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Zvolensky MJ, Shepherd JM, Clausen BK, de Dios M, Cano MÁ, Redmond BY. Differences in smoking behavior and beliefs about abstinence among Latinx individuals with and without depression who smoke cigarettes. J Ethn Subst Abuse 2023:1-19. [PMID: 38108308 PMCID: PMC11182888 DOI: 10.1080/15332640.2023.2293945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
There is a well-established relation between depression and smoking in the general population. However, past work focused on Latinx persons who smoke in relation to depressed affect has yielded inconsistent findings. The present investigation aimed to build on past research and evaluate differences among English-speaking Latinx adults who smoke combustible cigarettes with and without probable depression in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The current sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) that were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with probable depression (compared to those without) demonstrated higher levels of cigarette dependence, more severe problems when trying to quit, greater perceived barriers for quitting, and increased negative abstinence expectancies after adjusting for sociodemographic and concurrent substance use variables. Future work could build from this research to elucidate the role of depression in the maintenance and relapse of smoking among the Latinx population.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
| | | | | | - Marcel de Dios
- HEALTH Institute, University of Houston
- Department of Psychological, Health, and Learning Sciences, University of Houston
| | - Miguel Ángel Cano
- Peter O’Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center
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Krasieva K, Clair C, Gencer B, Carballo D, Klingenberg R, Räber L, Windecker S, Rodondi N, Matter CM, Lüscher TF, Mach F, Muller O, Nanchen D. Smoking cessation and depression after acute coronary syndrome. Prev Med 2022; 163:107177. [PMID: 35901973 DOI: 10.1016/j.ypmed.2022.107177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
Smoking and depression are risk factors for acute coronary syndrome (ACS) that often co-exist. We investigated the evolution of depression according to smoking cessation one-year after ACS. Data from 1822 ACS patients of the Swiss multicenter SPUM-ACS cohort study were analyzed over a one-year follow-up. Participants were classified in three groups based on smoking status one-year post-ACS - continuous smokers, smokers who quit within the year, and non-smokers. Depression status at baseline and one-year was assessed with the Center for Epidemiologic Studies Depression scale (CES-D) and antidepressant drug use. A CES-D score ≥ 16 defined depression. A multivariate-adjusted logistic regression model was used to calculate odds ratios (OR) between groups. The study sample mean age was 62.4 years and females represented 20.8%. At baseline, 22.6% were depressed, 40.9% were smokers, and 47.5% of these quit smoking over the year post-ACS. In comparison to depressed continuous smokers, depressed smokers who quit had an adjusted OR 2.59 (95% confidence interval (CI) 1.27-5.25) of going below a CES-D score of 16 or not using antidepressants. New depression at one-year was found in 24.4% of non-depressed smokers who quit, and in 27.1% of non-depressed continuous smokers, with an adjusted OR 0.85 (95% CI 0.55-1.29) of moving to a CES-D score of ≥16 or using antidepressants. In conclusion, smokers with depression at time of ACS who quit smoking improved their depression more frequently compared to continuous smokers. The incidence of new depression among smokers who quit after ACS was similar compared to continuous smokers.
