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BioPsychoSocial Medicine
Published in: BioPsychoSocial Medicine 1/2015

Open Access 01-12-2015 | Research

Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study

Authors: Phillip J. Tully, Helen R. Winefield, Robert A. Baker, Johan Denollet, Susanne S. Pedersen, Gary A. Wittert, Deborah A. Turnbull

Published in: BioPsychoSocial Medicine | Issue 1/2015

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Abstract

Background

Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.

Methods

Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.

Results

In the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.

Conclusions

Generalized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.
Literature
1.
Carney RM, Freedland KE, Sheline YI, Weiss ES. Depression and coronary heart disease: a review for cardiologists. Clin Cardiol. 1997;20:196–200.CrossRefPubMed
2.
Dickens C, Cherrington A, Adeyemi I, Roughley K, Bower P, Garrett C, et al. Characteristics of psychological interventions that improve depression in people with coronary heart disease: a systematic review and meta-regression. Psychosom Med. 2013;75:211–21.CrossRefPubMed
3.
Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Coch Data Syst Rev. 2011;9, CD008012.
4.
Linden W. How many meta-analyses does it take to settle a question? Psychosom Med. 2013;75:332–4.CrossRefPubMed
5.
Dreher H. Psychosocial factors in heart disease: a process model. Adv Mind Body Med. 2004;20:20–31.PubMed
6.
Ladwig KH, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, et al. Position paper on the importance of psychosocial factors in cardiology: Update 2013. Ger Med Sci. 2014;12:Doc09.PubMedPubMedCentral
7.
Pogosova N, Saner H, Pedersen SS, Cupples ME, McGee H, Höfer S, et al. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J Prev Cardiol. in press.
8.
Hori R, Hayano J, Kimura K, Shibata N, Kobayashi F. Psychosocial factors are preventive against coronary events in Japanese men with coronary artery disease: The Eastern Collaborative Group Study 7.7-year follow-up experience. Biopsychosoc Med. 2015;9:3.CrossRefPubMedPubMedCentral
9.
Baumeister H, Haschke A, Munzinger M, Hutter N, Tully PJ. Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review. Biopsychosoc Med. 2015;9.
10.
Watson D. Differentiating the mood and anxiety disorders: a quadripartite model. Annu Rev Clin Psychol. 2009;5:221–47.CrossRefPubMed
11.
Watson D. Locating anger in the hierarchical structure of affect: comment on Carver and Harmon-Jones (2009). Psychol Bull. 2009;135:205–8. discussion 215–207.CrossRefPubMed
12.
Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005;131:260–300.CrossRefPubMed
13.
Smith TW. Toward a more systematic, cumulative, and applicable science of personality and health: lessons from type D personality. Psychosom Med. 2011;73:528–32.CrossRefPubMed
14.
Suls J, Martin R. Heart disease occurs in a biological, psychological, and social matrix: cardiac risk factors, symptom presentation, and recovery as illustrative examples. Ann Behav Med. 2011;41:164–73.CrossRefPubMed
15.
Grande G, Romppel M, Barth J. Association between type D personality and prognosis in patients with cardiovascular diseases: a systematic review and meta-analysis. Ann Behav Med. 2012;43:299–310.CrossRefPubMed
16.
Kubzansky LD, Cole SR, Kawachi I, Vokonas P, Sparrow D. Shared and unique contributions of anger, anxiety, and depression to coronary heart disease: a prospective study in the normative aging study. Ann Behav Med. 2006;31:21–9.CrossRefPubMed
17.
Denollet J, Schiffer AA, Spek V. A general propensity to psychological distress affects cardiovascular outcomes: evidence from research on the type D (distressed) personality profile. Circ: Cardiovasc Qual Outcomes. 2010;3:546–57.
18.
Meyer FA, von Känel R, Saner H, Schmid JP, Stauber S. Positive affect moderates the effect of negative affect on cardiovascular disease-related hospitalizations and all-cause mortality after cardiac rehabilitation. Eur J Prev Cardiol. in press.
19.
Tully PJ, Baune BT. Comorbid anxiety disorders alter the association between cardiovascular diseases and depression: the German National Health Interview and Examination Survey. Soc Psych Psychiatr Epidemiol. 2014;49:683–91.CrossRef
