201
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Bush M, Gaynes BN, Smith SC. Additional Considerations for Screening and Treatment of Depression in Patients With Acute Coronary Syndrome. JAMA Intern Med 2020; 180:473. [PMID: 32119049 DOI: 10.1001/jamainternmed.2019.7116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Montika Bush
- Department of Emergency Medicine, School of Medicine, University of North Carolina, Chapel Hill
| | - Bradley N Gaynes
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill
| | - Sidney C Smith
- Division of Cardiology, Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill
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202
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Thomas M, Patel KK, Gosch K, Labrosciano C, Mena-Hurtado C, Fitridge R, Spertus JA, Smolderen KG. Mental health concerns in patients with symptomatic peripheral artery disease: Insights from the PORTRAIT registry. J Psychosom Res 2020; 131:109963. [PMID: 32065970 PMCID: PMC7417281 DOI: 10.1016/j.jpsychores.2020.109963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To document the prevalence and patient profiles of mental health concerns in patients with peripheral artery disease (PAD) seen in the vascular specialty setting. METHODS In a cohort of 1275 patients presenting to 16 specialty clinics with new or worsening claudication, symptoms of depression, anxiety, and stress were quantified in 957 patients. The Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder scale-2 (GAD-2), and Perceived Stress Scale-4 (PSS-4) were assessed for mental health concerns at the initial PAD work-up and repeated 12 months later. PHQ-8 ≥ 10, GAD-2 ≥ 3 and PSS-4 ≥ 6 were considered significant for depression, anxiety and stress respectively. Patient characteristics were compared in groups divided by presence of 0, 1, 2 or all 3 mental health concerns. RESULTS On the initial office visit, 336/957 (35%) of patients had high levels of at least one of the three mental health concerns. At both baseline and 12 months, high levels of perceived stress were most often reported (28.7% and 17.5% respectively), followed by symptoms of depression (14.1% and 8.9%) and then anxiety (8.3% and 5.7%). Patients with mental health concerns were more often female, younger, had more financial strain, less social support, and worse perceived health status. CONCLUSIONS Mental health concerns, particularly stress, are highly prevalent in patients with PAD, especially upon first presenting with new or worsening symptoms. The role of stress and how it may impede successful PAD management and impact subsequent outcomes warrants further investigation.
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Affiliation(s)
- Merrill Thomas
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States of America; Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, United States of America
| | - Krishna K Patel
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States of America; Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, United States of America
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, United States of America
| | - Clementine Labrosciano
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Translational Vascular Function Research, Basil Hetzel Institute for Translational Research, Woodville, South Australia, Australia
| | - Carlos Mena-Hurtado
- Yale New Haven Hospital, Yale University, New Haven, CT, United States of America
| | - Robert Fitridge
- Discipline of Surgery, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - John A Spertus
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States of America; Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, United States of America
| | - Kim G Smolderen
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, United States of America; Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, United States of America; Yale New Haven Hospital, Yale University, New Haven, CT, United States of America.
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203
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Murphy B, Le Grande M, Alvarenga M, Worcester M, Jackson A. Anxiety and Depression After a Cardiac Event: Prevalence and Predictors. Front Psychol 2020; 10:3010. [PMID: 32063868 PMCID: PMC7000459 DOI: 10.3389/fpsyg.2019.03010] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/19/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Patients who are anxious or depressed after an acute cardiac event are at increased risk of a subsequent event and premature death. It is therefore important to identify these patients early in order to initiate supportive or even preventive measures. In the present study, we report on the prevalence of anxiety and depression during the first 12 months after an acute cardiac event, and the patient characteristics predictive of increased anxiety and depression risk in early and late convalescence. Methods We recruited a sample of 911 patients with acute myocardial infarction (AMI), acute coronary syndrome (ACS), and/or unstable angina (UA), and/or undergoing coronary artery bypass graft surgery (CABGS). Patients completed the Hospital Anxiety and Depression Scale (HADS) close to the time of their event, and again during early (2–4 months post-event) and late (6–12 months post-event) convalescence. Using HADS-A and HADS-D cut-offs of 8+, prevalence rates for anxiety, depression, and comorbid anxiety and depression were determined for each timepoint. Chi-square tests and odds ratios were used to identify baseline patient characteristics associated with increased anxiety and depression risk over 12 months. Results Anxiety rates were 43, 28, and 27% at the time of the event, early, and late convalescence. Depression rates were 22, 17, and 15%, respectively. Factors consistently associated with increased anxiety and depression risk were history of depression, financial strain, poor self-rated health, low socioeconomic status, younger age (<55 years), and smoking. Obesity, diabetes, and social isolation (living alone or being unpartnered) were identified as important albeit less significant risk factors. Neither sex nor event type were predictive of anxiety or depression. Conclusion This large patient sample provided the opportunity to identify rates of anxiety and depression during the 12 months after a cardiac event and key patient characteristics for increased risk. These risk factors are easily identifiable at the time of the event, and could be used to guide the targeting of support programs for patients at risk.
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Affiliation(s)
- Barbara Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Burwood, VIC, Australia.,Department of Psychology, The University of Melbourne, Parkville, VIC, Australia
| | - Michael Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Marlies Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Marian Worcester
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alun Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Faculty of Health, Deakin University, Burwood, VIC, Australia.,Centre on Behavioral Health, The University of Hong Kong, Hong Kong, Hong Kong
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204
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Heenan A, Greenman PS, Tassé V, Zachariades F, Tulloch H. Traumatic Stress, Attachment Style, and Health Outcomes in Cardiac Rehabilitation Patients. Front Psychol 2020; 11:75. [PMID: 32047467 PMCID: PMC6997333 DOI: 10.3389/fpsyg.2020.00075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/10/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Research on psychosocial risk factors in cardiovascular disease (CVD) has identified traumatic stress and attachment style as independent risk factors for the development of CVD and poor prognosis for those with established CVD. Exploring the interrelationships between these variables will inform psychosocial risk factor modeling and potential avenues for intervention. Therefore, the hypothesis that attachment style is related to health outcomes among CR patients and that traumatic stress mediates this relationship was tested. METHODS Patients in a cardiac rehabilitation program (n = 201) completed validated self-report measures of traumatic stress and attachment style at baseline (program intake). Health outcomes were assessed at baseline and 3 months, including anxiety, depression, quality of life, fasting blood glucose, glycated hemoglobin (HbA1c), and cholesterol (HDL ratio). Multivariate structural equation modeling was used to fit the data. RESULTS Of the 201 participants, 42 (21%) had trauma scores indicating the probable presence of posttraumatic stress disorder. Via greater levels of traumatic stress, greater attachment anxiety at baseline was indirectly related to greater anxiety, depression, fasting blood glucose, and HbA1c, and poorer physical and mental quality of life. There were no significant indirect effects on HDL ratios. CONCLUSION Greater attachment anxiety predicted greater traumatic stress; this, in turn, predicted poorer health outcomes. Screening and treatment for these constructs in CVD patients is warranted.
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Affiliation(s)
- Adam Heenan
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Paul S. Greenman
- Département de Psychoéducation et de Psychologie, Universite du Québec en Outaouais, Gatineau, QC, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Vanessa Tassé
- Département de Psychoéducation et de Psychologie, Universite du Québec en Outaouais, Gatineau, QC, Canada
| | | | - Heather Tulloch
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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205
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Abstract
The occurrence of depression, anxiety, and insomnia is strikingly high in patients with heart failure and is linked to increased morbidity and mortality. However, symptoms are frequently unrecognized and the integration of mental health into cardiology care plans is not routine. This article describes the prevalence, identification, and treatment of common comorbid psychological disorders.
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Affiliation(s)
- Katherine E Di Palo
- Office of the Medical Director, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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206
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Mailloux LM, Haas MT, Kennedy SP, DeJongh BM. Implementation and evaluation of depression screening in patients with recently diagnosed coronary artery disease. Ment Health Clin 2020; 10:12-17. [PMID: 31942273 PMCID: PMC6956978 DOI: 10.9740/mhc.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Patients with coronary artery disease (CAD) are at an increased risk for depression. Additionally, comorbid depression in patients with CAD is associated with increased mortality and worse cardiac outcomes. Screening this patient population for depression is recommended but is not routinely done in practice. The purpose of this quality improvement initiative was to implement a protocol to screen patients with CAD for depression using the Patient Health Questionnaire (PHQ-9). Primary objectives were to determine the frequency of positive depression screens and the frequency of acceptance of mental health (MH) service referral. Methods Patients with CAD were screened for depression using the PHQ-9 during a hospital admission to the inpatient cardiology unit at the Clement J. Zablocki Veterans Affairs Medical Center. All patients were rescreened for depression at 4 and 8 weeks after discharge. Patients with positive screens for depression were offered referral for MH services, and reasons for decline were documented. Results Of the 36 patients screened for depression, 14 (39%) screened positive for depression, including 10 patients at baseline (28%), 3 additional patients (8%) at week 4 after discharge, and 1 additional patient (3%) at week 8 after discharge. Of the 14 patients who screened positive for depression, 3 patients (21%) accepted MH service referral. The most commonly reported reason for declining referral was no perceived benefit. Discussion The results of this initiative support the utility of using the PHQ-9 for depression screening in patients with recently diagnosed CAD and offering MH service referral for treatment of comorbid depression.
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207
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Tully PJ, Cosh SM. Post-traumatic Stress Disorder in Heart Failure Patients: A Test of the Cardiac Disease-induced PTSD Hypothesis. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666191113121558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:Post-traumatic stress disorder (PTSD) is prevalent in approximately 12% of patients with cardiovascular disease (CVD) and such patients are at risk of further CVD morbidity and mortality. It is unknown whether CVD patients with cardiac and non-cardiac traumatic events leading to PTSD differ in medical comorbidities and psychiatric vulnerabilities. Our objective was to compare heart failure (HF) patients with cardiac and non-cardiac PTSD.Method:A population of HF patients from 3 hospitals underwent a two-step depression and anxiety screening process to identify potential mental health treatment needs. The post-traumatic stress disorder module of the Structured Clinical Interview for DSM-IV Axis-I disorders was used to classify trauma(s) exposure, and other disorders. The patients with PTSD were sub-divided by cardiac related traumas (e.g. myocardial infarction, sudden cardiac arrest) and non-cardiac related traumas (e.g. sexual abuse, interpersonal violence).Results:10 patients met criteria for non-cardiac trauma and 18 patients met criteria for cardiacinduced trauma. There were no significant differences in HF aetiology or severity nor cardiac comorbidities. Time since PTSD, onset was significantly longer for those with non-cardiac PTSD. Among psychiatric comorbidities, alcohol and substance abuse disorders, as well as depression were more prevalent in patients with non-cardiac PTSD.Conclusion:Cardiac related PTSD was associated with less alcohol and substance abuse disorders, and depression by comparison to their non-cardiac induced PTSD counterparts. Ongoing research is required to establish if cardiac-induced PTSD truly reflects a unique subtype of PTSD, and whether there are different treatment needs and therapeutic approaches for this subtype.
