Screening for anxiety disorders in patients with coronary artery disease

Abstract

BackgroundAnxiety disorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxiety disorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxiety disorders in patients with CAD and diagnostic utility of self-rating scales for screening of anxiety disorders.MethodsFive-hundred and twenty-three CAD patients not receiving psychotropic treatments at initiation of rehabilitation program completed self-rating scales (Hospital Anxiety and Depression Scale or HADS; Spielberger State-Anxiety Inventory or SSAI; and Spielberger Trait-Anxiety Inventory or STAI) and were interviewed for generalized anxiety disorder (GAD), social phobia, panic disorder and agoraphobia (Mini-International Neuropsychiatric Interview or MINI).ResultsThirty-eight (7%) patients were diagnosed with anxiety disorder(s), including GAD (5%), social phobia (2%), agoraphobia (1%) and panic disorder (1%). Areas under the ROC curve of the HADS Anxiety subscale (HADS-A), STAI and SSAI for screening of any anxiety disorder were .81, .80 and .72, respectively. Optimal cut-off values for screening of any anxiety disorders were ≥8 for the HADS-A (sensitivity = 82%; specificity = 76%; and positive predictive value (PPV) = 21%); ≥45 for the STAI (sensitivity = 89%; specificity = 56%; and PPV = 14%); and ≥40 for the SSAI (sensitivity = 84%; specificity = 55%; PPV = 13%). In a subgroup of patients (n = 340) scoring below the optimal major depressive disorder screening cut-off value of HADS-Depression subscale (score <5), the HADS-A, STAI and SSAI had moderate-high sensitivity (range from 69% to 89%) and low PPVs (≤22%) for GAD and any anxiety disorders.ConclusionsAnxiety disorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxiety disorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxiety disorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying anxiety disorders.

Prevalence of Generalized Anxiety Disorder among the Patients Attending a Peripheral Health Center in Kashmir Valley

“…6,15 However there are other studies which has reported higher prevalence of GAD. 7,8,9,10,11,12,13,14,16,17 The study reported higher prevalence of GAD among females, illiterates and those belonging to lower socio economic class. 6,7,9,11,12,14,15 …”

Anksioznost in koronarna bolezen srca

“…Pri bolnikih z akutnim koronarnim dogodkom je depresija povezana z 2-do 2,7-krat večjim tveganjem za smrt. Ameriško združenje kardiologov je tako opredelilo depresivnost kot dejavnik tveganja za slabši izid po akutnem miokardnem infarktu, zato je priporoči-lo rutinsko testiranje za depresivnost pri bolnikih s koronarno boleznijo (1)(2)(3)(4).…”

Correlation between maternal anxiety, reactivity of fetal cerebral circulation to auditory stimulation, and birth outcome in normotensive and gestational hypertensive women

“…Subjects from both experimental groups completed the Spielberger (Bunevicius et al, 2013;Devier et al, 2009; for a detailed review, see Glozman, 2004;Özpelit et al, 2015). In our study, we have indeed utilized STAI scores as a continuous variable to determine possible correlations with RePi.…”