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Affiliation(s)
- Kristina Krasieva
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Carole Clair
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Baris Gencer
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - David Carballo
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospital Trust and Imperial College, London SW3 6NP, UK
| | - François Mach
- Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
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Gathright EC, Vickery KD, Ayenew W, Whited MC, Adkins-Hempel M, Chrastek M, Carter JK, Rosen RK, Wu WC, Busch AM. The development and pilot testing of a behavioral activation-based treatment for depressed mood and multiple health behavior change in patients with recent acute coronary syndrome. PLoS One 2022; 17:e0261490. [PMID: 35113860 PMCID: PMC8812840 DOI: 10.1371/journal.pone.0261490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients with acute coronary syndrome (ACS) with depressed mood demonstrate poor cardiovascular behavioral risk profiles and elevated risk for recurrent ACS and mortality. Behavioral Activation (BA) offers an intervention framework for an integrated treatment targeting both depression and critical health behaviors post-ACS. Behavioral Activation for Health and Depression (BA-HD) was developed and pilot tested in a multiphase iterative process. Methods First, an initial treatment manual was conceptualized based on the team’s prior work, as well as the extant literature. Second, qualitative interviews were conducted with target patients and target providers on the proposed BA-HD treatment rationale, content, and structure. Framework matrix analyses were used to summarize and aggregate responses. Third, an expert panel was convened to elicit additional manual refinements. Finally, patients with post-ACS depression and health behavior non-adherence were recruited to complete an open pilot trial to evaluate acceptability (Client Satisfaction Questionnaire [CSQ], exit interview) and treatment engagement (number of sessions attended; treatment completion was considered completion of 8 out of 10 possible sessions). Results The initial BA-HD treatment manual expanded an existing treatment manual for post-ACS BA-based mood management and smoking cessation to target four health behaviors relevant to post-ACS patients (e.g., smoking cessation, medication adherence, physical activity, and diet). After the initial conceptualization, ten post-ACS patients and eight cardiac rehabilitation professionals completed qualitative interviews. Patients endorsed bi-directional interactions between mood and health behaviors post-ACS. Both patients and providers expressed general support of the proposed treatment rationale and values-guided, collaborative goal-setting approach. Patients, providers, and experts provided feedback that shaped the iterative manual development. After the BA-HD manual was finalized, eight participants were enrolled in a single-arm pilot trial. The mean CSQ score was 30.57 ± 2.23, indicating high satisfaction. Seven out of eight (88%) completed treatment. Pre- to post treatment improvements in depressed mood and health behaviors were promising. Conclusions BA-HD treatment is an acceptable approach to target both mood and health behaviors in post-ACS patients with depression. A future larger, controlled trial is needed to evaluate the efficacy of the BA-HD treatment. Trial registration ClinicalTrials.gov Identifier: NCT04158219
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Affiliation(s)
- Emily C. Gathright
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
| | - Katherine Diaz Vickery
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Woubeshet Ayenew
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matthew C. Whited
- Department of Psychology, East Carolina University, Greenville, North Carolina, United States of America
| | - Melissa Adkins-Hempel
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Michelle Chrastek
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
| | - Jill K. Carter
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
| | - Rochelle K. Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Wen-Chih Wu
- Division of Cardiology, Providence Veterans Affairs Medical Center, Providence, Rhode Island, United States of America
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island, United States of America
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Andrew M. Busch
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, United States of America
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Behavioral Health Equity Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States of America
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Lovatt S, Wong CW, Holroyd E, Butler R, Phan T, Patwala A, Loke YK, Mallen CD, Kwok CS. Smoking cessation after acute coronary syndrome: A systematic review and meta-analysis. Int J Clin Pract 2021; 75:e14894. [PMID: 34541754 DOI: 10.1111/ijcp.14894] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Smoking cessation is an effective secondary prevention measure after acute coronary syndrome (ACS). We conducted a systematic review with the aim to better understand which patients have a greater propensity to quit smoking and the risk factors for continued smoking after ACS. METHODS We searched MEDLINE and EMBASE for studies that evaluated smoking cessation after ACS. The pooled rate of smoking cessation across included studies was performed. Random effects meta-analysis for different variables and their association with smoking cessation was conducted. RESULTS A total of 39 studies with 11 228 patients were included in this review. The pooled rate of smoking cessation following ACS across 38 studies was 45.0%. Factors associated with greater likelihood of smoking cessation were attendance at cardiac rehabilitation (OR 1.90 95% CI 1.44-2.51), married/not alone (OR 1.68 95% CI 1.32-2.13), intention/attempt to quit smoking (OR 1.27 95% CI 1.11-1.46), diabetes mellitus (OR 1.24 95% CI 1.03-1.51) and hospitalised duration (OR 1.09 95% CI 1.02-1.15). Variables associated with a lower likelihood of smoking cessation were depression (OR 0.57 95% CI 0.43-0.75), chronic obstructive pulmonary disease/lung disease (OR 0.73 95% CI 0.57-0.93), previous admission with acute myocardial infarction/cardiac admission (OR 0.61 95% CI 0.47-0.80), cerebrovascular disease/transient ischaemic attack (OR 0.42 95% CI 0.30-0.58) and unemployment (OR 0.37 95% CI 0.17-0.80). CONCLUSIONS The majority of smokers with an ACS continue to smoke after admission. Patients attending cardiac rehabilitation show increased odds of quitting while people who are depressed and those with chronic lung disease were less likely to quit smoking and should be targeted for intensive smoking cessation interventions.