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Affiliation(s)
- Phillip J. Tully
- Freemasons Foundation Centre for Men’s Health, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, Australia
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208
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Grech M, Turnbull DA, Wittert GA, Tully PJ. Identifying the Internalizing Disorder Clusters Among Recently Hospitalized Cardiovascular Disease Patients: A Receiver Operating Characteristics Study. Front Psychol 2020; 10:2829. [PMID: 31920862 PMCID: PMC6929587 DOI: 10.3389/fpsyg.2019.02829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022] Open
Abstract
Depression and anxiety disorders are common among cardiovascular disease (CVD) populations, leading several cardiology societies to recommend routine screening to streamline psychological interventions. However, it remains poorly understood whether routine screening in CVD populations identifies the broader groups of disorders that cluster together within individuals, known as anxious-misery and fear. This study examines the screening utility of four anxiety and depression questionnaires to identify the two internalizing disorder clusters; anxious-misery and fear. Patients with a recent hospital admission for CVD (n = 85, 69.4% males) underwent a structured clinical interview with the MINI International Neuropsychiatric Interview. The participants also completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, Overall Anxiety Severity Impairment Scale (OASIS), and the stress subscale of the Depression Anxiety Stress Scale (DASS). The PHQ-9 and the GAD-7 yielded appropriate screening properties to detect three different iterations of the anxious-misery cluster (sensitivity >80.95% and specificity >82.81%). The GAD-7 was the only instrument to display favorable screening properties to detect a fear cluster omitting post-traumatic stress disorder (PTSD) but including obsessive-compulsive disorder (OCD; sensitivity 81.25%, specificity 76.81%). These findings indicate that the PHQ-9 and GAD-7 could be implemented to reliably screen for anxious-misery disorders among CVD in-patients, however, the receiver operating characteristics (ROC) to detect fear disorders were contingent on the placement of PTSD and OCD within clusters. The findings are discussed in relation to routine screening guidelines in CVD populations and contemporary understandings of the internalizing disorders.
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Affiliation(s)
- Megan Grech
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia.,Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Phillip J Tully
- Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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209
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Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2020. [DOI: 10.5812/ijpbs.85820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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210
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Michal M, Eggebrecht L, Göbel S, Panova-Noeva M, Nagler M, Arnold N, Lauterbach M, Bickel C, Wiltink J, Beutel ME, Münzel T, Wild PS, Prochaska JH. The relevance of depressive symptoms for the outcome of patients receiving vitamin K antagonists: results from the thrombEVAL cohort study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:271-279. [PMID: 31922545 DOI: 10.1093/ehjcvp/pvz085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/14/2019] [Accepted: 01/06/2020] [Indexed: 02/02/2023]
Abstract
AIMS Although depressive symptoms are highly prevalent in patients receiving oral anticoagulation (OAC), the relevance of depression for the outcome of anticoagulated individuals is unknown. METHODS AND RESULTS We analysed data from the multicentre cohort study thrombEVAL (NCT01809015) investigating the efficacy of OAC with vitamin K antagonists. There was an independent study monitoring, and an independent review panel assessed the endpoints. Out of n = 1558 participants, information about depressive symptoms, as measured by the two-item screener of the patient health questionnaire (PHQ-2), was available in n = 1405 individuals. The mean follow-up period was 28.04 months, with a standard deviation of 11.52 months. In multivariable Cox regression analysis, baseline PHQ-2 sum score was a strong and robust predictor of clinically relevant bleeding [hazard ratio (HR) 1.13, 95% confidence interval 1.03-1.24; P = 0.011] and all-cause mortality (HR 1.18, 1.08-1.28; P = 0.001) independent of age, sex, high school graduation, partnership, clinical profile, intake of serotonin reuptake inhibitors, and quality of OAC therapy. Individuals with clinically significant depressive symptoms (PHQ-2 ≥ 3) had a 57% increased risk for clinically relevant bleeding (fully adjusted HR 1.57, 1.08-2.28) and 54% greater risk for death (fully adjusted HR 1.54, 1.09-2.17). There was no association of depressive symptoms with thromboembolic events. For hospitalization, individuals with depressive symptoms (PHQ-2 ≥ 3) did not experience an elevated risk in the fully adjusted model (HR 1.08, 0.86-1.35; P = 0.52). CONCLUSION Assessment of depression by the PHQ-2 provided independent long-term prognostic information beyond common biomedical risk factors. These findings highlight the need for targeting depressive symptoms in the management of patients receiving OAC therapy.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Lisa Eggebrecht
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sebastian Göbel
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Marina Panova-Noeva
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Markus Nagler
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Natalie Arnold
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Michael Lauterbach
- Department of Medicine 3, Barmherzige Brüder Hospital Trier, Nordallee 1, 54292 Trier, Germany
| | - Christoph Bickel
- Department of Medicine I, Federal Armed Forces Central Hospital, Rübenacher Str. 170, 56072 Koblenz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Thomas Münzel
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Cardiology - Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Philipp S Wild
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Jürgen H Prochaska
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Langenbeckstr. 1, 55131 Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
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211
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Donneyong M, Reynolds C, Mischoulon D, Chang G, Luttmann-Gibson H, Bubes V, Guilds M, Manson J, Okereke O. Protocol for studying racial/ethnic disparities in depression care using joint information from participant surveys and administrative claims databases: an observational cohort study. BMJ Open 2020; 10:e033173. [PMID: 31915172 PMCID: PMC6955513 DOI: 10.1136/bmjopen-2019-033173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Current evidence indicates that older racial/ethnic minorities encounter disparities in depression care. Because late-life depression is common and confers major adverse health consequences, it is imperative to reduce disparities in depression care. Thus, the primary objectives of this protocol are to: (1) quantify racial/ethnic disparities in depression treatment and (2) identify and quantify the magnitude of these disparities accountable for by a multifactorial combination of patient, provider and healthcare system factors. METHODS AND ANALYSIS Data will be derived from the Vitamin D and Omega-3 Trial-Depression Endpoint Prevention (VITAL-DEP) study, a late-life depression prevention ancillary study to the VITAL trial. A total of 25 871 men and women, aged 50+ and 55+ years, respectively, were randomised in a 2×2 factorial randomised trial of heart disease and cancer prevention to receive vitamin D and/or fish oil for 5 years starting from 2011. Most participants were aged 65+ years old at randomisation. Medicare claims data for over 19 000 VITAL/VITAL-DEP participants were linked to conduct our study.The major study outcomes are depression treatment (antidepressant use and/or receipt of psychotherapy services) and adherence to medication treatment (antidepressant adherence and acceptability). The National Academy of Medicine framework for studying racial disparities was leveraged to select patient-level, provider-level and healthcare system-level variables and to address their potential roles in depression care disparities. Blinder-Oaxaca regression decomposition methods will be implemented to quantify and identify correlates of racial/ethnic disparities in depression treatment and adherence. ETHICS AND DISSEMINATION This study received Institutional Review Board (IRB) approval from the Partners Healthcare (PHS) IRB, protocol# 2010P001881. We plan to disseminate our results through publication of manuscripts patient engagement activities, such as study newsletters regularly sent out to VITAL participants, and presentations at scientific meetings. TRIAL REGISTRATION NUMBER NCT01696435.
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Affiliation(s)
- Macarius Donneyong
- Pharmacy Practice and Science, College of Pharmacy, The Ohio University State University, Columbus, Ohio, USA
| | - Charles Reynolds
- Psychiatry, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Grace Chang
- Psychiatry, Harvard University, Cambridge, Massachusetts, USA
- Psychiatry, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Heike Luttmann-Gibson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Vadim Bubes
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Joann Manson
- Psychiatry, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Olivia Okereke
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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212
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Kronish IM, Moise N, Cheung YK, Clarke GN, Dolor RJ, Duer-Hefele J, Margolis KL, St Onge T, Parsons F, Retuerto J, Thanataveerat A, Davidson KW. Effect of Depression Screening After Acute Coronary Syndromes on Quality of Life: The CODIACS-QoL Randomized Clinical Trial. JAMA Intern Med 2020; 180:45-53. [PMID: 31633746 PMCID: PMC6806435 DOI: 10.1001/jamainternmed.2019.4518] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/21/2022]
Abstract
Importance Patients with acute coronary syndrome (ACS) and elevated depressive symptoms are at increased risk for recurrent cardiovascular events and mortality, worse quality of life, and higher health care costs. These observational findings prompted multiple scientific panels to advise universal depression screening in survivors of ACS prior to evidence from randomized screening trials. Objective To determine whether systematically screening for depression in survivors of ACS improves quality of life and depression compared with usual care. Design, Setting, and Participants A 3-group multisite randomized trial enrolled 1500 patients with ACS from 4 health care systems between November 1, 2013, and March 31, 2017, with follow-up ending July 31, 2018. Patients were eligible if they had been hospitalized for ACS in the previous 2 to 12 months and had no prior history of depression. All analyses were performed on an intention-to-treat basis. Interventions Patients with ACS were randomly assigned 1:1:1 to receive (1) systematic depression screening using the 8-item Patient Health Questionnaire, with notification of primary care clinicians and provision of centralized, patient-preference, stepped depression care for those with positive screening results (8-item Patient Health Questionnaire score ≥10; screen, notify, and treat, n = 499); (2) systematic depression screening, with notification of primary care clinicians for those with positive screening results (screen and notify, n = 501); and (3) usual care (no screening, n = 500). Main Outcomes and Measures The primary outcome was change in quality-adjusted life-years. The secondary outcome was depression-free days. Adverse effects and mortality were assessed by patient interview and hospital records. Results A total of 1500 patients (424 women and 1076 men; mean [SD] age, 65.9 [11.5] years) were randomized in the 18-month trial. Only 71 of 1000 eligible survivors of ACS (7.1%) had elevated 8-item Patient Health Questionnaire scores indicating depressive symptoms at screening. There were no differences in mean (SD) change in quality-adjusted life-years (screen, notify and treat, -0.06 [0.20]; screen and notify, -0.06 [0.20]; no screen, -0.06 [0.18]; P = .98) or cumulative mean (SD) depression-free days (screen, notify and treat, 343.1 [179.0] days; screen and notify, 351.3 [175.0] days; no screen, 339.0 [176.6] days; P = .63). Harms including death, bleeding, or sleep difficulties did not differ among groups. Conclusions and Relevance In patients with ACS without a history of depression, systematic depression screening with or without providing depression treatment did not alter quality-adjusted life-years, depression-free days, or harms. Trial Registration ClinicalTrials.gov identifier: NCT01993017.
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Affiliation(s)
- Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ying Kuen Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | | | - Rowena J. Dolor
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Joan Duer-Hefele
- Center for Personalized Medicine, Northwell Health, New York, New York
| | | | - Tara St Onge
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Faith Parsons
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jessica Retuerto
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Anusorn Thanataveerat
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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A pilot randomized controlled trial to assess the effect of Islamic spiritual intervention and of breathing technique with heart rate variability feedback on anxiety, depression and psycho-physiologic coherence in patients after coronary artery bypass surgery. Ann Gen Psychiatry 2020; 19:46. [PMID: 32817752 PMCID: PMC7425359 DOI: 10.1186/s12991-020-00296-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 08/07/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study investigated the effects of Islamic religious and breathing techniques with heart rate variability (HRV) biofeedback therapies on HRV and psycho-physiologic coherence (resonance frequency), depression and anxiety in coronary artery bypass graft surgery (CABG) patients. METHODS Sixty CABG patients were chosen and randomly assigned to religious, breathing techniques and control groups. The experimental groups received 8 weeks of treatments; a 2-h session with home works in each week. The control group received only their normal hospital interventions. The groups' depression, anxiety, HRV and psycho-physiologic coherence levels were assessed before and after the interventions by DASS-21 for depression and anxiety, and em-wave desktop software for HRV and psycho-physiologic coherence. The data were analyzed using ANCOVA with Bonferroni Comparison test and descriptive tests in SPSS software. RESULTS The findings showed that there were significant differences in psycho-physiologic coherence (HRV), depression and anxiety scores among the three groups in the post-tests. In fact, depression and anxiety were reduced more in the religious group, while psycho-physiologic coherence raised more in the breathing with the HRV feedback group. CONCLUSION The results showed that both Islamic religious and breathing techniques with HRV biofeedback therapies can be used in rehabilitation programs for CABG patients in clinics and hospitals.