20.
Andrews G, Goldberg DP, Krueger RF, Carpenter WT, Hyman SE, Sachdev P, et al. Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity? Psychol Med. 2009;39:1993–2000.CrossRefPubMed
21.
Goldberg DP, Krueger RF, Andrews G, Hobbs MJ. Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychol Med. 2011;2043–2059.
22.
Eaton NR, Krueger RF, Markon KE, Keyes KM, Skodol AE, Wall M, et al. The structure and predictive validity of the internalizing disorders. J Abnorm Psychol. 2013;122:86–92.CrossRefPubMed
23.
Wright AG, Krueger RF, Hobbs MJ, Markon KE, Eaton NR, Slade T. The structure of psychopathology: toward an expanded quantitative empirical model. J Abnorm Psychol. 2013;122:281–94.CrossRefPubMed
24.
25.
Baune BT, Adrian I, Arolt V, Berger K. Associations between major depression, bipolar disorders, dysthymia and cardiovascular diseases in the general adult population. Psychother Psychosom. 2006;75:319–26.CrossRefPubMed
26.
Stenman M, Holzmann MJ, Sartipy U. Relation of major depression to survival after coronary artery bypass grafting. Am J Cardiol. 2014;114:698–703.CrossRefPubMed
27.
Rafanelli C, Roncuzzi R, Milaneschi Y. Minor depression as a cardiac risk factor after coronary artery bypass surgery. Psychosomatics. 2006;47:289–95.CrossRefPubMed
28.
Denollet J, Pedersen SS, Daemen J, de Jaegere P, Serruys PW, van Domburg RT. Reduced positive affect (anhedonia) predicts major clinical events following implantation of coronary-artery stents. J Intern Med. 2008;263:203–11.CrossRefPubMed
29.
Pelle AJ, Pedersen SS, Szabo BM, Denollet J. Beyond Type D personality: reduced positive affect (anhedonia) predicts impaired health status in chronic heart failure. Qual Life Res. 2009;18:689–98.CrossRefPubMedPubMedCentral
30.
Davidson KW, Burg MM, Kronish IM, Shimbo D, Dettenborn L, Mehran R, et al. Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. Arch Gen Psychiatry. 2010;67:480–8.CrossRefPubMedPubMedCentral
31.
Leroy M, Loas G, Perez-Diaz F. Anhedonia as predictor of clinical events after acute coronary syndromes: a 3-year prospective study. Compr Psychiatry. 2010;51:8–14.CrossRefPubMed
32.
Edmondson D, Rieckmann N, Shaffer JA, Schwartz JE, Burg MM, Davidson KW, et al. Posttraumatic stress due to an acute coronary syndrome increases risk of 42-month major adverse cardiac events and all-cause mortality. J Psychiatr Res. 2011;45:1621–6.CrossRefPubMedPubMedCentral
33.
Frasure-Smith N, Lespérance F. Depression and anxiety as predictors of 2-year cardiac events in patients with stable coronary artery disease. Arch Gen Psychiatry. 2008;65:62–71.CrossRefPubMed
34.
Parker G, Hyett M, Hadzi-Pavlovic D, Brotchie H, Walsh W. GAD is good? Generalized anxiety disorder predicts a superior five-year outcome following an acute coronary syndrome. Psychiatry Res. 2011;188:383–9.CrossRefPubMed
35.
Martens EJ, de Jonge P, Na B, Cohen BE, Lett H, Whooley MA. Scared to death? Generalized anxiety disorder and cardiovascular events in patients with stable coronary heart disease: The Heart and Soul Study. Arch Gen Psychiatry. 2010;67:750–8.CrossRefPubMed
36.
Tully PJ, Cosh SM, Baumeister H. 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. J Psychosom Res. 2014;77:439–48.CrossRefPubMed
37.
Tully PJ, Pedersen SS, Winefield HR, Baker RA, Turnbull DA, Denollet J. Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients. Psychol Health Med. 2011;16:333–45.CrossRefPubMed
38.
Tully PJ, Newland RF, Baker RA. Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: an age and sex propensity matched study. Aust Crit Care. 2015;28:24–30.CrossRefPubMed
39.
The Australian Society of Cardiac and Thoracic Surgery. ASCTS cardiac surgery database project: data definitions. Melbourne: The Australian Society of Cardiac and Thoracic Surgery; 2008.
40.
Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Janavs J, Weiller E, Bonora LI, et al. Reliability and Validity of the MINI International Neuropsychiatric Interview (M.I.N.I.): according to the SCID-P. Eur Psychiatry. 1997;12:232–41.CrossRef
41.
Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan KH, et al. The MINI International Neuropsychiatric Interview (M.I.N.I.). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12:224–31.CrossRef
42.
