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Quindry JC, McNamara M, Oser C, Fogle C. Assessment of clinical depression metrics in cardiac patients using the patient health Questionnaire-9 before and after phase-II cardiac rehabilitation. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:240-245. [PMID: 39234489 PMCID: PMC11369830 DOI: 10.1016/j.smhs.2023.09.004] [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] [Received: 05/24/2023] [Revised: 08/18/2023] [Accepted: 09/06/2023] [Indexed: 09/06/2024] Open
Abstract
Cardiovascular disease remains a leading cause of morbidity and mortality, a fact that is commonly associated with co-morbidities such as clinical depression. While phase II cardiac rehabilitation is an established intervention for those with cardiovascular disease, its effect on patients who also suffer from depression are under studied. Aim: To quantify Pre- and Post-cardiac rehabilitation questionnaire scores collected from a large patient data registry. For this investigation, 27 670 patients completed Patient Health Questionnaire-9 questionnaires both Pre- and Post-rehabilitation (averaging [28.0 ± 8.7] phase II sessions). Findings reveal that questionnaire scores decreased by 40%-48% across all groups, a finding that was independent of assigned sex, race, and ethnicity. Moreover, when data were stratified for questionnaire scores that may indicate major and minor depressive disorder, phase II cardiac rehabilitation outcomes were lower by 61% and 49% respectively. While all groups exhibited lower questionnaire scores following cardiac rehabilitation participation, numerical differences at Pre- and Post-rehabilitation time points indicate that males and White patients have more favorable scores. This latter observation, while not confirmed currently, appears to be linked to referral rates to phase II cardiac rehabilitation, which remain poor for females, racial and ethnic minorities.
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Affiliation(s)
- John C. Quindry
- Integrative Physiology and Athletic Training, University of Montana, Missoula, MT, USA
- St. Patrick's Hospital, Missoula, MT, USA
| | - Michael McNamara
- Cardiovascular Health Program – Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Carrie Oser
- Cardiovascular Health Program – Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Crystelle Fogle
- Cardiovascular Health Program – Montana Department of Public Health and Human Services, Helena, MT, USA
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Banerjee P, Chau K, Kotla S, Davis EL, Turcios EB, Li S, Pengzhi Z, Wang G, Kolluru GK, Jain A, Cooke JP, Abe J, Le NT. A Potential Role for MAGI-1 in the Bi-Directional Relationship Between Major Depressive Disorder and Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:463-483. [PMID: 38958925 DOI: 10.1007/s11883-024-01223-5] [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] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW Major Depressive Disorder (MDD) is characterized by persistent symptoms such as fatigue, loss of interest in activities, feelings of sadness and worthlessness. MDD often coexist with cardiovascular disease (CVD), yet the precise link between these conditions remains unclear. This review explores factors underlying the development of MDD and CVD, including genetic, epigenetic, platelet activation, inflammation, hypothalamic-pituitary-adrenal (HPA) axis activation, endothelial cell (EC) dysfunction, and blood-brain barrier (BBB) disruption. RECENT FINDINGS Single nucleotide polymorphisms (SNPs) in the membrane-associated guanylate kinase WW and PDZ domain-containing protein 1 (MAGI-1) are associated with neuroticism and psychiatric disorders including MDD. SNPs in MAGI-1 are also linked to chronic inflammatory disorders such as spontaneous glomerulosclerosis, celiac disease, ulcerative colitis, and Crohn's disease. Increased MAGI-1 expression has been observed in colonic epithelial samples from Crohn's disease and ulcerative colitis patients. MAGI-1 also plays a role in regulating EC activation and atherogenesis in mice and is essential for Influenza A virus (IAV) infection, endoplasmic reticulum stress-induced EC apoptosis, and thrombin-induced EC permeability. Despite being understudied in human disease; evidence suggests that MAGI-1 may play a role in linking CVD and MDD. Therefore, further investigation of MAG-1 could be warranted to elucidate its potential involvement in these conditions.
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Affiliation(s)
- Priyanka Banerjee
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
- Medical Physiology, College of Medicine, Texas A&M Health Science Center, Bryan, TX, USA
| | - Khanh Chau
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Sivareddy Kotla
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eleanor L Davis
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Estefani Berrios Turcios
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Shengyu Li
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Zhang Pengzhi
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Guangyu Wang
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Abhishek Jain
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
- Department of Biomedical Engineering, College of Engineering, Texas A&M University, College Station, TX, USA
- Department of Medical Physiology, School of Medicine, Texas A&M Health Science Center, Bryan, USA
| | - John P Cooke
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA
| | - Junichi Abe
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nhat-Tu Le
- Center for Cardiovascular Regeneration, Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA.
