at CR using logistic regression 22,23,25–28,30–33. Therefore, the current findings confirm that the emotional difficulty associated with SCAD cannot be attributed simply to the fact that most patients with SCAD are younger females, or to their increased likelihood of having a mental health history.…”

“…In Australia, having private health insurance is associated with outright home ownership, luxury vehicle ownership, and a six-figure income,29 hence its relevance as an indicator of financial security. Other known red flags include social isolation, indicated by living alone or self-reported loneliness22,23,27,30 and having diabetes 22,23,31. Attendance at cardiac rehabilitation (CR) has been shown to ameliorate post-event anxiety and depression risk, providing a protective effect 30.…”

Psychological impact of first admission with cardiovascular disease in a tertiary hospital in Oman

“…The reported incidence of severe depression and anxiety after hospitalization for ACS or heart failure ranges from 10% to 30%, but rises to almost 50% when mild anxiety or depression are included. 6 , 7 , 8 Anxiety and depression have been shown to be an independent risk factor for poorer prognosis in these patients over long term: studies have reported an approximately two-to three-fold increase in major adverse cardiac events over 1–2 years’ follow-up in patients with high anxiety and depression scores. 9 Despite a wealth of available information, the psychological aspects of CVD, as with those of most illnesses, are often ignored by treating clinicians.…”

Positivity and Health Locus of Control: Key Variables to Intervene on Well-Being of Cardiovascular Disease Patients

“…In addition, the diagnosis of CVD may exacerbate anxiety and depressive symptoms in these patients. Some studies have reported a high prevalence of depression among patients with coronary artery disease, with 34% of them experiencing moderate to severe depression, which could negatively affect their prognosis [ 25 ]. A meta-analysis performed by Gathright et al [ 26 ] found that depression was a predictor of all-cause mortality in heart failure.…”