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214
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Li G, Li J, Gao F. Exercise and Cardiovascular Protection. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1228:205-216. [PMID: 32342460 DOI: 10.1007/978-981-15-1792-1_14] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Accumulating evidence has demonstrated that exercise training not only reduces cardiovascular disease risk but also provides direct endogenous cardiovascular protection. The mechanisms that have been proposed to be responsible for exercise-induced cardioprotection include intrinsic myocardial changes such as increased cytosolic antioxidant capacity and altered mitochondrial phenotype, myokine-mediated metabolic and anti-inflammatory effects in the cardiovascular system, and systemic effects on the cardiovascular system via interorgan cross talk. There remains much to be elucidated in the mechanisms for exercise-afforded cardioprotection. This chapter reviews exercise-induced acute and chronic responses in cardiovascular system, the epidemiological evidence of exercise training and cardiorespiratory fitness in the primary and secondary prevention of cardiovascular diseases, and the current understanding of the mechanisms of exercise-induced cardiovascular protective effects.
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Affiliation(s)
- Guohua Li
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Jia Li
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Feng Gao
- School of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China.
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Bajaj N, Sharma A, Bajaj S, Pisharody R, Patrikar S. Depressive disorders in angiographic-proven coronary artery disease: A Cross Sectional Study. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Pocock SJ, Brieger D, Gregson J, Chen JY, Cohen MG, Goodman SG, Granger CB, Grieve R, Nicolau JC, Simon T, Westermann D, Yasuda S, Hedman K, Rennie KL, Sundell KA. Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry. Clin Cardiol 2020; 43:24-32. [PMID: 31713893 PMCID: PMC6954378 DOI: 10.1002/clc.23283] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Risk prediction tools are lacking for patients with stable disease some years after myocardial infarction (MI). HYPOTHESIS A practical long-term cardiovascular risk index can be developed. METHODS The long-Term rIsk, Clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients prospective global registry enrolled patients 1 to 3 years post-MI (369 centers; 25 countries), all with ≥1 risk factor (age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, or chronic non-end-stage kidney disease [CKD]). Self-reported health was assessed with EuroQoL-5 dimensions. Multivariable Poisson regression models were used to determine key predictors of the primary composite outcome (MI, unstable angina with urgent revascularization [UA], stroke, or all-cause death) over 2 years. RESULTS The primary outcome occurred in 621 (6.9%) of 9027 eligible patients: death 295 (3.3%), MI 195 (2.2%), UA 103 (1.1%), and stroke 58 (0.6%). All events accrued linearly. In a multivariable model, 11 significant predictors of primary outcome (age ≥65 years, diabetes, second prior MI, CKD, history of major bleed, peripheral arterial disease, heart failure, cardiovascular hospitalization (prior 6 months), medical management (index MI), on diuretic, and poor self-reported health) were identified and combined into a user-friendly risk index. Compared with lowest-risk patients, those in the top 16% had a rate ratio of 6.9 for the primary composite, and 18.7 for all-cause death (overall c-statistic; 0.686, and 0.768, respectively). External validation was performed using the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events registry (c-statistic; 0.748, and 0.849, respectively). CONCLUSIONS In patients >1-year post-MI, recurrent cardiovascular events and deaths accrue linearly. A simple risk index can stratify patients, potentially helping to guide management.
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Affiliation(s)
- Stuart J. Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
| | - David Brieger
- Division of Cardiology, Concord Hospital and University of SydneySydneyAustralia
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
| | - Ji Y. Chen
- Department of Cardiology, Guangdong General Hospital, Provincial Key Laboratory of Coronary DiseaseGuangzhouChina
| | - Mauricio G. Cohen
- Cardiovascular Division, University of Miami Miller School of MedicineMiamiFlorida
| | - Shaun G. Goodman
- Already given, Terrence Donnelly Heart Centre, St Michael's Hospital, University of TorontoTorontoCanada
| | - Christopher B. Granger
- Cardiac Intensive Care Unit, Duke Clinical Research Institute, Duke University Medical CenterDurhamNorth Carolina
| | - Richard Grieve
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
| | - Jose C. Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São PauloSão PauloSPBrazil
| | - Tabassome Simon
- Assistance Publique‐Hopitaux de Paris (APHP) Department of Clinical Pharmacology and Clinical Research Platform of East of ParisParisFrance
- Department of Pharmacology, Sorbonne‐Université (UPMC‐Paris 06)ParisFrance
| | - Dirk Westermann
- Department of General and Interventional CardiologyUniversity Heart Center EppendorfHamburgGermany
- German Center for Cardiovascular Research (DZHK)Partner site Hamburg/Lübeck/KielHamburgGermany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular CenterOsakaJapan
| | - Katarina Hedman
- Global Medical Affairs Cardiovascular, Renal and Metabolic, AstraZenecaGothenburgSweden
| | - Kirsten L. Rennie
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
- Oxon Epidemiology (UK)LondonUK
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Gulati R, Behfar A, Narula J, Kanwar A, Lerman A, Cooper L, Singh M. Acute Myocardial Infarction in Young Individuals. Mayo Clin Proc 2020; 95:136-156. [PMID: 31902409 DOI: 10.1016/j.mayocp.2019.05.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/07/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022]
Abstract
Globally, cardiovascular disease remains a major cause of adverse outcomes in young individuals, unlike its decline in other age groups. This group is not well studied and has a unique risk profile with less traditional cardiovascular risk factors compared with older populations. Plaque rupture still remains the most common etiology of myocardial infarction, but unique syndromes such as plaque erosion, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary spasm related to drug use are more prevalent in this age group. Such diversity of diagnosis and presentation, along with therapeutic implications, underscore the need to study the profile of myocardial infarction in young persons. We searched PubMed for articles published from 1980 to 218 using the terms acute myocardial infarction, young, plaque rupture, plaque erosion, spontaneous coronary artery dissection (SCAD), coronary vasospasm, variant or Prinzmetal angina, drug-induced myocardial infarction, myocarditis, coronary embolism, microvascular dysfunction, MINOCA, and myocardial infarction in pregnancy and reviewed all the published studies. With the data from this search, we aim to inform readers of the prevalence, risk factors, presentation, and management of acute myocardial infarction in young patients and elaborate on special subgroups with diagnostic and therapeutic challenges. We also outline a parsimonious method designed to simplify management of these complex patients.
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Affiliation(s)
- Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jagat Narula
- Department of Medicine/Cardiology, Mount Sinai Hospital, New York, NY
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leslie Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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218
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Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study. BMC Psychiatry 2019; 19:426. [PMID: 31888603 PMCID: PMC6937690 DOI: 10.1186/s12888-019-2387-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinically significant depressive symptoms are prevalent in people attending low vision clinics and often go undetected. The Low Vision Service Wales (LVSW) plans to introduce depression screening and management pathways. Prior to implementation there is an unmet need to understand how eye care practitioners providing the service currently address depression with patients, and the characteristics and beliefs that influence their practice. METHODS A mixed methods convergent design was employed. Twelve low vision practitioners were purposively selected to engage in individual semi-structured interviews which were analysed using thematic analysis. A further 167 practitioners were invited to complete a questionnaire assessing professional background, current practice, confidence and perceived barriers in working with people with low vision and suspected depression. Multiple regression analyses were performed to determine the characteristics related to the Rasch-transformed questionnaire scores. RESULTS Of the 122 practitioners that responded to the questionnaire, 33% aimed to identify depression in patients, and those who were more confident were more likely to do so. Those who scored higher on the perceived barriers scale and lower on confidence were less likely to report acting in response to suspected depression (all p < 0.05). Three qualitative themes were identified; depression is an understandable response to low vision, patients themselves are a barrier to addressing depression and practitioners lacked confidence in their knowledge and skills to address depression. The qualitative data largely expanded the quantitative findings. CONCLUSIONS Practitioners viewed their own lack of knowledge and confidence as a barrier to the identification and management of depression and expressed a need for training prior to the implementation of service changes. The study findings will help to inform the development of a training programme to support low vision practitioners and those working with other chronic illness in Wales, and internationally, in the identification and management of people with depression.
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Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Bartlett
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Ryan Man
- Singapore Eye Research Institute, 20 College Road, The Academia, Discovery Tower Level 6, Singapore, 169856 Singapore
| | - Timothy Pickles
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jennifer H. Acton
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
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219
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Ryan CJ, Bierle RS, Vuckovic KM. The Three Rs for Preventing Heart Failure Readmission: Review, Reassess, and Reeducate. Crit Care Nurse 2019; 39:85-93. [PMID: 30936132 DOI: 10.4037/ccn2019345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Despite improvements in heart failure therapies, hospitalization readmission rates remain high. Nationally, increasing attention has been directed toward reducing readmission rates and thus identifying patients with the highest risk for readmission. This article summarizes the evidence related to decreasing readmission for patients with heart failure within 30 days after discharge, focusing on the acute setting. Each patient requires an individualized plan for successful transition from hospital to home and preventing readmission. Nurses must review the patient's current plan of care and adherence to it and look for clues to failure of the plan that could lead to readmission to the hospital. In addition, nurses must reassess the current plan with the patient and family to ensure that the plan continues to meet the patient's needs. Finally, nurses must continually reeducate patients about their plan of care, their plan for self-management, and strategies to prevent hospital readmission for heart failure.
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Affiliation(s)
- Catherine J Ryan
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago. .,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota. .,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago.
| | - Rebecca Schuetz Bierle
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
| | - Karen M Vuckovic
- Catherine J. Ryan is a clinical associate professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, and Director, Nursing Evidence Based Practice and Nursing Research, University of Illinois Hospital & Health Sciences System, Chicago.,Rebecca (Schuetz) Bierle is a nurse practitioner, Cardiology, Regional Health Heart and Vascular Institute, Rapid City, South Dakota.,Karen M. Vuckovic is an advanced practice nurse, Division of Cardiology, University of Illinois Hospital & Health Sciences System, and a clinical assistant professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago
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220
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Gisi B, Althouse AD, Mathier AS, Pusateri A, Rollman BL, LaRosa A, Magnani JW. The unmeasured burden: Contribution of depression and psychological stress to patient-reported outcomes in atrial fibrillation. Int J Cardiol 2019; 302:75-80. [PMID: 31837900 DOI: 10.1016/j.ijcard.2019.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/24/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Patient-reported outcomes are routinely assessed in atrial fibrillation (AF) to evaluate efficacy of treatment and as clinical trial outcomes. The relation of depression to such measures has had limited study in AF. METHODS In a cohort receiving treatment for AF, we assessed depression with the Patient Health Questionniare-9 (PHQ; 0-4, normal range; 5-9, mild depression; ≥10 moderate depression). We related depression to disease-specific quality of life with the AF Effect on QualiTy of life (AFEQT, range 0-100) and the Global Perceived Stress Scale (GPPS, range 0-24) in multivariable-adjusted models. RESULTS In 260 individuals (age 71.7 ± 10.1, 44.6% women) with AF, 51 (26.1%) had PHQ scores ≥5 and 17 (6.5%) ≥10. AFEQT scores decreased progressively with depression severity (normal range PHQ, 81.4 ± 14.1; mild depression, 65.8 ± 17.1; moderate depression, 50.6 ± 19.3). Individuals without depression had lower GPPS scores (3.0 ± 2.6) than those with mild (4.9 ± 2.5) or moderate (8.9 ± 4.0) depression. In multivariable-adjusted models mild depression was associated with a 12.1-point (95% confidence interval [CI], -17.2 to -6.9) decrease in AFEQT and 1.9-point (95% CI, 1.1 to 2.7) increase in GPSS, while moderate depression a 27.7-point (95% CI, -35.5 to -19.8) decrease in AFEQT and 5.5-point (95% CI, 4.2 to 6.8) increase in GPSS, relative to normal range PHQ. Regression analyses confirmed significant correlations between depression and AFEQT and GPPS scores in multivariable-adjusted models. CONCLUSIONS We determined that depression is associated with a step-wise, progressively adverse change in patient-centered outcomes in individuals with AF. Our findings suggest the importance of assessing depression in the evaluation of AF. Subject term list: health services, atrial fibrillation, risk factors.