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Inoue T. Depressive symptoms and the development of hypertension. Hypertens Res 2024:10.1038/s41440-024-01856-8. [PMID: 39169152 DOI: 10.1038/s41440-024-01856-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Taku Inoue
- Department of Preventive Medicine and Public Health, School of Medicine, Fukuoka University, Fukuoka, Japan.
- Cardiovascular Medicine, Omoromachi Medical Center, Naha, Japan.
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Tokioka S, Nakaya N, Hatanaka R, Nakaya K, Kogure M, Chiba I, Nochioka K, Metoki H, Murakami T, Satoh M, Nakamura T, Ishikuro M, Obara T, Hamanaka Y, Orui M, Kobayashi T, Uruno A, Kodama EN, Nagaie S, Ogishima S, Izumi Y, Fuse N, Kuriyama S, Hozawa A. Depressive symptoms as risk factors for the onset of home hypertension: a prospective cohort study. Hypertens Res 2024:10.1038/s41440-024-01790-9. [PMID: 38982291 DOI: 10.1038/s41440-024-01790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 07/11/2024]
Abstract
Depression is comorbid with somatic diseases; however, the relationship between depressive symptoms and hypertension (HT), a risk factor for cardiovascular events, remains unclear. Home blood pressure (BP) is more reproducible and accurately predictive of cardiovascular diseases than office BP. Therefore, we focused on home BP and investigated whether depressive symptoms contributed to the future onset of home HT. This prospective cohort study used data from the Tohoku Medical Megabank Community-Cohort Study (conducted in the Miyagi Prefecture, Japan) and included participants with home normotension (systolic blood pressure (SBP) < 135 mmHg and diastolic blood pressure (DBP) < 85 mmHg). Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale-Japanese version at the baseline survey. In the secondary survey, approximately 4 years later, the onset of home HT was evaluated (SBP ≥ 135 mmHg or DBP ≥ 85 mmHg) and was compared in participants with and without depressive symptoms. Of the 3 082 (mean age: 54.2 years; females: 80.9%) participants, 729 (23.7%) had depressive symptoms at the baseline survey. During the 3.5-year follow-up, 124 (17.0%) and 388 (16.5%) participants with and without depressive symptoms, respectively, developed home HT. Multivariable adjusted odds ratios were 1.37 (95% confidence interval (CI): 1.02-1.84), 1.18 (95% CI: 0.86-1.61), and 1.66 (95% CI: 1.17-2.36) for home, morning, and evening HT, respectively. This relationship was consistent in the subgroup analyses according to age, sex, BP pattern, and drinking habit. Depressive symptoms increased the risk of new-onset home HT, particularly evening HT, among individuals with home normotension. This prospective cohort study revealed that depressive symptoms are risk factors for new-onset home hypertension, particularly evening hypertension among individuals with home normotension. Assessing home blood pressure in individuals with depressive symptoms is important for the prevention of hypertension and concomitant cardiovascular diseases.
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Affiliation(s)
- Sayuri Tokioka
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Naoki Nakaya
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Rieko Hatanaka
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kumi Nakaya
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Mana Kogure
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ippei Chiba
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kotaro Nochioka
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takahisa Murakami
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Michihiro Satoh
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomohiro Nakamura
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Kyoto Women's University, Kyoto, Japan
| | - Mami Ishikuro
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Taku Obara
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Yohei Hamanaka
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masatsugu Orui
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Tomoko Kobayashi
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Akira Uruno
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Eiichi N Kodama
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Satoshi Nagaie
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Soichi Ogishima
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yoko Izumi
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Nobuo Fuse
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Tohoku University Hospital, Tohoku University, Sendai, Japan
| | - Shinichi Kuriyama
- Tohoku University Graduate School of Medicine, Sendai, Japan
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Atsushi Hozawa
- Tohoku University Graduate School of Medicine, Sendai, Japan.