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Affiliation(s)
- Saul Lovatt
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Eric Holroyd
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Rob Butler
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Thanh Phan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Ashish Patwala
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
- School of Medicine, Keele University, Stoke-on-Trent, UK
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Lee C, Lee SC, Shin YS, Park S, Won KB, Ann SH, Ko EJ. Severity, Progress, and Related Factors of Mood Disorders in Patients with Coronary Artery Disease: A Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8040568. [PMID: 33339355 PMCID: PMC7766069 DOI: 10.3390/healthcare8040568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Patients with coronary artery disease (CAD) are more likely to experience depression and anxiety, which, in turn, are risk factors for CAD. The Beck depression inventory (BDI) and Beck anxiety inventory (BAI) were applied for mood evaluation during hospitalization and again 3 months after discharge in 118 patients with CAD, and cardiopulmonary exercise tests were conducted in the outpatient department. Of the patients diagnosed with CAD, 40 (33.9%) had depressive moods, and 51 (43.2%) had anxious moods. A family history of CAD, low Korean activity scale index (KASI), and use of beta-blockers were independent factors causing depressive mood, while lower left ventricular ejection fraction (LVEF) and low KASI score were independent factors causing anxious mood. A considerable number of patients (35.7% with depressive mood and 25.0% with anxious mood) still had emotional problems after 3 months of discharge. The change values of BDI were associated with lower LVEF and longer hospital stay, while those of BAI was associated with a longer hospital stay. Since some patients had depressive and anxious moods after three months of discharge, evaluating and treating them are essential.
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Affiliation(s)
- Changbae Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Sang Cheol Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Yeon Seob Shin
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Ki Bum Won
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Korea
- Correspondence:
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Amiri S. The prevalence of depression symptoms after smoking cessation: a systematic review and meta-analysis. J Addict Dis 2020; 39:109-124. [PMID: 33084511 DOI: 10.1080/10550887.2020.1826104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Smoking cessation can have positive effects on people's health, especially mental health. This study aimed to address the prevalence of depression in the smoking cessation population. Methods: In the present meta-analysis study, PRISMA protocol was used. Two databases, PubMed and Scopus, were selected. Articles in these two databases in English were targeted and the search was limited to July 2020. First, the results related to the prevalence of depression were calculated. The results were pooled. Results: Forty-nine articles with different designs were eligible for meta-analysis. The prevalence of depression in the smoking cessation population was 18% and the confidence interval was 14-22%. The highest depression prevalence was in Asia and Europe, followed by America. The prevalence of major depression in the smoking cessation population was 15% and the prevalence of depressive symptoms was 17%. The smoking cessation population had a lower odds of depression than current smokers (OR= 0.63 CI = 0.54-0.75; I2 83.9%). There was little evidence for publication bias. Discussion: The status of depression in the smoking cessation population is different from that of nonsmokers and current smokers. Therefore, in terms of health policy and encouraging people to smoking cessation, the issue of its positive effects on mental health should be emphasized.
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Affiliation(s)
- Sohrab Amiri
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Effect of Smoking Status on Exercise Perception and Intentions for Cardiac Rehabilitation Enrollment Among Patients Hospitalized With an Acute Cardiac Condition. J Cardiopulm Rehabil Prev 2019; 38:286-290. [PMID: 29120970 DOI: 10.1097/hcr.0000000000000288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cardiac rehabilitation (CR) attendance has been associated with higher smoking cessation (SC) rates. However, for unclear reasons, smokers are consistently less likely to enroll in CR than nonsmokers, and it is uncertain what might encourage them to attend. METHODS We surveyed patients eligible for CR who were cigarette smokers at the time of hospital admission. We assessed patient intention to quit smoking, start exercising, and enroll in CR. We also measured anxiety and depression levels. RESULTS Of the 105 patients approached, 81 (77%) completed the survey (69% males, aged 57 ± 10 y, 72% white). Most patients reported interest in SC (80%) and attending CR (78%). Many felt that SC medications (41%), stress management programs (35%), and an exercise program with SC counseling (30%) would increase their likelihood to attend CR; however, 30% stated that they would be less likely to enroll in CR if they continued smoking following discharge. Many patients indicated high levels of anxiety (51%) and depression (27%); many desired to reduce stress following discharge (73%), with 35% stating that stress management programs would increase their likelihood to attend CR. CONCLUSIONS Hospitalized smokers eligible for CR report significant interest in SC, attending CR, and beginning an exercise program. These patients show high levels of anxiety and depression and indicate a strong interest in stress management programs. These results suggest that messages emphasizing the role of CR in the treatment of depression, anxiety, and stress are likely to resonate with smokers, increase their enrollment in CR, and support long-term SC.