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Affiliation(s)
- Brittany Gisi
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew D Althouse
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abigail S Mathier
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Bruce L Rollman
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Behavioral Health and Smart Technology, Pittsburgh, PA, USA
| | - Anna LaRosa
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jared W Magnani
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Cardiology, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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Worcester MU, Goble AJ, Elliott PC, Froelicher ES, Murphy BM, Beauchamp AJ, Jelinek MV, Hare DL. Mild Depression Predicts Long-Term Mortality After Acute Myocardial Infarction: A 25-Year Follow-Up. Heart Lung Circ 2019; 28:1812-1818. [DOI: 10.1016/j.hlc.2018.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
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10-Year trend in the prevalence and predictors of depression among patients with heart failure in the USA from 2007-2016. Int J Cardiol 2019; 301:123-126. [PMID: 31757653 DOI: 10.1016/j.ijcard.2019.09.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart failure (HF) constitutes a major public health problem in the USA with self-management playing a key role in treatment. Depressed patients often have poor insights which correlates with increased rates of adverse events such as emergency room visits, admissions and readmissions, length of hospital stay and mortality. AIM To determine the prevalence, trends, and predictors of depression among community-based patients with HF in the USA, and its association with self-perceived health status. METHODS Using the 2007 through 2016 NHANES data, we identified patients with HF aged 20-80 years with completed PHQ-9 depression screening questionnaire. PHQ-9 scores ≥10 were considered diagnostic for depression. The Chi square test was used for comparison of prevalence of depression between subgroups with p < 0.05 considered statistically significant. RESULTS The prevalence of depression among community-based patients with HF was 17.3% and remained stable from 2007 through 2016. Female participants, persons <60years, individuals with low socioeconomic status, and never married individuals were more likely to be depressed, comparatively. After controlling for confounders, living in poverty was the lone predictor of depression with OR 5.1 (95% CI 1.4-17.9), compared to those with incomes ≥3 times the poverty threshold. Depressed individuals were more likely to report a poor health status (76.4%) compared to non-depressed individuals (45.9%), p < 0.001. CONCLUSION Over 1 in 6 community-based patients with HF suffers from depression with women, individuals <60years, never married, and persons with low socioeconomic status shouldering a disproportionately higher burden.
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Davidson KW, Alcántara C, Miller GE. Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities. ACTA ACUST UNITED AC 2019; 73:1019-1030. [PMID: 30394780 DOI: 10.1037/amp0000239] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Evidence of popular interest in the interrelationships between mind, body, and heart disease dates to Ancient Grecian times and paved the way for modern-day scientific inquiry into the relationships between psychological comorbidities in coronary heart disease. Although the systematic evidence has suggested an association of poor medical prognosis and lower quality of life among patients with coronary heart disease with comorbid psychological conditions, the mechanisms are less well understood. In this selective review article, the epidemiology, mechanisms, screening, and treatment recommendations for 4 common psychological conditions (depression, anxiety, stress, and insomnia) comorbid with coronary heart disease are presented. We focus on the grand challenges and unprecedented opportunities for research in this area considering the methodological and technological innovations of the 21st century. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Karina W Davidson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center
| | - Carmela Alcántara
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center
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Depression, Anxiety, Perceived Stress, and Their Changes Predict Greater Decline in Physical Health Functioning over 12 Months Among Patients with Coronary Heart Disease. Int J Behav Med 2019; 26:352-364. [PMID: 31218559 DOI: 10.1007/s12529-019-09794-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although the deleterious impact of psychological distress on patients with coronary heart disease (CHD) is recognized, few studies have examined the influence of change in psychological distress on health outcomes over time. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted the decline in physical functioning in CHD patients over 12 months. In addition, perceived social support was examined as a buffer of psychological distress or a direct predictor of physical functioning. METHODS Participants were 255 CHD patients with a mean age of 63 (SD = 8.65) years, including 208 men and 47 women. Psychological distress and physical functioning were assessed at baseline, 6 months and 12 months. Hierarchical regression analyses were conducted to examine the influences of psychological factors on physical functioning over 12 months. All models were adjusted for baseline physical functioning, age, gender, marital status, education, BMI, and length of participation at a wellness center. RESULTS For each psychological distress variable (depression, anxiety, or perceived stress), both the baseline (βs = - 0.19 to - 0.32, ps = 0.008 to < 0.001) and its respective change over time (βs = - 0.17 to - 0.38, ps = 0.020 to < 0.001) independently and significantly predicted greater decline in physical functioning at 6 and 12 months, after adjusting for covariates. Perceived social support predicted greater improvement in physical functioning at 12 months (β = 0.13, p = 0.050), but it did not buffer impact of psychological distress. CONCLUSIONS Findings underscore the importance of monitoring various forms of psychological distress continuously over time for CHD patients.
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Sousa Pinto G, Bader L, Billberg K, Criddle D, Duggan C, El Bizri L, Gharat M, Hogue MD, Jacinto I, Oyeneyin Y, Zhou Y, Laven A. Beating non-communicable diseases in primary health care: The contribution of pharmacists and guidance from FIP to support WHO goals. Res Social Adm Pharm 2019; 16:974-977. [PMID: 31668903 DOI: 10.1016/j.sapharm.2019.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 11/27/2022]
Abstract
According to the World Health Organization (WHO), more than 36 million people die annually from non-communicable diseases (NCDs), representing over 60% of deaths worldwide, 15 million of which occur before the age of 70 years. Prevention and control of NCDs and their risk factors require interventions that are therapeutically cost-effective, affordable by the patient and/or health systems and feasible, based upon local resources. This commentary paper sets a basis of global evidence to advocate, nationally and internationally, for an expanded role for pharmacists in NCD management by compiling best practices and examples. It encourages pharmacists around the world to act upon NCDs, from prevention and screening activities, to patient referral when appropriate, and to pharmacist-led, patient-centred NCD management to improve outcomes and quality of life. Priority NCDs fall into four areas: cardiovascular diseases, diabetes, asthma/chronic obstructive pulmonary disease and cancer. Building on the key roles they already play as primary healthcare professionals in the community, pharmacists can provide focused interventions, specialised counselling and care coordination, improving patient engagement to achieve better outcomes in the global fight against NCDs.
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Affiliation(s)
| | - Lina Bader
- International Pharmaceutical Federation (FIP), The Hague, the Netherlands
| | | | - Deirdre Criddle
- South Metropolitan Health Service and Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Catherine Duggan
- International Pharmaceutical Federation (FIP), The Hague, the Netherlands
| | - Luna El Bizri
- School of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Manjiri Gharat
- Indian Pharmaceutical Association, Mumbai, and KM Kundnani Pharmacy Polytechnic, Ulhasnagar, India
| | - Michael D Hogue
- Loma Linda University School of Pharmacy, Loma Linda, CA, USA
| | - Isabel Jacinto
- National Association of Pharmacies of Portugal, Lisbon, Portugal
| | - Yetunde Oyeneyin
- Association of Industrial Pharmacists of Nigeria/ Pharmaceutical Society of Nigeria, Lagos, Nigeria
| | - Ying Zhou
- Chinese Pharmaceutical Association, Beijing, China
| | - Anna Laven
- Pharmabrain GmbH, Research and Training Centre, Berlin, Germany
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Rao A, Zecchin R, Newton PJ, Phillips JL, DiGiacomo M, Denniss AR, Hickman LD. The prevalence and impact of depression and anxiety in cardiac rehabilitation: A longitudinal cohort study. Eur J Prev Cardiol 2019; 27:478-489. [PMID: 31597473 DOI: 10.1177/2047487319871716] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Co-morbid depression and anxiety symptoms are frequently under-recognised and under-treated in heart disease and this negatively impacts self-management. AIMS The purpose of this study was to determine the prevalence, correlates and predictors of depression and anxiety in cardiac rehabilitation programmes, the impact of cardiac rehabilitation on moderate depression, anxiety and stress symptoms, and the relationship between moderate depression, anxiety and stress symptoms and cardiac rehabilitation adherence. METHODS This was a retrospective cohort study of 5908 patients entering cardiac rehabilitation programmes from 2006-2017, across two Sydney metropolitan teaching hospitals. Variables included demographics, diagnoses, cardiovascular risk factors, medication use, participation rates, health status (Medical Outcomes Study Short Form-36) and psychological health (Depression Anxiety Stress Scales) subscale scores. RESULTS Moderate depression, anxiety or stress symptoms were prevalent in 18%, 28% and 13% of adults entering cardiac rehabilitation programmes, respectively. Adults with moderate depression (24% vs 13%), anxiety (32% vs 23%) or stress (18% vs 10%) symptoms were significantly less likely to adhere to cardiac rehabilitation compared with those with normal-mild symptoms (p < 0.001). Anxiety (odds ratio 4.395, 95% confidence interval 3.363-5.744, p < 0.001) and stress (odds ratio 4.527, 95% confidence interval 3.315-6.181, p < 0.001) were the strongest predictors of depression. Depression (odds ratio 3.167, 95% confidence interval 2.411-4.161) and stress (odds ratio 5.577, 95% confidence interval 4.006-7.765, p < 0.001) increased the risk of anxiety on entry by more than three times, above socio-demographic factors, cardiovascular risk factors, diagnoses and quality of life. CONCLUSION Monitoring depression and anxiety symptoms on entry and during cardiac rehabilitation can assist to improve adherence and may identify the need for additional psychological health support. Exploring the relevance and use of adjunct psychological support strategies within cardiac rehabilitation programmes is warranted.