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
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Wu Y, Yu X, Zhu Y, Shi C, Li X, Jiang R, Niu S, Gao P, Li S, Yan L, Maulik PK, Guo G, Patel A, Gao R, Blumenthal JA. Integrating depression and acute coronary syndrome care in low resource hospitals in China: the I-CARE randomised clinical trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101126. [PMID: 39040037 PMCID: PMC11261764 DOI: 10.1016/j.lanwpc.2024.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/13/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024]
Abstract
Background Acute coronary syndrome (ACS) often co-occurs with depression, which adversely affects prognosis and increases medical costs, but effective treatment models are lacking, particularly in low-resource settings. This study aims to determine the effectiveness of an ACS and depression integrative care (IC) model compared to usual care (UC) in improving depression symptoms and other health outcomes among patients discharged for ACS in Chinese rural hospitals. Methods A multicentre, randomised controlled trial was conducted in sixteen rural county hospitals in China, from October 2014 to March 2017, to recruit consecutively all ACS patients aged 21 years and older after the disease stablised and before discharge. Patients were randomly assigned in a 1:1 ratio to receive either the IC or UC, stratified by hospital and depression severity. Patients allocated to IC received an ACS secondary prevention program and depression care including case screening, group counselling, and individual problem-solving therapy. Patients allocated to UC received usual care. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) from baseline to 6 and 12 months. Main secondary outcomes included major adverse events (MAEs) composed of all-cause death, non-fatal myocardial infarction and stroke, and all-cause re-hospitalisation. Participants were followed up till March 2018. All data were collected in person by trained assessors blinded to treatment group and MAEs were adjudicated centrally. This trial is registered with ClinicalTrials.gov, NCT02195193. Findings Among 4041 eligible patients (IC: 2051; UC: 1990), the mean age was 61 ± 10 years and 63% were men. The mean PHQ-9 score lowered at both 6 and 12 months in both groups but was not lower in IC compared to UC at 6 months (mean difference (MD): -0.04, 95% confidence interval (CI): -0.20, 0.11) or 12 months (MD: -0.06, 95% CI: -0.21, 0.09). There were no treatment group differences for MAEs or other secondary outcomes except for secondary prevention medications at 12 months (45.2% in IC vs 40.8% in UC; relative risk: 1.21, 95% CI: 1.05-1.40). Pre-specified subgroup analyses showed that IC, compared to UC, may be more effective in lowering PHQ-9 scores in women, older patients, and patients with low social support, but less effective in moderately and severely depressed patients (all p for interaction <0.05). Interpretation The study found that the cardiology nurse-led ACS- and depression-integrated care, compared to usual care, did not improve depression symptoms in all patients discharged with ACS. Greater benefits in certain subgroups warrants further studies. Funding R01MH100332 National Institute of Mental Health.
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Affiliation(s)
- Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Xin Yu
- Peking University Institute of Mental Health, National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Yidan Zhu
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Chuan Shi
- Peking University Institute of Mental Health, National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
| | - Ronghuan Jiang
- Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Beijing, China
| | - Sheng Niu
- Department of Psychiatry, Chinese PLA (People's Liberation Army) Medical School, Beijing, China
| | - Pei Gao
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Shenshen Li
- The George Institute for Global Health at Peking University Health Science Centre (PUHSC), Beijing, China
| | - Lijing Yan
- The Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Pallab K. Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
| | - Guifang Guo
- Peking University School of Nursing, Beijing, China
| | - Anushka Patel
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Runlin Gao
- The Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Centre, Durham, NC, USA
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Galin S, Keren H. The Predictive Potential of Heart Rate Variability for Depression. Neuroscience 2024; 546:88-103. [PMID: 38513761 DOI: 10.1016/j.neuroscience.2024.03.013] [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: 08/17/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024]
Abstract
Heart rate variability (HRV),a measure of the fluctuations in the intervals between consecutive heartbeats, is an indicator of changes in the autonomic nervous system. A chronic reduction in HRV has been repeatedly linked to clinical depression. However, the chronological and mechanistic aspects of this relationship, between the neural, physiological, and psychopathological levels, remain unclear. In this review we present evidence by which changes in HRV might precede the onset of depression. We describe several pathways that can facilitate this relationship. First, we examine a theoretical model of the impact of autonomic imbalance on HRV and its role in contributing to mood dysregulation and depression. We then highlight brain regions that are regulating both HRV and emotion, suggesting these neural regions, and the Insula in particular, as potential mediators of this relationship. We also present additional possible mediating mechanisms involving the immune system and inflammation processes. Lastly, we support this model by showing evidence that modification of HRV with biofeedback leads to an improvement in some symptoms of depression. The possibility that changes in HRV precede the onset of depression is critical to put to the test, not only because it could provide insights into the mechanisms of the illness but also because it may offer a predictive anddiagnosticphysiological marker for depression. Importantly, it could also help to develop new effective clinical interventions for treating depression.
