Recognizing Increased Risk of Depressive Comorbidity after Myocardial Infarction: Looking for 4 Symptoms of Anxiety-Depression

Abstract

Background: Screening for depression in myocardial infarction (MI) patients must be improved: (1) depression often goes unrecognized and (2) anxiety has been largely overlooked as an essential feature of depression in these patients. We therefore examined the co-occurrence of anxiety and depression after MI, and the validity of a brief mixed anxiety-depression index as a simple way to identify post-MI patients at increased risk of comorbid depression. Methods: One month after MI, 176 patients underwent a psychiatric interview and completed the Beck Depression Inventory (BDI) and the Symptoms of Anxiety-Depression index (SAD₄) containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness). Results: Thirty-one MI patients (18%) had comorbid depression and 37 (21%) depressive or anxiety disorder. High factor loadings and item-total correlations (SAD₄, α = 0.86) confirmed that symptoms of anxiety and depression co-occurred after MI. Mixed anxiety-depression (SAD₄≧3) was present in 90% of depressed MI patients and in 100% of severely depressed patients. After adjustment for standard depression symptoms (BDI; OR = 4.4, 95% CI 1.6–12.1, p = 0.004), left ventricular ejection fraction, age and sex, mixed anxiety-depression symptomatology was associated with an increased risk of depressive comorbidity (OR = 11.2, 95% CI 3.0–42.5, p < 0.0001). Mixed anxiety-depression was also independently associated with depressive or anxiety disorder (OR = 9.2, 95% CI 3.0–27.6, p < 0.0001). Conclusions: Anxiety is underrecognized in post-MI patients; however, the present findings suggest that anxiety symptomatology should not be overlooked in these patients. Depressive comorbidity after MI is characterized by symptoms of mixed anxiety-depression, after controlling for standard depression symptoms. The SAD₄ represents an easy way to recognize the increased risk of post-MI depression.

Watching the paint dry at work: psychometric examination of the Dutch Boredom Scale

“…The results obtained for these two items were inconclusive and ambiguous, as compared to the other six items. Restlessness and aimlessness have previously also been found to relate positively rather than negatively to anxiety (i.e., Denollet, Strik, & Lousberg, 2006;Diefenbach et al, 2001). Therefore, our referring to ''spending time aimlessly'' and ''feeling restless'' in these items may have been ambivalent for the participants, as these behaviors may stem from stress or depression rather than boredom.…”

Psychological Distress and Mortality in Systolic Heart Failure

“…Elevated anxiety/ depression symptoms were defined according to a previously defined cutoff score of Ն3. 24 The Symptoms of Anxiety-Depression Index is internally consistent (Cronbach ␣ϭ0.86) and has been shown to independently predict a diagnosis of clinical depression and a composite of anxiety or depressive disorder. 24 Type D personality was assessed with the 14-item type D scale.…”

“…Symptoms of mixed anxiety/depression were assessed with the Symptoms of Anxiety-Depression Index, 24 because anxiety and depression tend to co-occur in both healthy individuals and cardiac patients. 25,26 This 4-item scale, originally developed in post-MI patients, consists of 2 items assessing anxious symptoms (tension and restlessness) and 2 items assessing depressive symptoms (feeling blue and hopelessness).…”

Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

“…Alternatively, the 2-item patient health questionnaire (PHQ-2; Löve et al 2005) and the 4-item Symptoms of mixed AnxietyDepression index (SAD 4 ; Denollet et al 2006) both comprise an item assessing hopelessness. The former measure has been shown to be sensitive to change and the latter to predict major depressive disorder, adjusting for depressive symptoms.…”