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Affiliation(s)
- A Rao
- University of Technology Sydney, Australia
| | - R Zecchin
- University of Technology Sydney, Australia.,Western Sydney Local Health District (WSLHD), Australia
| | | | | | | | - A R Denniss
- Western Sydney Local Health District (WSLHD), Australia.,Western Sydney University, Australia
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227
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He C, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Krishnan A, Wu Y, Sun Y, Imran M, Boruff J, Cuijpers P, Gilbody S, Ioannidis JP, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Beraldi A, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Clover K, Conwell Y, de Man-van Ginkel JM, Fann JR, Fischer FH, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Harrison PA, Härter M, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki M, Ismail K, Jetté N, Khamseh ME, Kiely KM, Kwan Y, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, Marsh L, McGuire A, Mohd-Sidik S, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Reuter K, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van Weert HC, White J, Whooley MA, Winkley K, Yamada M, Thombs BD, Benedetti A. The Accuracy of the Patient Health Questionnaire-9 Algorithm for Screening to Detect Major Depression: An Individual Participant Data Meta-Analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2019; 89:25-37. [PMID: 31593971 PMCID: PMC6960351 DOI: 10.1159/000502294] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/19/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Screening for major depression with the Patient Health Questionnaire-9 (PHQ-9) can be done using a cutoff or the PHQ-9 diagnostic algorithm. Many primary studies publish results for only one approach, and previous meta-analyses of the algorithm approach included only a subset of primary studies that collected data and could have published results. OBJECTIVE To use an individual participant data meta-analysis to evaluate the accuracy of two PHQ-9 diagnostic algorithms for detecting major depression and compare accuracy between the algorithms and the standard PHQ-9 cutoff score of ≥10. METHODS Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, Web of Science (January 1, 2000, to February 7, 2015). Eligible studies that classified current major depression status using a validated diagnostic interview. RESULTS Data were included for 54 of 72 identified eligible studies (n participants = 16,688, n cases = 2,091). Among studies that used a semi-structured interview, pooled sensitivity and specificity (95% confidence interval) were 0.57 (0.49, 0.64) and 0.95 (0.94, 0.97) for the original algorithm and 0.61 (0.54, 0.68) and 0.95 (0.93, 0.96) for a modified algorithm. Algorithm sensitivity was 0.22-0.24 lower compared to fully structured interviews and 0.06-0.07 lower compared to the Mini International Neuropsychiatric Interview. Specificity was similar across reference standards. For PHQ-9 cutoff of ≥10 compared to semi-structured interviews, sensitivity and specificity (95% confidence interval) were 0.88 (0.82-0.92) and 0.86 (0.82-0.88). CONCLUSIONS The cutoff score approach appears to be a better option than a PHQ-9 algorithm for detecting major depression.
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Affiliation(s)
- Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Kira E. Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Alexander W. Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Danielle B. Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - John P.A. Ioannidis
- Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA
| | | | - Dean McMillan
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - Scott B. Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Roy C. Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dickens H. Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, New Zealand
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Hamid R. Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Murray Baron
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Anna Beraldi
- Kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Klinik für Psychiatrie, Psychotherapie & Psychosomatik, Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Peter Butterworth
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Marcos H. Chagas
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana C. N. Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
- Hong Kong Institute of Diabetes and Obesity, Hong Kong Special Administrative Region, China
| | - Rushina Cholera
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
- Psycho-Oncology Service, Calvary Mater Newcastle, New South Wales, Australia
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Felix H. Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Germany
| | - Daniel Fung
- Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Catherine G. Greeno
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau Special Administrative Region, China
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-Universität Frankfurt, German Depression Foundation, Frankfurt, Germany
| | - Leanne Hides
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Stevan E. Hobfoll
- STAR-Stress, Anxiety, and Resilience Consultants, Chicago, Illinois, USA
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Thomas Hyphantis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London Weston Education Centre, London, UK
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohammad E. Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Kim M. Kiely
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Yunxin Kwan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore
| | - Femke Lamers
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Shen-Ing Liu
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sonia R. Loureiro
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laura Marsh
- Baylor College of Medicine, Houston and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Anthony McGuire
- Department of Nursing, St. Joseph's College, Standish, Maine, USA
| | - Sherina Mohd-Sidik
- Cancer Resource & Education Centre, and Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tiago N. Munhoz
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
| | - Flávia L. Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Philippe Persoons
- Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Katrin Reuter
- Practice for Psychotherapy and Psycho-oncology, Freiburg, Germany
| | - Alasdair G. Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK
| | - Iná S. Santos
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Juwita Shaaban
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Adam Simning
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Sharon Sung
- Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | | | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, New South Wales, Newcastle, Australia
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Henk C. van Weert
- Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Mary A. Whooley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi, Kodaira, Tokyo, Japan
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada
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228
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Modarresi S, Suh N, Walton DM, MacDermid JC. Depression affects the recovery trajectories of patients with distal radius fractures: A latent growth curve analysis. Musculoskelet Sci Pract 2019; 43:96-102. [PMID: 31374477 DOI: 10.1016/j.msksp.2019.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common and can lead to substantial pain and disability. Most people recover in six months, but some experience persistent pain and disability for one year or longer after injury. Therefore, it is important to understand the factors that can help predict poor recovery. OBJECTIVE To identify recovery trajectories in DRF patients and to determine the factors that can help predict poor recovery. METHODS Recovery was assessed in 318 patients using the Patient-Rated Wrist Evaluation scale at baseline, three, six, and 12 months. Demographic information was collected in addition to the Self-Administered Comorbidity Questionnaire, from which data regarding depression were extracted. Latent growth curve analysis (LGCA) was used to identify the recovery trajectories. Comparisons of proportion between the emergent classes were then conducted using chi-square and Kruskal-Wallis tests. RESULTS The LGCA revealed three distinct trajectories (rapid-recovery: (69%), slow-recovery: (23%), and non-recovery: (8%) as the best fit to the data. The proportion of people with depression was significantly greater in the non-recovery class (24%) compared to the slow (16%, p = 0.04) and rapid-recovery (8%, p = 0.03) classes. Additionally, the proportion of females were significantly lower in the non-recovery (64%, p = 0.03) compared to the slow (85%, p = 0.03) and the rapid-recovery classes (81%, p = 0.048). CONCLUSION Recovery from DRF was best described using three different trajectories. Greater self-reported depression and a lower proportion of females in the non-recovery class were distinguishing factors between the classes. Patients who appear to be in slow-recovery or non-recovery classes may be followed more closely.
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Affiliation(s)
- Shirin Modarresi
- Health & Rehabilitation Science, Western University, London, ON, Canada.
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada
| | - David M Walton
- School of Physical Therapy, Western University, London, ON, Canada
| | - Joy C MacDermid
- Roth
- McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Orthopedic Surgery, Western University, London, ON, Canada; School of Physical Therapy, Western University, London, ON, Canada; School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
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229
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Abstract
Loneliness and social isolation are increasingly being acknowledged as risk factors for both physical and mental health problems. Recent statistics demonstrate that loneliness and isolation are on the rise internationally, to the point of being classed as an epidemic. In this paper, the authors outline some of the recent research linking loneliness and isolation to significant chronic diseases such as cardiovascular disease and type II diabetes; mental health disorders such as anxiety and depression; cognitive disorders and dementia. Isolation has also been shown to compromise recovery after acute cardiac events, being associated with increased hospital readmission and premature death. Indeed, isolation has now been identified as a risk factor equivalent in effect to traditional risk factors such as smoking, hypertension and obesity. While distinguishing between objective and subjective indicators of isolation, the authors highlight the complexity of this phenomenon, both in terms of definition and measurement, as well as the interplay between subjective and objective indicators. Important clinical implications for health professionals working with cardiac patients are also proposed, in terms of screening for isolation, and possible interventions to support patients at risk of isolation. The aim of the current article is to emphasise the importance of acknowledging loneliness and isolation as key risk factors requiring urgent attention, both in research and in clinical practice.
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Affiliation(s)
- Jackson Alun
- Director, Australian Centre for Heart Health, Melbourne, Victoria, Australia; Honorary Professor, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Honorary Professor, Centre on Behavioural Health, University of Hong Kong, Pakfulam, Hong Kong
| | - Barbara Murphy
- Principal Researcher, Australian Centre for Heart Health, Melbourne, Victoria, Australia; Honorary Associate Professor, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Honorary Senior Research Fellow, Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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Whitehead AM, Maher NH, Goldstein K, Bean-Mayberry B, Duvernoy C, Davis M, Safdar B, Saechao F, Lee J, Frayne SM, Haskell SG. Sex Differences in Veterans' Cardiovascular Health. J Womens Health (Larchmt) 2019; 28:1418-1427. [DOI: 10.1089/jwh.2018.7228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Alison M. Whitehead
- Department of Veterans Affairs, Central Office, Washington, District of Columbia
| | - Nancy H. Maher
- Department of Veterans Affairs, Central Office, Washington, District of Columbia
| | - Karen Goldstein
- Durham VA and Duke University School of Medicine, Durham, North Carolina
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles and Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Claire Duvernoy
- VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, Michigan
| | - Melinda Davis
- Department of Medicine, Cardiology Clinic, University of Michigan, Ann Arbor, Michigan
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, Connecticut
| | - Fay Saechao
- VA Health Services Research and Development (HSR&D) Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Jimmy Lee
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Susan M. Frayne
- VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Sally G. Haskell
- Department of Veterans Affairs, Central Office, Washington, District of Columbia
- VA Connecticut Healthcare System and Yale University, West Haven, Connecticut
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231
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Bremner JD, Fani N, Cheema FA, Ashraf A, Vaccarino V. Effects of a mental stress challenge on brain function in coronary artery disease patients with and without depression. Health Psychol 2019; 38:910-924. [PMID: 31380683 PMCID: PMC6746592 DOI: 10.1037/hea0000742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Coronary artery disease (CAD) patients with comorbid depression show an increase in mortality compared to cardiac patients without depression, but the mechanisms mediating this effect remain obscure. One possible explanation for this finding is that depressed patients with CAD exhibit an increased vulnerability to stress. The purpose of this study was to assess the effects of stress and depression on brain function and to explore its relationship with myocardial ischemia in CAD patients. METHODS Patients with CAD and depression (N = 13) and CAD without depression (N = 15) underwent imaging of the brain with positron emission tomography and [O-15] water and imaging of the heart with single photon emission computed tomography (SPECT) and [Tc-99m] sestamibi under mental stress task and control conditions. RESULTS CAD patients with depression compared to nondepressed showed decreased function with mental stress in the rostral anterior cingulate, the hippocampus, parts of the dorsolateral temporal and parietal cortex, the cerebellum, and the uncus, with increased blood flow in the parahippocampus, visual association cortex, and posterior cingulate. Depressed CAD patients who became ischemic during a mental stress task had relative decreases in the caudal and posterior cingulate, orbitofrontal cortex, and cerebellum, and increased activation in the parietal cortex and precuneus/visual association cortex compared to nonischemic depressed CAD patients. CONCLUSIONS These findings are consistent with dysfunction in a network of brain regions involved in the stress response in patients with comorbid CAD and depression that has direct and indirect links to the heart, suggesting a pathway by which stress and depression could lead to increased risk of heart disease related morbidity and mortality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences
| | | | - Ali Ashraf
- Department of Psychiatry and Behavioral Sciences
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Salman A, Sellami M, Al-Mohannadi AS, Chun S. The Associations between Mental Well-Being and Adherence to Physical Activity Guidelines in Patients with Cardiovascular Disease: Results from the Scottish Health Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193596. [PMID: 31561424 PMCID: PMC6801738 DOI: 10.3390/ijerph16193596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
Abstract
The association between physical activity (PA) and mental well-being in individuals with a cardiovascular disease (CVD) is poorly studied. The objective of this study was to assess the association between mental well-being and adherence to the recommended guidelines for PA in a Scottish adult population with CVD. The study used data from 3128 adults who had CVD conditions (1547 men and 1581 women; mean age 63.29 years) who participated in the Scottish Health Survey between 2014 and 2017. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was used as a surrogate measure of mental health. PA was classified as "met" or "unmet" on the basis of the recommended PA guidelines (150 min of moderate activity or 75 min of vigorous activity per week). The relationship between PA guidelines being met and the WEMWBS score was explored using hierarchical linear regression accounting for a set of health and sociodemographic characteristics. Of the participants, ~41.8% met the recommended PA levels. Among those with CVD, the mean (SD) WEMWBS scores of individuals who did not have a long-standing illness (51.14 ± 7.65 vs 47.07 ± 9.54; p < 0.05), diabetes (48.44 ± 9.05 vs 46.04 ± 10.25; p < 0.05), or high blood pressure (48.63 ± 9.08 vs 47.52 ± 9.47; p < 0.05) were significantly higher than those of individuals with such conditions. Meeting PA recommendations was significantly associated with a higher mean WEMWBS score (50.64 ± 7.97 vs 46.06 ± 9.75; p < 0.05). Multiple regression analysis of health-related behaviors improved the prediction of mental well-being over and above meeting the recommended PA levels. Mental well-being was strongly correlated with PA adherence in CVD patients. It seems that for patients with CVD, PA should be tailored to meet patients' health conditions in order to promote mental well-being and improve overall health.