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Affiliation(s)
- Shir Galin
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel; Gonda Interdisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Hanna Keren
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel; Gonda Interdisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel.
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Sinclair LI, Lawton MA, Palmer JC, Ballard CG. Characterization of Depressive Symptoms in Dementia and Examination of Possible Risk Factors. J Alzheimers Dis Rep 2023; 7:213-225. [PMID: 36994115 PMCID: PMC10041449 DOI: 10.3233/adr-239000] [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] [Accepted: 01/12/2023] [Indexed: 03/06/2023] Open
Abstract
Background Depression in individuals with Alzheimer's disease (AD) is common, distressing, difficult to treat, and inadequately understood. It occurs more frequently in AD than in older adults without dementia. The reasons why some patients develop depression during AD and others do not remain obscure. Objective We aimed to characterize depression in AD and to identify risk factors. Methods We used data from three large dementia focused cohorts: ADNI (n = 665 with AD, 669 normal cognition), NACC (n = 698 with AD, 711 normal cognition), and BDR (n = 757 with AD). Depression ratings were available using the GDS and NPI and in addition for BDR the Cornell. A cut-off of≥8 was used for the GDS and the Cornell Scale for Depression in Dementia,≥6 for the NPI depression sub-scale, and≥2 for the NPI-Q depression sub-scale. We used logistic regression to examine potential risk factors and random effects meta-analysis and an interaction term to look for interactions between each risk factor and the presence of cognitive impairment. Results In individual studies there was no evidence of a difference in risk factors for depressive symptoms in AD. In the meta-analysis the only risk factor which increased the risk of depressive symptoms in AD was previous depression, but information on this was only available from one study (OR 7.78 95% CI 4.03-15.03). Conclusion Risk factors for depression in AD appear to differ to those for depression per se supporting suggestions of a different pathological process, although a past history of depression was the strongest individual risk factor.
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Affiliation(s)
- Lindsey I. Sinclair
- Dementia Research Group, Bristol Medical School, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael A. Lawton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer C. Palmer
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Importance of Depressive Symptoms in Patients With Coronary Heart Disease - Review Article. Curr Probl Cardiol 2023; 48:101646. [PMID: 36773947 DOI: 10.1016/j.cpcardiol.2023.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Patients with myocardial infarction (MI) have both major depression as well as depressive symptoms. Therefore, due to the high prevalence of depression in post-MI patients, an assessment of its prognostic importance was put on the agenda. Patients after ACS frequently report fatigue, sleep problems, and sadness. Evaluation of these symptoms is very important because it should be clarified whether these symptoms are related only to the main disease or they indicate the presence of concomitant depression. Given a high predictive value of somatic-affective symptoms, it is recommended to assess them in post-MI patients. Further treatment of somatic and cognitive-affective symptoms of depression will improve the quality of life of patients with acute coronary events.
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Nanayakkara GL, Krincic L, Lightfoot R, Reinhardt W, De Silva K, Senaratne JM, Senaratne MPJ. Demographics and risk factors that influence the prevalence of depression in patients attending cardiac rehabilitation. Medicine (Baltimore) 2022; 101:e30470. [PMID: 36086695 PMCID: PMC10980405 DOI: 10.1097/md.0000000000030470] [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: 04/27/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
Depression has been associated with adverse outcomes in patients with cardiac disease. Data on its prevalence and the factors influencing it are limited in the cardiac rehabilitation program (CRP) setting. To elucidate the prevalence of and the factors that influence depression in patients attending CRP. Patients attending the CRP from 2003 to 2016 were included in the study. All patients had a Beck Depression Inventory-II (BDI-II) performed prior to commencement in CRP and were followed longitudinally. The BDI-II for the 4989 patients were as follows: 0 to 13 (normal) = 3623 (72%); 14 to 19 (mild depression) = 982 (20%); 20 to 28 (moderate depression) = 299 (6%); 29 to 63 (severe depression) = 85 (2%). The BDI-II (mean ± SEM) for males (mean age: 60.8 ± 0.1 years) and females (mean age: 63.4 ± 0.3 years, P < .001) were 7.0 ± 0.1 and 8.5 ± 0.2 (P < .001), respectively. Elevated BDI-II scores (14-63) were more common in type 1 (41.1%) and type 2 (30.5%) diabetics than nondiabetics (25.7%). Similarly, elevated scores were more common in smokers (36.1%) than never-smokers (24.7%). The BDI-II scores for Caucasians, South Asians, and East Asians were 7.3 ± 0.1, 8.0 ± 0.3, and 7.0 ± 0.3 respectively (P = .01 for CA vs SA by 1-way ANOVA and least significant difference test). The prevalence of depression is high in patients attending CRP affecting 28% of the population. BDI-II is a simple validated screening tool that can be applied to patients attending CRP. Diabetics, current smokers, and South Asians all had a higher prevalence of depression.
