Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Current Psychiatry Reports
Published in: Current Psychiatry Reports 11/2016

01-11-2016 | Anxiety Disorders (A Pelissolo, Section Editor)

Anxiety Disorders and Cardiovascular Disease

Authors: Christopher M. Celano, Daniel J. Daunis, Hermioni N. Lokko, Kirsti A. Campbell, Jeff C. Huffman

Published in: Current Psychiatry Reports | Issue 11/2016

Login to get access

Abstract

Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.
Literature
1.
Grace SL, Abbey SE, Irvine J, Shnek ZM, Stewart DE. Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events. Psychother Psychosom. 2004;73(6):344–52. doi:10.​1159/​000080387.PubMedCrossRef
2.
Hanssen TA, Nordrehaug JE, Eide GE, Bjelland I, Rokne B. Anxiety and depression after acute myocardial infarction: an 18-month follow-up study with repeated measures and comparison with a reference population. Eur J Cardiovasc Prev Rehabil. 2009;16(6):651–9. doi:10.​1097/​HJR.​0b013e32832e4206​.PubMedCrossRef
3.
Koivula M, Tarkka MT, Tarkka M, Laippala P, Paunonen-Ilmonen M. Fear and anxiety in patients at different time-points in the coronary artery bypass process. Int J Nurs Stud. 2002;39(8):811–22.PubMedCrossRef
4.
Easton K, Coventry P, Lovell K, Carter LA, Deaton C. Prevalence and measurement of anxiety in samples of patients with heart failure: meta-analysis. J Cardiovasc Nurs. 2015. doi:10.​1097/​JCN.​0000000000000265​.
5.
Brouwers C, Denollet J, Caliskan K, de Jonge N, Constantinescu A, Young Q, et al. Psychological distress in patients with a left ventricular assist device and their partners: an exploratory study. Eur J Cardiovasc Nurs. 2015;14(1):53–62. doi:10.​1177/​1474515113517607​.PubMedCrossRef
6.
Modica M, Ferratini M, Torri A, Oliva F, Martinelli L, De Maria R, et al. Quality of life and emotional distress early after left ventricular assist device implant: a mixed-method study. Artif Organs. 2015;39(3):220–7. doi:10.​1111/​aor.​12362.PubMedCrossRef
7.
8.•
Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol. 2010;56(1):38–46. doi:10.​1016/​j.​jacc.​2010.​03.​034. This meta-analysis, including 249,846 healthy adults who were followed over an average of 11 years, found that anxiety was associated with an increased risk of incident coronary artery disease and cardiac death, independent of relevant covariates.PubMedCrossRef
9.•
Celano CM, Millstein RA, Bedoya CA, Healy BC, Roest AM, Huffman JC. Association between anxiety and mortality in patients with coronary artery disease: a meta-analysis. Am Heart J. 2015;170:1105–15. This meta-analysis examined the relationship between anxiety and adverse cardiac outcomes in over 30,000 individuals with established coronary artery disease. In unadjusted analyses, anxiety was associated with a moderately increased risk of adverse cardiac events; however, these relationships were attenuated in adjusted analyses. The relationship between anxiety and outcomes appeared to be stronger when anxiety was measured during a period of clinical stability, compared to after an acute coronary syndrome.PubMedCrossRef
10.
11.
12.
Konstam V, Salem D, Pouleur H, Kostis J, Gorkin L, Shumaker S, et al. Baseline quality of life as a predictor of mortality and hospitalization in 5,025 patients with congestive heart failure. SOLVD Investigations. Studies of Left Ventricular Dysfunction Investigators. Am J Cardiol. 1996;78(8):890–5.PubMedCrossRef
13.
14.
15.
Fleet RP, Dupuis G, Marchand A, Burelle D, Arsenault A, Beitman BD. Panic disorder in emergency department chest pain patients: prevalence, comorbidity, suicidal ideation, and physician recognition. Am J Med. 1996;101(4):371–80. doi:10.​1016/​S0002-9343(96)00224-0.PubMedCrossRef