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Affiliation(s)
- Ahmad Salman
- College of Health Sciences, QU Health, Qatar University, 2713 Doha, Qatar.
- Department of Health Sciences, University of York, York YO10 5DD, UK.
- Kuwait Public Policy Centre, General Secretariat of the Supreme Council for Planning and Development, 13001 Safat, Kuwait.
| | - Maha Sellami
- Sport Science Program (SSP), College of Arts and Sciences (CAS), Qatar University,2713 Doha, Qatar.
| | - Abdulla Saeed Al-Mohannadi
- Research and Scientific Support Department; Aspetar, Orthopaedic and Sports Medicine Hospital, 29222 Doha, Qatar.
| | - Sungsoo Chun
- Kuwait Public Policy Centre, General Secretariat of the Supreme Council for Planning and Development, 13001 Safat, Kuwait.
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233
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Yang M, Sun M, Du T, Long H, Chen J, Liang F, Lao L. The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 28:1415-1425. [PMID: 31529993 DOI: 10.1177/2047487319876761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Abstract
Objective The aim of this study was to assess the efficacy and safety of acupuncture in the treatment of patients with stable angina pectoris. Methods A literature search was performed in nine databases, including PubMed and the Cochrane Library, from their inception to 30 August 2018. Randomized controlled trials that compared acupuncture therapy with sham acupuncture or no treatment were included. Two reviewers under the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines assessed the eligibility of each record and extracted essential information independently. The data were merged using a fixed-effect model. Results Pooled analysis of 17 eligible trials with 1516 participants showed that acupuncture was associated with reduced angina attack frequency (–4.91; 95% confidence interval, –6.01– –3.82; p < 0.00001) and improved depression (–1.23; 95% confidence interval, –1.47– –1.00; p < 0.00001) and anxiety level (–0.96; 95% confidence interval, –1.16– –0.75; p < 0.00001) relative to sham treatment or standard care alone. No increased risk of adverse events was observed during treatment (relative risk, 0.70; 95% confidence interval, 0.33–1.48; p = 0.35). No significant improvement was shown in nitroglycerin use or angina intensity. The included studies were associated with unclear to high risk of selection or performance bias, and the quality of evidence was low to moderate. Conclusions Acupuncture may safely and effectively improve physical restrictions, emotional distress, and attack frequency in patients with stable angina pectoris. However, angina intensity and medication use were not reduced. Studies with adequate blinding and a valid sham control group are still warranted due to the current low quality of evidence.
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Affiliation(s)
- Mingxiao Yang
- School of Chinese Medicine, University of Hong Kong, China
- Department of Chinese Medicine, University of Hong Kong-Shenzhen Hospital, China
| | - Mingsheng Sun
- School of Acupuncture, Chengdu University of TCM, China
| | - Ting Du
- Department of Rehabilitation, Xishan People's Hospital, China
| | - Hulin Long
- Department of Acupuncture, Teaching Hospital of Chengdu University of TCM, China
| | - Ji Chen
- School of Acupuncture, Chengdu University of TCM, China
| | - Fanrong Liang
- School of Acupuncture, Chengdu University of TCM, China
| | - Lixing Lao
- School of Chinese Medicine, University of Hong Kong, China
- Department of Chinese Medicine, University of Hong Kong-Shenzhen Hospital, China
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Drudi LM, Ades M, Turkdogan S, Huynh C, Lauck S, Webb JG, Piazza N, Martucci G, Langlois Y, Perrault LP, Asgar AW, Labinaz M, Lamy A, Noiseux N, Peterson MD, Arora RC, Lindman BR, Bendayan M, Mancini R, Trnkus A, Kim DH, Popma JJ, Afilalo J. Association of Depression With Mortality in Older Adults Undergoing Transcatheter or Surgical Aortic Valve Replacement. JAMA Cardiol 2019; 3:191-197. [PMID: 29344620 DOI: 10.1001/jamacardio.2017.5064] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. Objective To determine the prevalence of depression and its association with all-cause mortality in older adults undergoing TAVR or SAVR. Design, Setting, and Participants This preplanned analysis of the Frailty Aortic Valve Replacement (FRAILTY-AVR) prospective cohort study included 14 centers in 3 countries from November 15, 2011, through April 7, 2016. Individuals 70 years or older who underwent TAVR or SAVR were enrolled. Depressive symptoms were evaluated using the Geriatric Depression Scale Short Form at baseline and follow-up. Main Outcomes and Measures All-cause mortality at 1 and 12 months after TAVR or SAVR. Logistic regression was used to determine the association of depression with mortality after adjusting for confounders such as frailty and cognitive impairment. Results Among 1035 older adults (427 men [41.3%] and 608 women [58.7%]) with a mean (SD) age of 81.4 (6.1) years, 326 (31.5%) had a positive result of screening for depression, whereas only 89 (8.6%) had depression documented in their clinical record. After adjusting for clinical and geriatric confounders, baseline depression was found to be associated with mortality at 1 month (odds ratio [OR], 2.20; 95% CI, 1.18-4.10) and at 12 months (OR, 1.532; 95% CI, 1.03-2.24). Persistent depression, defined as baseline depression that was still present 6 months after the procedure, was associated with a 3-fold increase in mortality at 12 months (OR, 2.98; 95% CI, 1.08-8.20). Conclusions and Relevance One in 3 older adults undergoing TAVR or SAVR had depressive symptoms at baseline and a higher risk of short-term and midterm mortality. Patients with persistent depressive symptoms at follow-up had the highest risk of mortality.
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Affiliation(s)
- Laura M Drudi
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Vascular Surgery, McGill University, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Matthew Ades
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sena Turkdogan
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Caroline Huynh
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolo Piazza
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Yves Langlois
- Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Louis P Perrault
- Division of Cardiac Surgery, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Anita W Asgar
- Division of Cardiology, Institut de Cardiologie de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Nicolas Noiseux
- Division of Cardiac Surgery, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mark D Peterson
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rakesh C Arora
- Division of Cardiac Surgery, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brian R Lindman
- Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - Melissa Bendayan
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Rita Mancini
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Amanda Trnkus
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Dae H Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
| | - Jonathan Afilalo
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada.,Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Xiao Y, Li W, Zhou J, Zheng J, Cai X, Guo M, Hao X, Zhang Z, Liu Y, Yuan Z. Impact of depression and/or anxiety on patients with percutaneous coronary interventions after acute coronary syndrome: a protocol for a real-world prospective cohort study. BMJ Open 2019; 9:e027964. [PMID: 31492778 PMCID: PMC6731775 DOI: 10.1136/bmjopen-2018-027964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Acute coronary syndrome (ACS) is one of the leading causes of death. Depression and/or anxiety after ACS is common. Studies from developed countries have reported that the occurrence of anxiety or depression after ACS might increase the risk of cardiovascular events and mortality. However, the results varied, and are limited in developing countries. Therefore, well designed large-scale real-world study is needed to make further clarification. The main objective of this study is to evaluate whether depression or anxiety could affect the prognosis of patients with percutaneous coronary intervention (PCI) post-ACS. METHOD AND ANALYSIS The study is a prospective, multicentre, cohort study, which will be performed at 12 large hospitals in northwest China and led by the First Affiliated Hospital of Xi'an Jiaotong University. A total of 5000 patients with PCI post-ACS will be enrolled and followed up for 2 years. Their depression and anxiety status will be evaluated with the Patient Health Questionnaire-9 or Generalised Anxiety Disorder-7 Assessment scales during the follow-up. A Cox proportional hazard model will be used to determine if depression/anxiety after PCI increase the risk of cardiovascular events. The impact of antidepression or antianxiety treatment on the cardiac prognosis will be explored as well among the patients with ACS who received the treatment after PCI. ETHICS AND DISSEMINATION This study has been approved by the ethics committee of the First Affiliated Hospital of Xi'an Jiaotong University (approval number: XJTU1AF2016LSL-036). The results will be published in research articles or conference papers. TRIAL REGISTRATION NUMBER NCT03057691.
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Affiliation(s)
- Yihui Xiao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenyuan Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Juan Zhou
- Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, China
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaojie Cai
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Manyun Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiang Hao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhanyi Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Liu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zuyi Yuan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Key Laboratory of Molecular Cardiology, Xi'an Jiaotong University, Xi'an, China
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Hammash M, McEvedy SM, Wright J, Cameron J, Miller J, Ski CF, Thompson DR, Biddle MJ, Wimsatt A, Schrader M, Smith RV, Chung ML, Moser DK. Perceived control and quality of life among recipients of implantable cardioverter defibrillator. Aust Crit Care 2019; 32:383-390. [DOI: 10.1016/j.aucc.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/28/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
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237
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Moise N, Davidson KW, Cheung YKK, Clarke GN, Dolor RJ, Duer-Hefele J, Ladapo JA, Margolis KL, St Onge T, Parsons F, Retuerto J, Schmit KM, Thanataveerat A, Kronish IM. Rationale, design, and baseline data for a multicenter randomized clinical trial comparing depression screening strategies after acute coronary syndrome: The comparison of depression identification after acute Coronary Syndromes-Quality of Life and Cost Outcomes (CODIACS-QOL) trial. Contemp Clin Trials 2019; 84:105826. [PMID: 31419605 PMCID: PMC6754099 DOI: 10.1016/j.cct.2019.105826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Elevated depressive symptoms among survivors of acute coronary syndromes (ACS) confer recurrent cardiovascular events and mortality, worse quality of life, and higher healthcare costs. While multiple scientific groups advise routine depression screening for ACS survivors, no randomized trials exist to inform this screening recommendation. We aimed to assess the effect of screening for depression on change in quality of life over 18 months among ACS patients. METHODS The Comparison of Depression Identification after Acute Coronary Syndrome on Quality of Life and Cost Outcomes (CODIACS-QoL) trial is a pragmatic, 3-arm trial that randomized ACS patients to 1) systematic depression screening using the 8-item Patient Health Questionnaire (PHQ-8) and if positive screen (PHQ-8 ≥ 10), notification of primary care providers (PCPs) and invitation to participate in centralized, patient-preference, stepped depression care (Screen, Notify, and Treat, N = 499); 2) systematic depression screening and PCP notification only (Screen and Notify, N = 501); and 3) usual care (No Screen, N = 500). Adults hospitalized for ACS in the previous 2-12 months without prior history of depression were eligible for participation. Key outcomes will be quality-adjusted life years (primary), cost of health care utilization, and depression-free days across 18 months. RESULTS A total of 1500 patients were randomized in the CODIACS-QOL trial (28.3% women; 16.3% Hispanic; mean age 65.9 (11.5) years). Only 7% of ACS survivors had elevated depressive symptoms. CONCLUSIONS Using a novel randomization schema and pragmatic design principles, the CODIACS-QoL trial achieved its enrollment target. Eventual results of this trial will inform future depression screening recommendations in cardiac patients. TRIAL REGISTRATION ClinicalTrials.gov (NCT01993017).