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Umer H, Negash A, Birkie M, Belete A. Determinates of depressive disorder among adult patients with cardiovascular disease at outpatient cardiac clinic Jimma University Teaching Hospital, South West Ethiopia: cross-sectional study. Int J Ment Health Syst 2019; 13:13. [PMID: 30867676 PMCID: PMC6399879 DOI: 10.1186/s13033-019-0269-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Depression and heart disease are an important public-health problem. Depression is one of the most prevalent and disabling psychiatric disorders with more than three times increased risk among patients with cardiovascular disorders. OBJECTIVE To identify the prevalence and associated factors of depressive disorder among adult patients with cardiovascular disease. METHODS Institution based cross-sectional study design was used to conduct this study on 293 study participants attending an outpatient cardiac clinic at Jimma University Teaching Hospital. All eligible patients were recruited into the study consecutively. Depression was assessed using patient health questionnaire-9. The patient health questionnaire-9 had a total score of 27, from which 0-4: no/minimal depression, 5-9: mild depression, 10-14: moderately depression, 15-19: moderately severe depression and 20-27 severe depression. The data was feed into Epi-data version 3.1 and lastly exported to SPSS version 21 for analysis. Bivariate analysis was used to analyze the statistical association of covariates of interest with depressive disorder among patients with cardiovascular disease. Then, logistic regression analysis was used as a final model to control confounders. The strength of association was measured by a 95% confidence interval. RESULTS A total of 293 adult patients diagnosed with the cardiovascular disease were included in the study with 97% (n = 284) of response rate, 47.2% (n = 134) males and 52.8% (n = 150) females, making female to a male ratio around 1.1:1. The prevalence of depression was 52.8% (n = 150/284). Out of the subjects with depression 52.67% (n = 79), 36.0% (n = 54) and 11.33% (n = 17) were mild, moderate and severe depression, respectively. Variables such as employed, unemployed, physical activity, current cigarette user and poor social support were independently associated with depression in the final model. CONCLUSIONS In this study, depression was found to be highly prevalent psychiatric comorbidity in adult cardiovascular disease patients.
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Affiliation(s)
- Halima Umer
- Research and Training Department of Amanuel Mental Specialized Hospital, Addis Abeba, Ethiopia
| | - Alemayehu Negash
- Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mengesha Birkie
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asmare Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Sever S, Golder S, Doherty P. Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation. BMC Cardiovasc Disord 2018; 18:230. [PMID: 30526515 PMCID: PMC6288923 DOI: 10.1186/s12872-018-0974-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/03/2018] [Indexed: 12/01/2022] Open
Abstract
Background The literature suggests that comorbid depression, defined in this paper as a history of depression prior to a cardiovascular event, has an impact on later onset depression as well as constituting increased risk of mortality and adverse cardiac events. However, which factors are associated with depression, specifically in patients with comorbid depression, is unclear. Therefore, this paper investigates the factors associated with depression in patients with comorbid depression attending cardiac rehabilitation (CR). Methods This observational study used routinely collected data from the British Heart Foundation National Audit of Cardiac Rehabilitation for the time period between April 2012 and March 2017. CR participants with comorbid depression were selected as the study population. An independent t-test and chi-square test were used to compare the association between acute depression symptoms and baseline characteristics in this population. Results A total of 2715 CR patients with comorbid depression were analysed. Characteristics associated with acute depressive symptoms in patients with comorbid depression were found to be: young age (MD: 2.71, 95% CI 1.91, 3.50), increased number of comorbidities (MD: -0.50, 95% CI -0.66, − 0.34), increased weight (MD: -1.94, 95% CI -3.35, − 0.52), high BMI (MD: -1.94, 95% CI -3.35, − 0.52), HADS anxiety (MD: -5.17, 95% CI -5.47, − 4.87), comorbid anxiety (52.4%, p < 0.001), physical inactivity (150 min moderate physical activity a week and 75 min vigorous exercise a week; 27.5%, p < 0.001; 5.6%, p < 0.001 respectively), smoking (12.7%, p < 0.001), and being less likely to be partnered (63.6%, p < 0.001). Conclusion The study demonstrated the association between a variety of clinical and socio-demographic factors and depression. The findings of the research indicated that, at CR baseline assessment, caution must be taken with patients with comorbid depression, specifically those with higher level depressive symptoms at the start of rehabilitation. Furthermore, their multi-comorbid condition must also be taken into account. Patients with higher depression symptoms and comorbid depression scored five points higher on the HADS anxiety scale in comparison to patients with lower level depression symptoms at the start of CR, which demonstrated that anxiety and depression are interrelated and present together.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, Faculty of Science, University of York, York, UK.