16.
Ortiz-Garrido O, Ortiz-Olvera NX, Gonzalez-Martinez M, Moran-Villota S, Vargas-Lopez G, Dehesa-Violante M, et al. Clinical assessment and health-related quality of life in patients with non-cardiac chest pain. Rev Gastroenterol Mex. 2015;80(2):121–9. doi:10.​1016/​j.​rgmx.​2015.​03.​005.PubMed
17.
Hutter Jr AM, Amsterdam EA, Jaffe AS. 31st Bethesda Conference. Emergency Cardiac Care. Task force 2: Acute coronary syndromes: Section 2B—Chest discomfort evaluation in the hospital. J Am Coll Cardiol. 2000;35(4):853–62.PubMed
18.
19.
20.
21.
22.
23.
24.
Tully PJ, Winefield HR, Baker RA, Denollet J, Pedersen SS, Wittert GA, et al. Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study. Biopsychosoc Med. 2015;9:14. doi:10.​1186/​s13030-015-0041-541.PubMedPubMedCentralCrossRef
25.
Fleet R, Lavoie K, Beitman BD. Is panic disorder associated with coronary artery disease? A critical review of the literature. J Psychosom Res. 2000;48(4-5):347–56.PubMedCrossRef
26.
27.
28.
29.
30.
Walters K, Rait G, Petersen I, Williams R, Nazareth I. Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database. Eur Heart J. 2008;29(24):2981–8. doi:10.​1093/​eurheartj/​ehn477.PubMedCrossRef
31.••
Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, et al. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events. Psychol Med. 2015;45(14):2909–20. doi:10.​1017/​S003329171500096​3. This systematic review and meta-regression found that panic disorder was significantly associated with incident coronary artery disease and major adverse cardiac events, even when controlling for depression.PubMedCrossRef
32.
33.
34.
35.
36.••
Edmondson D, Kronish IM, Shaffer JA, Falzon L, Burg MM. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J. 2013;166(5):806–14. doi:10.​1016/​j.​ahj.​2013.​07.​031. This meta-analysis, which included over 400,000 individuals, found that post-traumatic stress disorder was associated with an increased risk of incident coronary artery disease, independent of medical variables and depression.PubMedCrossRef
37.
38.
39.
Ladwig KH, Baumert J, Marten-Mittag B, Kolb C, Zrenner B, Schmitt C. Posttraumatic stress symptoms and predicted mortality in patients with implantable cardioverter-defibrillators: results from the prospective living with an implanted cardioverter-defibrillator study. Arch Gen Psychiatry. 2008;65(11):1324–30. doi:10.​1001/​archpsyc.​65.​11.​1324.PubMedCrossRef
40.
Bradley SM, Stanislawski MA, Bekelman DB, Monteith LL, Cohen BE, Schilling JH, et al. Invasive coronary procedure use and outcomes among veterans with posttraumatic stress disorder: insights from the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. Am Heart J. 2014;168(3):381–90. doi:10.​1016/​j.​ahj.​2014.​05.​015.PubMedCrossRef
41.
Duncan K, Pozehl B. Effects of an exercise adherence intervention on outcomes in patients with heart failure. Rehabil Nurs. 2003;28(4):117–22.PubMedCrossRef
42.
43.
McDermott MM, Schmitt B, Wallner E. Impact of medication nonadherence on coronary heart disease outcomes. A critical review. Arch Intern Med. 1997;157(17):1921–9.PubMedCrossRef
44.
45.
Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434–44.PubMedCrossRef
46.
47.
48.
49.
Gavrieli A, Farr OM, Davis CR, Crowell JA, Mantzoros CS. Early life adversity and/or posttraumatic stress disorder severity are associated with poor diet quality, including consumption of trans fatty acids, and fewer hours of resting or sleeping in a US middle-aged population: A cross-sectional and prospective study. Metabolism. 2015;64(11):1597–610. doi:10.​1016/​j.​metabol.​2015.​08.​017.​S0026-0495(15)00250-4.PubMedCrossRef
50.
51.