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Affiliation(s)
- Nathalie Moise
- Columbia University Medical Center, New York, NY, United States of America.
| | | | - Ying Kuen K Cheung
- Columbia University Medical Center, New York, NY, United States of America
| | - Gregory N Clarke
- Kaiser Permanente Northwest, Portland, OR, United States of America
| | - Rowena J Dolor
- Duke Primary Care Research Consortium, Durham, NC, United States of America
| | | | - Joseph A Ladapo
- University of California Los Angeles, Los Angeles, CA, United States of America
| | | | - Tara St Onge
- Columbia University Medical Center, New York, NY, United States of America
| | - Faith Parsons
- Columbia University Medical Center, New York, NY, United States of America
| | - Jessica Retuerto
- Columbia University Medical Center, New York, NY, United States of America
| | - Kristine M Schmit
- Duke Primary Care Research Consortium, Durham, NC, United States of America
| | | | - Ian M Kronish
- Columbia University Medical Center, New York, NY, United States of America
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238
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Piña IL, Di Palo KE, Ventura HO. Psychopharmacology and Cardiovascular Disease. J Am Coll Cardiol 2019; 71:2346-2359. [PMID: 29773162 DOI: 10.1016/j.jacc.2018.03.458] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 11/25/2022]
Abstract
This review discusses common mental health disorders and their associations with cardiovascular disease risks. Commonly found mental health disorders include depression, anxiety, and personality types. The link between depression and cardiovascular disease mortality has been established. Depression is also common in patients with heart failure. In addition to discussing psychological disorders, a review of psychotropic drugs is also included. Drugs are described for therapy for depression and anxiety, as well as associations with cardiovascular drug-drug interactions. Drug-drug interactions are more common and potentially dangerous in elderly patients, in whom the conditions often coexist. The most common drug-drug interactions involve the P450 system of enzymes.
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Affiliation(s)
- Ileana L Piña
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
| | - Katherine E Di Palo
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, New Orleans, Louisiana; The University of Queensland School of Medicine, St. Lucia, Queensland, Australia
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239
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Shah A, Meadows JT, Anderson KG, Raveis VH, Scogin F, Templeton S, Simpson K, Ingram L. Gerontological social work and cardiac rehabilitation. SOCIAL WORK IN HEALTH CARE 2019; 58:633-650. [PMID: 31244394 DOI: 10.1080/00981389.2019.1620903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/13/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
Cardiac rehabilitation is a setting in which integrating social work services can benefit older adults. Many cardiac rehabilitation patients endorse symptoms of stress and depression following a cardiac event, impeding their ability to participate fully in cardiac rehabilitation services or recover from a heart attack. Gerontologically trained social workers can improve the care of older adults with heart disease in a variety of ways and this paper discusses the potential roles social workers can play in enhancing care. Two examples demonstrating how community academic partnerships can lead to improved options for older adults following a heart attack are discussed. First, using a microsystems approach, social workers embedded within cardiac rehabilitation may improve patient quality of life, address social service needs, provide mental health treatment, and assist in the completion of standard cardiac rehabilitation assessments. Second, using a macrosystems approach, social workers can help communities by developing partnerships to establish infrastructure for new cardiac rehabilitation clinics that are integrated with mental health services in rural areas. Social workers can serve an important role in addressing the psychological or social service needs of cardiac rehabilitation patients while increasing access to care.
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Affiliation(s)
- Avani Shah
- a School of Social Work , The University of Alabama , Tuscaloosa , AL , USA
| | - James T Meadows
- a School of Social Work , The University of Alabama , Tuscaloosa , AL , USA
| | | | - Victoria H Raveis
- b College of Dentistry Psychosocial Research Unit on Health, Aging and the Community , New York University , New York , NY , USA
| | - Forrest Scogin
- c Department of Psychology , The University of Alabama , Tuscaloosa , AL , USA
| | - Stacey Templeton
- d Cardiac Rehabilitation Clinic , DCH Regional Medical Center , Tuscaloosa , AL , USA
| | - Kersey Simpson
- d Cardiac Rehabilitation Clinic , DCH Regional Medical Center , Tuscaloosa , AL , USA
| | - Lee Ingram
- d Cardiac Rehabilitation Clinic , DCH Regional Medical Center , Tuscaloosa , AL , USA
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Social Support, Unstable Angina, and Stroke as Predictors of Depression in Patients With Coronary Heart Disease. J Cardiovasc Nurs 2019; 33:179-186. [PMID: 28489724 DOI: 10.1097/jcn.0000000000000419] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression is known to adversely affect coronary heart disease patients in western countries; however, no study of social support and depression has been conducted in the Chinese population. OBJECTIVE The aim of this study was to investigate the predictors of depression in patients with coronary heart disease. METHODS Between January and December 2015, a cross-sectional sample of 105 Taiwanese patients from cardiology units completed a demographic and clinical characteristics questionnaire, Enhancing Recovery in Coronary Heart Disease Social Support Inventory, and Patient Health Questionnaire-9. RESULTS Thirty-nine percent of the participants reported low social support, and 61.0% had depression symptoms. Eight factors predicted depression. Social support was significantly and adversely correlated with depression (r = -.481, P < .01). The other 7 factors were positively correlated with depression: age (r = .212, P < .05), reported monthly income of less than US $600 (F = 4.98, P = .001), lack of exercise (F = 3.75, P = .027), history of stroke (t = -2.45, P = .016) and kidney disease (t = -2.41, P = .018), unstable angina (F = 3.56, P = .031), and groin puncture (F = 3.27, P = .042). A hierarchical regression model explained 43.7% of the variance in depression. CONCLUSION Social support, unstable angina, and stroke may be important predictors of depression in patients with coronary heart disease. These findings help clinical staff to understand physical and mental health problems in cardiovascular patients. Thus, we suggest that early depression prediction and sufficient social support can help patients to face their disease and thus improve depression and health care quality.
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241
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Gholizadeh L, Shahmansouri N, Heydari M, Davidson PM. Assessment and detection of depression in patients with coronary artery disease: validation of the Persian version of the PHQ-9. Contemp Nurse 2019; 55:185-194. [PMID: 31280682 DOI: 10.1080/10376178.2019.1641119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Depression is a common comorbidity in patients with coronary artery disease (CAD), which often remains undetected and untreated. Objective: This study aimed to examine the psychometric properties of the Depression Module of the Patient Health Questionnaire (PHQ-9) on a sample of cardiac patients in Iran. Method: The Persian version of the PHQ-9 was developed and administered to 150 patients with CAD, admitted to a tertiary hospital in Tehran, Iran. The major depression module of the International Neuropsychiatric Interview (MINI) was used as the gold standard for the diagnosis of depression. Results: The Persian PHQ-9 demonstrated acceptable internal consistency, with Cronbach's alpha coefficient of 0.80. The optimal cut-off score of ≥7 showed a sensitivity of 76, specificity of 78, and the area under curve of 0.82. Conclusion: The Persian PHQ-9 has acceptable psychometric properties to screen for and detect a current depressive episode in patients with CAD, with recommended cut-off score of ≥7.
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Affiliation(s)
- Leila Gholizadeh
- a Faculty of Health, University of Technology Sydney , Sydney , Australia
| | - Nazila Shahmansouri
- b Tehran Heart Center, Tehran University of Medical Sciences , Tehran , Iran
| | - Mehrdad Heydari
- c Faculty of Health, University of Technology Sydney , Sydney , Australia
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D'Antono B, Bouchard V. Impaired sleep quality is associated with concurrent elevations in inflammatory markers: are post-menopausal women at greater risk? Biol Sex Differ 2019; 10:34. [PMID: 31287027 PMCID: PMC6615113 DOI: 10.1186/s13293-019-0250-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/30/2019] [Indexed: 12/30/2022] Open
Abstract
Abstract Background Chronic inflammation and impaired sleep increase the risk for cardiovascular disease. Menopausal women may be particularly at risk as a result of impaired sleep. The objective of the current investigation was to assess the relationship between poor sleep and C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and myeloperoxidase (MPO) in healthy non- and postmenopausal women and men. Methods A fasting blood draw was obtained from 122 healthy men and women (31 were postmenopausal). Higher scores on the Pittsburgh Sleep Quality Index (PSQI) were used to define poor sleep. Given the sample size and healthy nature of the sample, hierarchical linear regression analyses were performed on a composite inflammatory score involving CRP, IL-6, and TNF-α. Sex/menopausal group and PSQI were entered as predictors, and the interaction of the group by PSQI was entered stepwise. Analyses on MPO were performed separately. Results Sleep quality was associated with higher inflammatory activity (β = 0.272, P = 0.003), which remained significant (P = 0.046) after controlling for age, waist circumference, exercise times per week, and depressive symptoms. While in the same direction, sleep quality was not significantly associated with MPO. Dichotomizing sleep quality led to similar results. Conclusion Impaired sleep quality is independently associated with greater inflammation in healthy adult men and women. Despite an overall less favorable metabolic and inflammatory profile in postmenopausal women, impaired sleep did not emerge as differentially related to inflammatory activity in this group.
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Affiliation(s)
- Bianca D'Antono
- Research Center, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, H1T 1C8, Canada. .,Psychology Department, Université de Montréal, Montreal, Quebec, Canada.
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Suzuki T, Shiga T, Nishimura K, Omori H, Tatsumi F, Hagiwara N. Patient Health Questionnaire-2 Screening for Depressive Symptoms in Japanese Outpatients with Heart Failure. Intern Med 2019; 58:1689-1694. [PMID: 30799347 PMCID: PMC6630118 DOI: 10.2169/internalmedicine.2034-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective Depression is common in patients with heart failure (HF) and is a possible risk factor for adverse outcomes. The aim of this study was to determine the prevalence of depression assessed by the 2-item Patient Health Questionnaire (PHQ-2) and the effect of depression on outcomes in Japanese outpatients with HF. Methods This sub-analysis of a prospective observational study assessed 976 patients with HF (mean age 66±13 years; 26.7% female; 42.7% with an ischemic etiology). Depression was defined as a PHQ-2 score ≥3. The main composite outcome was death from any cause or hospitalization due to worsening HF. PHQ-2 items were extracted from the PHQ-9 results. To evaluate the association of PHQ-2 scores with outcomes, Cox proportional hazards models were evaluated. Results Fifty-seven (5.8%) patients were diagnosed with depression. During a median follow-up of 21 months, the incidence rates for death from any cause and hospitalization due to worsening HF in patients with and without depression were 2.2 vs. 0.9 per 100 person-years and 6.7 vs. 1.6, p<0.001, respectively. There was a higher incidence of the main outcome in patients with depression than in those without depression (p<0.001). After adjustment for conventional risk factors, depression (PHQ-2 ≥3) was an independent predictor of the main outcome (hazard ratio 2.41, 95% confidence interval 1.14-4.67, p=0.022), and a score for item 1 of the PHQ-2 (loss of interest or pleasure) ≥2 was also an independent risk factor (hazard ratio 3.57, 95% confidence interval 1.85-6.46, p<0.001). Conclusion Depression as assessed by the PHQ-2 was identified in 5.8% of Japanese outpatients with HF and was associated with outcomes.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Japan
| | | | - Hisako Omori
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Japan
| | - Fujio Tatsumi
- Department of Cardiology, Institute of Geriatrics, Women's Medical University, Japan
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Wu PH, Lin MY, Huang TH, Lin YT, Hung CC, Yeh YC, Kuo HT, Chiu YW, Hwang SJ, Tsai JC, Carrero JJ. Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study. PLoS One 2019; 14:e0218335. [PMID: 31194838 PMCID: PMC6564035 DOI: 10.1371/journal.pone.0218335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/30/2019] [Indexed: 02/02/2023] Open
Abstract
Background Depression is common in dialysis patients, but the clinical impact of this condition is poorly defined. Methods Out of 57,703 patients starting dialysis during 2000–2007 recorded in the National Health Insurance Research Database of Taiwan, we identified 2,475 patients with a clinical diagnosis of depression, and compared them with 1:5 age- and sex-matched patients without a depression diagnosis (n = 12,375). Patients were followed up for hospitalisation due to severe infections, major adverse cardiovascular events (MACE) and death. Multivariable Cox regression and competing risk analyses (accounting for death when appropriate) were used to estimate risk associations. Results Patients with depression had a higher frequency of comorbidities. During a mean follow-up of 3.2 years, 1,140 severe infections, 806 MACE, and 1,121 deaths were recorded. Compared to controls, patients with depression were at increased risk of death (adjusted hazard ratio 1.24; 95%CI 1.16–1.33). Patients with depression were also at higher risk of severe (1.14; 1.06–1.22) and fatal infections (death within 30 days, 1.22; 1.09–1.35), attributed mainly to sepsis (1.19; 1.08–1.31), septic shock (1.36; 1.13–1.62) and pneumonia (1.19; 1.07–1.33). Conversely, no association was observed between depression and the MACE risk (1.04; 0.94–1.15). Conclusion Dialysis patients with depression are associated with increased risk of infections and death.