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Affiliation(s)
| | - Lena Krincic
- Grey Nuns Community Hospital, Edmonton, AB, Canada
| | | | | | | | - Janek M. Senaratne
- Grey Nuns Community Hospital, Edmonton, AB, Canada
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Manohara P. J. Senaratne
- Grey Nuns Community Hospital, Edmonton, AB, Canada
- Division of Cardiology, University of Alberta, Edmonton, AB, Canada
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Ge Y, Chao T, Sun J, Liu W, Chen Y, Wang C. Frontiers and Hotspots Evolution in Psycho-cardiology: A Bibliometric Analysis From 2004 to 2022. Curr Probl Cardiol 2022; 47:101361. [PMID: 35995242 DOI: 10.1016/j.cpcardiol.2022.101361] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022]
Abstract
In the last 20 years, research on the topic of psycho-cardiology has gradually entered the public eye, with more innovations and applications of evidence-based medical research, biological mechanism research, and guideline consensus in the field of psycho-cardiology. This study uses a bibliometric approach to visualize and analyze the literature within the field of psycho-cardiology over the last 20 years to visualize the development process, research hotspots, and cutting-edge trends in clinical practice, mechanisms, and management strategies related to psycho-cardiology. Quantitative description and evaluation of 409 articles published in the field from 2004-2022 were conducted using CiteSpace and VOSviewer, to provide a theoretical reference for the development of psycho-cardiology.
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Lewis C, Dokucu ME, Brown CH, Balmert L, Srdanovic N, Madhan AS, Samra SS, Csernansky J, Grafman J, Hogue CW. Postoperative but not preoperative depression is associated with cognitive impairment after cardiac surgery: exploratory analysis of data from a randomized trial. BMC Anesthesiol 2022; 22:157. [PMID: 35606688 PMCID: PMC9125857 DOI: 10.1186/s12871-022-01672-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study we hypothesize that depression is associated with perioperative neurocognitive dysfunction and altered quality of life one month after surgery. METHODS Data were obtained as part of a study evaluating cerebral autoregulation monitoring for targeting arterial pressure during cardiopulmonary bypass. Neuropsychological testing was performed before surgery and one month postoperatively. Testing included the Beck Depression Inventory, a depression symptoms questionnaire (0-63 scale), as well as anxiety and quality of life assessments. Depression was defined as a Beck Depression Inventory score > 13. RESULTS Beck Depression data were available from 320 patients of whom cognitive domain endpoints were available from 88-98% at baseline and 69-79% after surgery. This range in end-points data was due to variability in the availability of each neuropsychological test results between patients. Depression was present in 50 (15.6%) patients before surgery and in 43 (13.4%) after surgery. Baseline depression was not associated with postoperative domain-specific neurocognitive function compared with non-depressed patients. Those with depression one month after surgery, though, had poorer performance on tests of attention (p = 0.017), memory (p = 0.049), verbal fluency (p = 0.010), processing speed (p = 0.017), and fine motor speed (p = 0.014). Postoperative neurocognitive dysfunction as a composite outcome occurred in 33.3% versus 14.5% of patients with and without postoperative depression (p = 0.040). Baseline depression was associated with higher anxiety and lower self-ratings on several quality of life domains, these measures were generally more adversely affected by depression one month after surgery. CONCLUSIONS The results of this exploratory analysis suggests that preoperative depression is not associated with perioperative neurocognitive dysfunction, but depression after cardiac surgery may be associated with impairment in in several cognitive domains, a higher frequency of the composite neurocognitive outcome, and altered quality of life. TRIAL REGISTRATION www. CLINICALTRIALS gov, NCT00981474 (parent study).
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Affiliation(s)
- Choy Lewis
- Department of Anesthesiology, The Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 251 East Huron St, Feinberg 5-704, Chicago, IL, 60611, USA
| | - Mehmet E Dokucu
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charles H Brown
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Balmert
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Srdanovic
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashwin Shaan Madhan
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sahej Singh Samra
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Csernansky
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jordan Grafman
- Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Charles W Hogue
- Department of Anesthesiology, The Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 251 East Huron St, Feinberg 5-704, Chicago, IL, 60611, USA.