Lane D, Carroll D, Ring C, Beevers DG, Lip GY. Predictors of attendance at cardiac rehabilitation after myocardial infarction. J Psychosom Res. 2001;51(3):497–501.PubMedCrossRef
52.
53.
54.
Moyer CF, Sajuthi D, Tulli H, Williams JK. Synthesis of IL-1 alpha and IL-1 beta by arterial cells in atherosclerosis. Am J Pathol. 1991;138(4):951–60.PubMedPubMedCentral
55.
56.
Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med. 2000;343(16):1139–47. doi:10.​1056/​NEJM200010193431​602.PubMedCrossRef
57.
Hasper D, Hummel M, Kleber FX, Reindl I, Volk HD. Systemic inflammation in patients with heart failure. Eur Heart J. 1998;19(5):761–5.PubMedCrossRef
58.
Vasan RS, Sullivan LM, Roubenoff R, Dinarello CA, Harris T, Benjamin EJ, et al. Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart Study. Circulation. 2003;107(11):1486–91.PubMedCrossRef
59.
60.
61.
62.
63.
Passos IC, Vasconcelos-Moreno MP, Costa LG, Kunz M, Brietzke E, Quevedo J, et al. Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry. 2015;2(11):1002–12. doi:10.​1016/​S2215-0366(15)00309-0.PubMedCrossRef
64.
Heitzer T, Schlinzig T, Krohn K, Meinertz T, Munzel T. Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease. Circulation. 2001;104(22):2673–8.PubMedCrossRef
65.
Drexler H. Endothelial dysfunction: clinical implications. Prog Cardiovasc Dis. 1997;39(4):287–324.PubMedCrossRef
66.
67.
Narita K, Murata T, Hamada T, Takahashi T, Kosaka H, Yoshida H, et al. Association between trait anxiety and endothelial function observed in elderly males but not in young males. Int Psychogeriatr. 2007;19(5):947–54. doi:10.​1017/​S104161020600457​1.PubMedCrossRef
68.
69.
Harris KF, Matthews KA, Sutton-Tyrrell K, Kuller LH. Associations between psychological traits and endothelial function in postmenopausal women. Psychosom Med. 2003;65(3):402–9.PubMedCrossRef
70.
Felice F, Di Stefano R, Pini S, Mazzotta G, Bovenzi FM, Bertoli D, et al. Influence of depression and anxiety on circulating endothelial progenitor cells in patients with acute coronary syndromes. Hum Psychopharmacol. 2015;30(3):183–8. doi:10.​1002/​hup.​2470.PubMedCrossRef
71.
72.
73.
Garvey MJ, Noyes R, Woodman C, Laukes C. The association of urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid in patients with generalized anxiety. Neuropsychobiology. 1995;31(1):6–9.PubMedCrossRef
74.
75.
Miyata K, Shimokawa H, Higo T, Yamawaki T, Katsumata N, Kandabashi T, et al. Sarpogrelate, a selective 5-HT2A serotonergic receptor antagonist, inhibits serotonin-induced coronary artery spasm in a porcine model. J Cardiovasc Pharmacol. 2000;35(2):294–301.PubMedCrossRef
76.
Vikenes K, Farstad M, Nordrehaug JE. Serotonin is associated with coronary artery disease and cardiac events. Circulation. 1999;100(5):483–9.PubMedCrossRef
77.
78.
Levine SP, Towell BL, Suarez AM, Knieriem LK, Harris MM, George JN. Platelet activation and secretion associated with emotional stress. Circulation. 1985;71(6):1129–34.PubMedCrossRef
79.
Bedi US, Arora R. Cardiovascular manifestations of posttraumatic stress disorder. J Natl Med Assoc. 2007;99(6):642–9.PubMedPubMedCentral
80.
81.
82.
Gerritsen J, Dekker JM, TenVoorde BJ, Kostense PJ, Heine RJ, Bouter LM, et al. Impaired autonomic function is associated with increased mortality, especially in subjects with diabetes, hypertension, or a history of cardiovascular disease: the Hoorn Study. Diabetes Care. 2001;24(10):1793–8.PubMedCrossRef
83.
Buccelletti E, Gilardi E, Scaini E, Galiuto L, Persiani R, Biondi A, et al. Heart rate variability and myocardial infarction: systematic literature review and meta-analysis. Eur Rev Med Pharmacol Sci. 2009;13(4):299–307.PubMed
84.