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Affiliation(s)
- Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Teng-Hui Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Lin
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Family Medicine, Kaohsiung Municipal Hsiao–Kang Hospital, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Tien Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (JCT); (HTK)
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Chia Tsai
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (JCT); (HTK)
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden
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Voss M, Wild B, von Hirschhausen E, Fuchs T, Ong P. [Effect of humor training on stress, cheerfulness and depression in patients with coronary artery disease and refractory angina pectoris]. Herz 2019; 45:80-87. [PMID: 31187195 DOI: 10.1007/s00059-019-4813-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/22/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Angina pectoris refractory to conventional medical treatment is a common phenomenon in patients with stable coronary artery disease (CAD). Many of these patients suffer from depression and generate substantial costs in the healthcare system. Therefore, the development of new therapeutic concepts is of particular importance. This study investigated whether professional, structured humor training has a positive effect on the symptoms of patients with treatment refractory angina pectoris. METHODS Between 2013 and 2014 a total of 35 patients with stable CAD were included. Enrolment was possible if patients suffered from treatment refractory angina pectoris (Canadian Cardiovascular Society, CCS grades II-IV) despite optimal antianginal medication and exhaustion of options for myocardial revascularization. Previously, 25.8% of the patients had had a myocardial infarction. In this study, a professional humor coaching was conducted with a duration of 7 weeks. In order to evaluate the effects of the coaching, the following examinations were performed before and after the intervention: exercise stress test (treadmill), hair segment cortisol analysis, Beck Depression Inventory (BDI), the Trier Inventory for the Assessment of Chronic Stress (TICS) and the State-Trait-Cheerfulness Inventory (STCI). RESULTS Out of the 35 initially recruited patients 31 completed the study. The mean age was 65.5 years and 94.5% were female. There was a significant improvement in cheerfulness (STCI, pre 23.3 ± 5.4, post 27.5 ± 5, p = 0,03). This effect was even stronger in a subgroup analysis in which only female patients were included (pre 23.6 ± 5.5, post 27.7 ± 4.6, p = 0.003). The results of the BDI showed a remarkable improvement in the pre-post analysis (pre 14.6 ± 8.1, post 11.0 ± 6.5, p = 0.064). Analyzing only the female patients, this difference became significant (pre 13.1 ± 6.4, post 9.9 ± 4.6 p = 0,037). The hair segment investigations showed that patients who had a higher cortisol level in the beginning (>25. percentile, n = 22) showed a significant reduction of the cortisol concentration (pre 6.54 pg/mg, 3.78-12.12 pg/mg, post 3.65 pg/mg, 2.82-7.68 pg/mg, p = 0.029). CONCLUSION Patients with refractory angina pectoris and stable CAD benefit from a professional humor coaching. This effect was shown in a) a significant decrease in cortisol concentrations in the hair segment analysis, b) an improvement in cheerfulness in the STCI and c) a significant difference in the BDI between pre-post values.
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Affiliation(s)
- M Voss
- Abteilung für Kardiologie, Zentrum für Innere Medizin III, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - B Wild
- , Strohberg 27e, 70180, Stuttgart, Deutschland
| | | | | | - P Ong
- Abteilung für Kardiologie, Zentrum für Innere Medizin III, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
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Mohammad D, Herrmann N, Saleem M, Swartz RH, Oh PI, Bradley J, Chan P, Ellis C, Lanctôt KL. Validity of a novel screen for cognitive impairment and neuropsychiatric symptoms in cardiac rehabilitation. BMC Geriatr 2019; 19:163. [PMID: 31185923 PMCID: PMC6558737 DOI: 10.1186/s12877-019-1177-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Currently, there is no composite screening tool that can efficiently and effectively assess prevalent yet under-recognized cognitive and neuropsychiatric comorbidities in patients with cardiovascular disease. We aimed to determine the validity and feasibility of a novel screen assessing cognitive impairment, anxiety, apathy and depression (CAAD screen) in those attending cardiac rehabilitation (CR). METHODS All patients diagnosed with cardiovascular disease or cardiovascular risk factors entering CR were screened as part of clinical care. A subset of those patients agreed to complete validation assessments (n = 127). Screen results were compared to widely accepted standards for cognition, anxiety, apathy, and depression using a modified receiver operating characteristic (ROC) and area under the curve analysis. RESULTS The screen was completed by 97% of participants in 10 min or less with an average completion time of approximately 5 min. Screening scores adjusted for age, sex and years of education had acceptable or excellent validity compared to widely accepted standard diagnoses: CAAD-Cog (AUC = 0.80); CAAD-Anx (AUC = 0.81); CAAD-Apathy (AUC = 0.79) and CAAD-Dep (AUC = 0.85). CONCLUSIONS The CAAD screen may be a valid and feasible tool for detecting cognitive impairment, anxiety, apathy and depression in CR settings.
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Affiliation(s)
- Dana Mohammad
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
| | - Mahwesh Saleem
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
| | - Richard H. Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
| | - Paul I. Oh
- University Health Network at Toronto Rehabilitation Institute, Toronto, Ontario Canada
| | - Janelle Bradley
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
| | - Parco Chan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario Canada
| | - Courtney Ellis
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario Canada
| | - Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
- University Health Network at Toronto Rehabilitation Institute, Toronto, Ontario Canada
- Sunnybrook Hospital, FG-08, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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McPhillips R, Salmon P, Wells A, Fisher P. Cardiac Rehabilitation Patients' Accounts of Their Emotional Distress and Psychological Needs: A Qualitative Study. J Am Heart Assoc 2019; 8:e011117. [PMID: 31433708 PMCID: PMC6585358 DOI: 10.1161/jaha.118.011117] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/21/2019] [Indexed: 12/14/2022]
Abstract
Background Psychological distress is prevalent among patients with cardiovascular disease and is linked to increased risk of future cardiac events. Cardiac rehabilitation (CR) is widely recommended for treating psychological distress but has been of limited benefit. This study aims to understand how distressed cardiac patients describe their emotional needs and the response of CR. Methods and Results A qualitative descriptive study was conducted with 46 patients who screened positively for anxiety and/or depression. Semi-structured interviews were held, and data were analyzed using a constant comparative approach. Patients described low mood and diverse concerns, including threat of another cardiac event, restrictions on their lives, and problems unrelated to their health. Patients described worrying constantly about these concerns, worrying about their worry, and feeling that worry was uncontrollable and harmful. Patients wanted to "get back to normal" but lacked any sense of how to achieve this and were reluctant to discuss their worries with CR staff. They hoped to recover over time, meanwhile seeking reassurance that they were responding "normally." Patients were mostly dismissive of psychological techniques used in CR. Conclusions These findings expose a conundrum. Distressed CR patients have diverse worries but do not generally want to discuss them, so they invest hopes for feeling better in time passing and reassurance. An intervention acceptable to CR patients would allow them to address diverse worries but without having to share the content of worries, would have "face validity," and would address patients' worry about worry. Metacognitive therapy is an intervention that might be suitable. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02420431.
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Affiliation(s)
- Rebecca McPhillips
- School of Psychological SciencesFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterUnited Kingdom
- Department of Research and InnovationGreater Manchester Mental Health TrustManchester Academic Health Science CentreManchesterUnited Kingdom
| | - Peter Salmon
- Division of Clinical PsychologyPsychological SciencesUniversity of LiverpoolUnited Kingdom
| | - Adrian Wells
- School of Psychological SciencesFaculty of Biology, Medicine and HealthManchester Academic Health Science CentreUniversity of ManchesterUnited Kingdom
- Department of Research and InnovationGreater Manchester Mental Health TrustManchester Academic Health Science CentreManchesterUnited Kingdom
| | - Peter Fisher
- Division of Clinical PsychologyPsychological SciencesUniversity of LiverpoolUnited Kingdom
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Abstract
Heart failure is one of the most prevalent long-term physical health conditions. It is suggested that up to 26 million people are living with it worldwide including approximately 920 000 people in the UK. Evidence has consistently demonstrated the links between cardiac health and mental health; therefore, this article will explain depression and its presentation in heart failure, as these two conditions have been strongly and consistently linked. The prevalence of depression in heart failure will be reviewed from epidemiological studies and an overview of the impact of comorbid depression in heart failure will be provided, with a particular focus on mortality, morbidity and quality of life outcomes. The relationship between depression and heart failure will be discussed by examining pathophysiological and behavioural mechanisms, as well as evidence regarding the appropriate identification and subsequent management of heart failure depression will be reviewed.
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Affiliation(s)
- John Sharp
- Consultant Clinical Psychologist, Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Monica McCowat
- Assistant Psychologist, Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, UK
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Hamad R, Nguyen TT, Bhattacharya J, Glymour MM, Rehkopf DH. Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis. PLoS Med 2019; 16:e1002834. [PMID: 31237869 PMCID: PMC6592509 DOI: 10.1371/journal.pmed.1002834] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors. METHODS AND FINDINGS We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992-2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971-2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β -0.036, 95%CI: -0.06, -0.02, p < 0.01; NHANES β -0.032, 95%CI: -0.05, -0.02, p < 0.01), depression (HRS β -0.049, 95%CI: -0.07, -0.03, p < 0.01), triglycerides (NHANES β -0.039, 95%CI: -0.06, -0.01, p < 0.01), and heart disease (HRS β -0.025, 95%CI: -0.04, -0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts. CONCLUSIONS This study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD.
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, Department of Family & Community Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Thu T. Nguyen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Jay Bhattacharya
- Department of Medicine, Stanford University, Stanford, California, United States of America
| | - M. Maria Glymour
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - David H. Rehkopf
- Department of Medicine, Stanford University, Stanford, California, United States of America
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