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12
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Gong Y, Wang X, Li N, Fu Y, Zheng H, Zheng Y, Zhan S, Ling Y. A Partially Randomized Patient Preference Trial to Assess the Quality of Life and Patency Rate After Minimally Invasive Cardiac Surgery-Coronary Artery Bypass Grafting: Design and Rationale of the MICS-CABG PRPP Trial. Front Cardiovasc Med 2022; 9:804217. [PMID: 35548423 PMCID: PMC9081498 DOI: 10.3389/fcvm.2022.804217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background Minimally invasive cardiac surgery-coronary artery bypass grafting (MICS-CABG) has emerged as a safe alternative to standard cardiac surgery. However, treatment preferences can decrease the generalizability of RCT results to the clinical population (i.e., reduce external validity) and influence adherence to the treatment protocol and study outcomes (i.e., reduce internal validity). However, this has not yet been properly investigated in randomized trials with consideration of treatment preferences. Study Design In this study, patients with a preference will be allocated to treatment strategies accordingly, whereas only those patients without a distinct preference will be randomized. The randomized trial is a 248-patient controlled, randomized, investigator-blinded trial. It is designed to compare whether treatment with MICS-CABG is beneficial in comparison to CABG. This study is aimed to establish the superiority hypothesis for the physical component summary (PCS) accompanied by the non-inferiority hypothesis for overall graft patency. Patients with no treatment preference will be randomized in a 1:1 fashion to one of the two treatment arms. The primary efficacy endpoints are the PCS score at 30 days after surgery and the overall patency rate of the grafts within 14 days after surgery. Secondary outcome measures include the PCS score and patency rate at different time points. Safety endpoints include major adverse cardiac and cerebrovascular events, complications, bleeding, wound infection, death, etc. Conclusions This trial will address essential questions of the efficacy and safety of MICS-CABG. The study will also address the impact of patients' preferences on external validity and internal validity.
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Affiliation(s)
- Yichen Gong
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yuanhao Fu
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Hui Zheng
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Ye Zheng
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Siyan Zhan
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Siyan Zhan
| | - Yunpeng Ling
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
- *Correspondence: Yunpeng Ling
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13
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Rawashdeh SI, Ibdah R, Kheirallah KA, Al-kasasbeh A, Raffee LA, Alrabadi N, Albustami IS, Haddad R, Ibdah RM, Al-Mistarehi AH. Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention. Clin Pract Epidemiol Ment Health 2021; 17:103-113. [PMID: 34733349 PMCID: PMC8493832 DOI: 10.2174/1745017902117010103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial. OBJECTIVES This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI). METHODS All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed. RESULTS Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p<0.001); (t(333) = 5.13, p<0.001); and (t(333) = 2.79, p=0.042), respectively. CONCLUSION This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.
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Affiliation(s)
- Sukaina I. Rawashdeh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rasheed Ibdah
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Khalid A. Kheirallah
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdullah Al-kasasbeh
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Liqaa A. Raffee
- Department of Accident and Emergency Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Iyad S. Albustami
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Rabia Haddad
- Department of Nursing, King Abdullah University Hospital, Irbid, Jordan
| | - Raed M. Ibdah
- Division of Psychiatry, Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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14
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Iqbal K, Irshad Y, Ali Gilani SR, Hussain S, Ahmad M, Khan UA, Choudhry VS, Khakwani AS. Quality of Life in Patients Undergoing Cardiac Surgery: Role of Coping Strategies. Cureus 2021; 13:e16435. [PMID: 34414051 PMCID: PMC8365267 DOI: 10.7759/cureus.16435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 11/20/2022] Open
Abstract
Adaptive coping strategies are used to reduce stress in patients undergoing cardiac surgery. These strategies have a major role in physical health, psychological health, quality of life and also affect an individual’s response to the disease. The current study was conducted to comprehend the impact of coping strategies on the quality of life of patients suffering from cardiac disease. A purposive convenient sampling method was used to collect data from different hospitals in South Punjab. We applied Carver's Brief Coping Orientation to Problem Experienced (Brief COPE) inventory and the WHO quality of life scale. A cross-sectional research design was proposed for the study. The findings of the study showed that coping strategies and quality of life are associated with each other, and the use of emotion-focused and problem-focused coping strategies have a significant impact on patients experiencing cardiac surgery. Demographic details of patients also revealed the differences in both variables. Implications and future recommendations have also been discussed.