| | - Su Golder
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, York, UK
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Jani BD, Cavanagh J, Barry SJE, Der G, Sattar N, Mair FS. Relationship Between Blood Pressure Values, Depressive Symptoms, and Cardiovascular Outcomes in Patients With Cardiometabolic Disease. J Clin Hypertens (Greenwich) 2016; 18:1027-1035. [PMID: 27040355 PMCID: PMC5096031 DOI: 10.1111/jch.12813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 01/28/2023]
Abstract
The authors studied the joint effect of blood pressure (BP) and depression on the risk of major adverse cardiovascular outcome in patients with existing cardiometabolic disease. A cohort of 35,537 patients with coronary heart disease, diabetes, or stroke underwent depression screening and BP measurement recorded concurrently. The authors used Cox's proportional hazards to calculate risk of major adverse cardiovascular event (MACE; myocardial infarction/heart failure/stroke or cardiovascular death) over 4 years associated with baseline BP and depression. A total of 11% (3939) had experienced a MACE within 4 years. Patients with very high systolic BP (160-240 mm Hg; hazard ratio, 1.28) and depression (hazard ratio, 1.22) at baseline had significantly higher adjusted risk. Depression had a significant interaction with systolic BP in risk prediction (P=.03). Patients with a combination of high systolic BP and depression at baseline had 83% higher adjusted risk of MACE, as compared with patients with reference systolic BP without depression. Patients with cardiometabolic disease and comorbid depression may benefit from closer monitoring of systolic BP.
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Affiliation(s)
- Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jonathan Cavanagh
- Mental Health and Wellbeing, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sarah J E Barry
- Robertson Centre for Biostatistics, Institute of Health and Well Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Geoff Der
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Metabolic Medicine, BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Systematic review and meta-analysis of the impact of depression on subsequent smoking cessation in patients with coronary heart disease: 1990 to 2013. Psychosom Med 2014; 76:44-57. [PMID: 24367125 DOI: 10.1097/psy.0000000000000020] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Smoking cessation is crucial for patients with coronary heart disease (CHD), yet depression may impede cessation success. We systematically reviewed the prospective association between depression and subsequent smoking cessation in individuals with CHD to quantify this effect. METHODS Electronic databases (PsychInfo, PubMed, CINAHL) were searched for prospective studies of patients with CHD that measured depression at baseline (scales, diagnostic interview, or antidepressant prescription) and reported smoking continuation/cessation at follow-up. Inclusive dates were January 1, 1990, to May 22, 2013. Standardized mean differences (SMDs) and associated 95% confidence intervals were estimated using random-effects meta-analysis. Sensitivity analysis explored the impact of limiting meta-analysis to studies using different depression measures (validated scales, diagnostic interviews, antidepressant prescription), different durations of follow-up, or higher-quality studies. RESULTS From 1185 citations retrieved, 28 relevant articles were identified. Meta-analysis of all available data from 20 unique data sets found that depressed patients with CHD were significantly less likely to quit smoking at follow-up (SMD = -0.39, 95% confidence interval = -0.50 to -0.29; I(2) = 51.2%, p = .005). Estimates remained largely unchanged for each sensitivity analysis, except for two studies that used antidepressants, which showed a much larger effect (SMD = -0.94, -1.38 to -0.51; I(2) = 57.7%, p = .124). CONCLUSIONS Patients with CHD and depressive symptoms are significantly less likely to quit smoking than their nondepressed counterparts. This may have implications for cardiovascular prognosis, and CHD smokers may require aggressive depression treatment to enhance their chances of quitting.
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Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol 2013; 2013:695925. [PMID: 23653854 PMCID: PMC3638710 DOI: 10.1155/2013/695925] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/18/2013] [Indexed: 12/13/2022] Open
Abstract
In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors—including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities—may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.
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