van Vliet IM, de Beurs E. The MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschr Psychiatr. 2007;49:393–7.PubMed
43.
Watson D, Weber K, Assenheimer JS, Clark LA, Strauss ME, McCormick RA. Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. J Abnorm Psychol. 1995;104:3–14.CrossRefPubMed
44.
Wardenaar KJ, van Veen T, Giltay EJ, de Beurs E, Penninx BW, Zitman FG. Development and validation of a 30-item short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ). Psychiatry Res. 2010;179:101–6.CrossRefPubMed
45.
Tully PJ, Wardenaar KJ, Penninx BW. Operating characteristics of depression and anxiety disorder phenotype dimensions and trait neuroticism: a theoretical examination of the fear and distress disorders from the Netherlands study of depression and anxiety. J Affect Disord. 2015;174:611–8.CrossRefPubMed
46.
Lin A, Yung AR, Wigman JT, Killackey E, Baksheev G, Wardenaar KJ. Validation of a short adaptation of the Mood and Anxiety Symptoms Questionnaire (MASQ) in adolescents and young adults. Psychiatry Res. 2014;215:778–83.CrossRefPubMed
47.
Reidy J, Keogh E. Testing the discriminant and convergent validity of the mood and anxiety sympotms questionnaire using a British sample. Personal Individ Differ. 1997;23:337–44.CrossRef
48.
Keogh E, Reidy J. Exploring the factor structure of the Mood and Anxiety Symptom Questionnaire (MASQ). J Pers Assess. 2000;74:106–25.CrossRefPubMed
49.
Bedford A, Lukic G, Allerhand M, Deary IJ. Mood and anxiety symptom questionnaire anxiety items in an adult British clinical sample: one scale or two? Clin Psychol Psychother. 2011;18:347–53.CrossRefPubMed
50.
Schalet BD, Cook KF, Choi SW, Cella D. Establishing a common metric for self-reported anxiety: linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. J Anxiety Disord. 2014;28:88–96.CrossRefPubMed
51.
de Beurs E, den Hollander-Gijsman ME, Helmich S, Zitman FG. The tripartite model for assessing symptoms of anxiety and depression: psychometrics of the Dutch version of the mood and anxiety symptoms questionnaire. Behav Res Ther. 2007;45:1609–17.CrossRefPubMed
52.
Nitschke JB, Heller W, Imig JC, McDonald RP, Miller GA. Distinguishing dimensions of anxiety and depression. Cogn Ther Res. 2001;25:1–22.CrossRef
53.
54.
de Jonge P, Ormel J, van den Brink RH, van Melle JP, Spijkerman TA, Kuijper A, et al. Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. Am J Psychiatr. 2006;163:138–44.CrossRefPubMed
55.
56.
Almeida OP, Alfonso H, Pirkis J, Kerse N, Sim M, Flicker L, et al. A practical approach to assess depression risk and to guide risk reduction strategies in later life. Int Psychogeriatr. 2011;23:280–91.CrossRefPubMed
57.
Biancari F, Kangasniemi OP, Luukkonen J, Vuorisalo S, Satta J, Pokela R, et al. EuroSCORE predicts immediate and late outcome after coronary artery bypass surgery. Ann Thorac Surg. 2006;82:57–61.CrossRefPubMed
58.
Kobayashi KJ, Williams JA, Nwakanma LU, Weiss ES, Gott VL, Baumgartner WA, et al. EuroSCORE predicts short- and mid-term mortality in combined aortic valve replacement and coronary artery bypass patients. J Card Surg. 2009;24:637–43.CrossRefPubMed
59.
Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999;16:9–13.CrossRefPubMed
60.
Goodwin RD, Davidson KW, Keyes K. Mental disorders and cardiovascular disease among adults in the United States. J Psychosom Res. 2009;43:239–46.CrossRef
61.
Chalmers J, Quintana DS, Abbott MJ, Kemp AH. Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Front Psychiatry. 2014;5.
62.
Tully PJ, Cosh SM, Baune BT. A review of the affects of worry and generalized anxiety disorder upon cardiovascular health and coronary heart disease. Psychol Health Med. 2013;18:627–44.CrossRefPubMed
63.
Shaffer JA, Whang W, Shimbo D, Burg M, Schwartz JE, Davidson KW. Do different depression phenotypes have different risks for recurrent coronary heart disease? Health Psychol Rev. 2012;6:165–79.CrossRefPubMed
64.
Patron E, Messerotti Benvenuti S, Favretto G, Valfrè C, Bonfà C, Gasparotto R, et al. Association between depression and heart rate variability in patients after cardiac surgery: a pilot study. J Psychosom Res. 2012;73:42–6.CrossRefPubMed
65.
Patron E, Messerotti Benvenuti S, Zanatta P, Polesel E, Palomba D. Preexisting depressive symptoms are associated with long-term cognitive decline in patients after cardiac surgery. Gen Hosp Psychiatry. 2013;35:472–9.CrossRefPubMed