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Affiliation(s)
- Khizra Iqbal
- Clinical Psychology, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan, PAK
| | - Yusra Irshad
- Internal Medicine, Kulsoom International Hospital, Islamabad, PAK
| | - Syed Rafay Ali Gilani
- Cardiothoracic Surgery, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan, PAK
| | - Shafqat Hussain
- Cardiothoracic Surgery, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan, PAK
| | - Mubashar Ahmad
- Psychiatry, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan, PAK
| | - Usman A Khan
- Internal Medicine and Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Varda S Choudhry
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Aemen S Khakwani
- Internal Medicine, Suburban Community Hospital, Norriton East, USA
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15
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Allabadi H, Alkaiyat A, Zahdeh T, Assadi A, Ghanayim A, Hasan S, Abu Al Haj D, Allabadi L, Haj-Yahia S, Schindler C, Kwiatkowski M, Zemp E, Probst-Hensch N. Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine. PLoS One 2021; 16:e0255077. [PMID: 34314470 PMCID: PMC8315523 DOI: 10.1371/journal.pone.0255077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings. Materials and methods For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline. Results The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors. Discussion Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.
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Affiliation(s)
- Hala Allabadi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Abdulsalam Alkaiyat
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Tamer Zahdeh
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaa Assadi
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Aya Ghanayim
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Shaden Hasan
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Dalia Abu Al Haj
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Liana Allabadi
- Faculty of Graduate Studies, Arab American University, Ramallah, Palestine
| | - Salim Haj-Yahia
- School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
- Institute of Cardiovascular and Medical Sciences, Glasgow University, 126 University Place, Glasgow, United Kingdom
| | - Christian Schindler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marek Kwiatkowski
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Elisabeth Zemp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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16
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Ladapo JA, Davidson KW, Moise N, Chen A, Clarke GN, Dolor RJ, Margolis KL, Thanataveerat A, Kronish IM. Economic outcomes of depression screening after acute coronary syndromes: The CODIACS-QoL randomized clinical trial. Gen Hosp Psychiatry 2021; 71:47-54. [PMID: 33933921 PMCID: PMC10784112 DOI: 10.1016/j.genhosppsych.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of screening for depression in patients with acute coronary syndrome (ACS) and no history of depression. METHODS Cost-effectiveness analysis of a randomized trial enrolling 1500 patients with ACS between 2013 and 2017. Patients were randomized to no screening, screening and notifying the primary care provider (PCP), and screening, notifying the PCP, and providing enhanced depression treatment. Outcomes measured were Healthcare utilization, costs, and incremental cost-effectiveness ratios. RESULTS 7.1% of patients screened positive for depressive symptoms. There was no significant difference in usage of mental health services, cardiovascular tests and procedures, and medications. Mean total costs in No Screen group ($7440), in Screen, Notify, and Treat group ($6745), and in Screen and Notify group ($6204). The difference was only significant in the Screen and Notify group versus the No Screen group (-$1236, 95% confidence interval -$2388 to -$96). Because mean QALYs were higher (+0.003 QALY in Screen and Notify; +0.004 QALYs in Screen, Notify, and Treat) and mean total costs were lower in both intervention groups, these interventions were cost-effective. There was substantial uncertainty because confidence intervals around cost differences were wide and QALY effects were small. CONCLUSION Depression screening strategies for patients with ACS may be modestly cost-effective.