La Rovere MT, Pinna GD, Hohnloser SH, Marcus FI, Mortara A, Nohara R, et al. Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001;103(16):2072–7.PubMedCrossRef
85.
86.
Kawachi I, Sparrow D, Vokonas PS, Weiss ST. Decreased heart rate variability in men with phobic anxiety (data from the Normative Aging Study). Am J Cardiol. 1995;75(14):882–5.PubMedCrossRef
87.
88.
89.
Cohen H, Kotler M, Matar MA, Kaplan Z, Loewenthal U, Miodownik H, et al. Analysis of heart rate variability in posttraumatic stress disorder patients in response to a trauma-related reminder. Biol Psychiatry. 1998;44(10):1054–9.PubMedCrossRef
90.
American Psychiatric Association. Desk reference to the diagnostic criteria from DSM-5. Washington: American Psychiatric Publishing; 2013.
91.
92.
93.
94.
Alvarez W, Pickworth KK. Safety of antidepressant drugs in the patient with cardiac disease: a review of the literature. Pharmacotherapy. 2003;23(6):754–71.PubMedCrossRef
95.
Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288(6):701–9.PubMedCrossRef
96.
Lesperance F, Frasure-Smith N, Koszycki D, Laliberte MA, van Zyl LT, Baker B, et al. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA. 2007;297(4):367–79. doi:10.​1001/​jama.​297.​4.​367.PubMedCrossRef
97.
Strik JJ, Honig A, Lousberg R, Lousberg AH, Cheriex EC, Tuynman-Qua HG, et al. Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: findings from a double-blind, placebo-controlled trial. Psychosom Med. 2000;62(6):783–9.PubMedCrossRef
98.
Fraguas R, da Silva Telles RM, Alves TC, Andrei AM, Rays J, Iosifescu DV, et al. A double-blind, placebo-controlled treatment trial of citalopram for major depressive disorder in older patients with heart failure: the relevance of the placebo effect and psychological symptoms. Contemp Clin Trials. 2009;30(3):205–11. doi:10.​1016/​j.​cct.​2009.​01.​007.PubMedCrossRef
99.
Gottlieb SS, Kop WJ, Thomas SA, Katzen S, Vesely MR, Greenberg N, et al. A double-blind placebo-controlled pilot study of controlled-release paroxetine on depression and quality of life in chronic heart failure. Am Heart J. 2007;153(5):868–73. doi:10.​1016/​j.​ahj.​2007.​02.​024.PubMedCrossRef
100.
O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, et al. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol. 2010;56(9):692–9. doi:10.​1016/​j.​jacc.​2010.​03.​068.PubMedPubMedCentralCrossRef
101.
Pellicori P, Clark AL. Clinical trials update from the European Society of Cardiology-Heart Failure meeting 2015: AUGMENT-HF, TITRATION, STOP-HF, HARMONIZE, LION HEART, MOOD-HF, and renin-angiotensin inhibitors in patients with heart and renal failure. Eur J Heart Fail. 2015;17(9):979–83. doi:10.​1002/​ejhf.​340.PubMedCrossRef
102.
Angermann CE, Gelbrich G, Stork S, Fallgatter A, Deckert J, Faller H, et al. Rationale and design of a randomised, controlled, multicenter trial investigating the effects of selective serotonin re-uptake inhibition on morbidity, mortality and mood in depressed heart failure patients (MOOD-HF). Eur J Heart Fail. 2007;9(12):1212–22. doi:10.​1016/​j.​ejheart.​2007.​10.​005.PubMedCrossRef
103.
Beach SR, Kostis WJ, Celano CM, Januzzi JL, Ruskin JN, Noseworthy PA, et al. Meta-analysis of selective serotonin reuptake inhibitor-associated QTc prolongation. J Clin Psychiatry. 2014;75(5):e441–9. doi:10.​4088/​JCP.​13r08672.PubMedCrossRef
104.
Beach SR, Celano CM, Noseworthy P, Januzzi J, Huffman JC. QTc prolongation, torsades de pointes, and psychotropic medications. Psychosomatics. 2013;54(1):1–13.PubMedCrossRef
105.
106.
Guck TP, Elsasser GN, Kavan MG, Barone EJ. Depression and congestive heart failure. Congest Heart Fail. 2003;9(3):163–9.PubMedCrossRef
107.
108.
Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, et al. Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation. 2003;108(8):939–44. doi:10.​1161/​01.​CIR.​0000085163.​21752.​0A.PubMedCrossRef
109.
110.
111.
Taylor CB, Youngblood ME, Catellier D, Veith RC, Carney RM, Burg MM, et al. Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Arch Gen Psychiatry. 2005;62(7):792–8. doi:10.​1001/​archpsyc.​62.​7.​792.PubMedCrossRef
112.
113.
114.
115.
Ho JM, Gomes T, Straus SE, Austin PC, Mamdani M, Juurlink DN. Adverse cardiac events in older patients receiving venlafaxine: a population-based study. J Clin Psychiatry. 2014;75(6):e552–8. doi:10.​4088/​JCP.​13m08508.PubMedCrossRef
116.
Cohen HW, Gibson G, Alderman MH. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. Am J Med. 2000;108(1):2–8.PubMedCrossRef
117.
Huffman JC, Stern TA. The use of benzodiazepines in the treatment of chest pain: a review of the literature. J Emerg Med. 2003;25(4):427–37.PubMedCrossRef
118.
119.
120.
121.
122.
Cully JA, Stanley MA, Deswal A, Hanania NA, Phillips LL, Kunik ME. Cognitive-behavioral therapy for chronic cardiopulmonary conditions: preliminary outcomes from an open trial. Prim Care Companion J Clin Psychiatry. 2010;12:4. doi:10.​4088/​PCC.​09m00896blu.
123.
124.
125.•
Tully PJ, Selkow T, Bengel J, Rafanelli C. A dynamic view of comorbid depression and generalized anxiety disorder symptom change in chronic heart failure: the discrete effects of cognitive behavioral therapy, exercise, and psychotropic medication. Disabil Rehabil. 2015;37(7):585–92. doi:10.​3109/​09638288.​2014.​935493. The only study examining the efficacy of CBT for anxiety disorders in HF, this trial enrolled 29 HF patients with both GAD and depression, then allowed patients to choose whether they preferred anxiety- or depression-focused CBT. Depression and anxiety appeared to improve in both groups, but patients receiving anxiety-focused CBT were less likely to have unplanned admissions during the follow-up period.PubMedCrossRef
126.
Berkman LF, Blumenthal J, Burg M, Carney RM, Catellier D, Cowan MJ, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA. 2003;289(23):3106–16. doi:10.​1001/​jama.​289.​23.​3106.PubMedCrossRef
127.
128.
Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Rubin EH. Cognitive behavior therapy for depression and self-care in heart failure patients: a randomized clinical trial. JAMA Intern Med. 2015;1:10. doi:10.​1001/​jamainternmed.​2015.​5220.
Metadata
Title
Anxiety Disorders and Cardiovascular Disease
Authors
Christopher M. Celano
Daniel J. Daunis
Hermioni N. Lokko
Kirsti A. Campbell
Jeff C. Huffman
Publication date
01-11-2016
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 11/2016
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-016-0739-5

Other articles of this Issue 11/2016

Current Psychiatry Reports 11/2016 Go to the issue

Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)

Psychological Mechanisms of PTSD and Its Treatment

Geriatric Disorders (W McDonald, Section Editor)

Apathy in Dementia: Systematic Review of Recent Evidence on Pharmacological Treatments

Military Mental Health (CH Warner, Section Editor)

Identifying and Managing Malingering and Factitious Disorder in the Military

Disaster Psychiatry: Trauma, PTSD, and Related Disorders (E Foa and A Asnaani, Section Editors)

The Role of Fear-Related Behaviors in the 2013–2016 West Africa Ebola Virus Disease Outbreak

Child and Adolescent Disorders (TD Benton, Section Editor)

Emergency Department Screening for Suicide and Mental Health Risk

Mood Disorders (MA Oquendo and MF Grunebaum, Section Editors)

Cognitive, Emotional, Temperament, and Personality Trait Correlates of Suicidal Behavior