66.
Dao TK, Youssef NA, Gopaldas RR, Chu D, Bakaeen F, Wear E, et al. Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes. J Cardiothorac Surg. 2010;5:36.CrossRefPubMedPubMedCentral
67.
Edmondson D, Richardson S, Falzon L, Davidson KW, Mills MA, Neria Y. Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLoS ONE. 2012;7, e38915.CrossRefPubMedPubMedCentral
68.
Wardenaar KJ, Vreeburg SA, van Veen T, Giltay EJ, Veen G, Penninx BW, et al. Dimensions of depression and anxiety and the hypothalamo-pituitary-adrenal axis. Biol Psychiatry. 2011;69:366–73.CrossRefPubMed
69.
Luppino FS, van Reedt Dortland AK, Wardenaar KJ, Bouvy PF, Giltay EJ, Zitman FG, et al. Symptom dimensions of depression and anxiety and the metabolic syndrome. Psychosom Med. 2011;73:257–64.CrossRefPubMed
70.
van Veen T, Wardenaar KJ, Carlier IV, Spinhoven P, Penninx BW, Zitman FG. Are childhood and adult life adversities differentially associated with specific symptom dimensions of depression and anxiety? Testing the tripartite model. J Affect Disord. 2013;146:238–45.CrossRefPubMed
71.
72.
Huffman JC, Mastromauro CA, Beach SR, Celano CM, Dubois CM, Healy BC, et al. Collaborative care for depression and anxiety disorders in patients with recent cardiac events: The Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial. JAMA Intern Med. 2014;174:927–36.CrossRefPubMed
73.
Huffman JC, Mastromauro CA, Sowden GL, Wittmann C, Rodman R, Januzzi JL. A collaborative care depression management program for cardiac inpatients: depression characteristics and in-hospital outcomes. Psychosomatics. 2011;52:26–33.CrossRefPubMed
74.
Tully PJ, Selkow T, Bengel J, Rafanelli C. A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: discrete effects of cognitive behavioral therapy, exercise rehabilitation, and psychotropic medication. Disabil Rehabil. 2015;37:585–92.CrossRefPubMed
75.
Dao TK, Youssef NA, Armsworth M, Wear E, Papathopoulos KN, Gopaldas R. Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2011;142:e109–15.CrossRefPubMed
76.
Doering LV, Chen B, Cross Bodan R, Magsarili MC, Nyamathi A, Irwin MR. Early cognitive behavioral therapy for depression after cardiac surgery. J Cardiovasc Nurs. 2013;28:370–9.CrossRefPubMedPubMedCentral
77.
Freedland KE, Skala JA, Carney RM, Rubin EH, Lustman PJ, Davila-Roman VG, et al. Treatment of depression after coronary artery bypass surgery: a randomized controlled trial. Arch Gen Psychiatry. 2009;66:387–96.CrossRefPubMed
78.
Rollman BL, Belnap BH, LeMenager MS, Mazumdar S, Schulberg HC, Reynolds 3rd CF. The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression. Psychosom Med. 2009;71:217–30.CrossRefPubMedPubMedCentral
79.
Hackam DG, Mrkobrada M. Selective serotonin reuptake inhibitors and brain hemorrhage: a meta-analysis. Neurology. 2012;79:1862–5.CrossRefPubMed
80.
Auerbach AD, Vittinghoff E, Maselli J, Pekow PS, Young JQ, Lindenauer PK. Perioperative use of selective serotonin reuptake inhibitors and risks for adverse outcomes of surgery. JAMA Intern Med. 2013;173:1075–81.CrossRefPubMed
81.
Tully PJ, Cardinal T, Bennetts JS, Baker RA. Selective serotonin reuptake inhibitors, venlafaxine and duloxetine are associated with in hospital morbidity but not bleeding or late mortality after coronary artery bypass graft surgery. Heart Lung Circ. 2012;21:206–14.CrossRefPubMed
82.
Rollman BL, Belnap BH, LeMenager MS, Mazumdar S, Houck PR, Counihan PJ, et al. Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. J Am Med Assoc. 2009;302:2095–103.CrossRef
83.
Prabhu A, Tully PJ, Bennetts JS, Tuble SC, Baker RA. The morbidity and mortality outcomes of indigenous Australian peoples after isolated coronary artery bypass graft surgery: the influence of geographic remoteness. Heart Lung Circ. 2013;22:599–605.CrossRefPubMed
Metadata
Title
Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study
Authors
Phillip J. Tully
Helen R. Winefield
Robert A. Baker
Johan Denollet
Susanne S. Pedersen
Gary A. Wittert
Deborah A. Turnbull
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BioPsychoSocial Medicine / Issue 1/2015
Electronic ISSN: 1751-0759
DOI
https://doi.org/10.1186/s13030-015-0041-5

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