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Affiliation(s)
- Joseph A Ladapo
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
| | - Karina W Davidson
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Nathalie Moise
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Alexander Chen
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | | | - Rowena J Dolor
- Duke University School of Medicine, Durham, NC, United States of America
| | - Karen L Margolis
- HealthPartners Institute, Minneapolis, MN, United States of America
| | | | - Ian M Kronish
- Columbia University Irving Medical Center, New York, NY, United States of America
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17
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Wang Y, Jia Y, Li M, Jiao S, Zhao H. Hotspot and Frontier Analysis of Exercise Training Therapy for Heart Failure Complicated With Depression Based on Web of Science Database and Big Data Analysis. Front Cardiovasc Med 2021; 8:665993. [PMID: 34095256 PMCID: PMC8169975 DOI: 10.3389/fcvm.2021.665993] [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: 02/09/2021] [Accepted: 04/15/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Exercise training has been extensively studied in heart failure (HF) and psychological disorders, which has been shown to worsen each other. However, our understanding of how exercise simultaneously protect heart and brain of HF patients is still in its infancy. The purpose of this study was to take advantage of big data techniques to explore hotspots and frontiers of mechanisms that protect the heart and brain simultaneously through exercise training. Methods: We studied the scientific publications on related research between January 1, 2003 to December 31, 2020 from the WoS Core Collection. Research hotspots were assessed through open-source software, CiteSpace, Pajek, and VOSviewer. Big data analysis and visualization were carried out using R, Cytoscape and Origin. Results: From 2003 to 2020, the study on HF, depression, and exercise simultaneously was the lowest of all research sequences (two-way ANOVAs, p < 0.0001). Its linear regression coefficient r was 0.7641. The result of hotspot analysis of related keyword-driven research showed that inflammation and stress (including oxidative stress) were the common mechanisms. Through the further analyses, we noted that inflammation, stress, oxidative stress, apoptosis, reactive oxygen species, cell death, and the mechanisms related to mitochondrial biogenesis/homeostasis, could be regarded as the primary mechanism targets to study the simultaneous intervention of exercise on the heart and brain of HF patients with depression. Conclusions: Our findings demonstrate the potential mechanism targets by which exercise interferes with both the heart and brain for HF patients with depression. We hope that they can boost the attention of other researchers and clinicians, and open up new avenues for designing more novel potential drugs to block heart-brain axis vicious circle.
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Affiliation(s)
- Yan Wang
- Scientific Research Center, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yuhong Jia
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Molin Li
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
| | - Sirui Jiao
- Department of Anatomy, College of Basic Medical Sciences, Dalian Medical University, Dalian, China.,Graduate School of Dalian Medical University, Dalian, China
| | - Henan Zhao
- Department of Pathophysiology, College of Basic Medical Sciences, Dalian Medical University, Dalian, China
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18
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Dunham S, Wilkening GL, Schwier NC. Which SSRI is safest for patients with CVD and major depressive disorder? JAAPA 2021; 34:18-19. [PMID: 33735134 DOI: 10.1097/01.jaa.0000735792.92508.a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Major depressive disorder is a common mood disorder and presents increased morbidity and mortality risks for patients with comorbid cardiovascular disease (CVD). Selective serotonin reuptake inhibitors (SSRIs) are a cornerstone of treatment for major depressive disorder, given their relative safety and affordability compared with other antidepressant classes, and SSRIs frequently are used in patients with CVD. However, clinicians should carefully weigh safety considerations before prescribing SSRIs in these patients. This article reviews the safety of SSRIs in patients with CVD and discusses SSRI selection.
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Affiliation(s)
- Sabrina Dunham
- Sabrina Dunham is a cardiology pharmacy specialty resident at HCA Tristar Centennial Medical Center/University of Tennessee College of Pharmacy in Nashville, Tenn. G. Lucy Wilkening is an associate professor in the Department of Clinical Psychopharmacology at Idaho State University's College of Pharmacy in Meridian, Idaho. Nicholas C. Schwier is an associate professor at the University of Oklahoma Health Sciences Center and a clinical pharmacy specialist in cardiology at OU Medicine Inc., both in Oklahoma City, Okla. The authors have disclosed no potential conflicts of interest, financial or otherwise
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19
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Sama J, Vaidya D, Mukherjee M, Williams M. Effects of clinical depression on left ventricular dysfunction in patients with acute coronary syndrome. J Thromb Thrombolysis 2021; 51:693-700. [PMID: 32876809 PMCID: PMC11140724 DOI: 10.1007/s11239-020-02268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression is associated with heart failure independent of traditional cardiovascular disease risk factors. Enhanced platelet activation has been suggested as a potential mechanism and has been associated with negative inotropic effects that can affect left ventricular ejection fraction (LVEF). We examined 131 consecutive acute coronary syndrome (ACS) patients to assess whether depression increased the risk for developing LV dysfunction, and to determine the effects of platelet serotonin signaling in this relationship. Major depression was assessed using the Structured Clinical Interview and depressive symptoms were measured using the Beck Depression Inventory (BDI), with BDI ≥ 10 defined as abnormal. LV dysfunction was defined as LVEF ≤ 45%. Platelet serotonin response was measured by serotonin augmented platelet aggregation and platelet serotonin receptor density. Mean age of ACS participants was 59 years, 78.6% male and 74.0% Caucasian. 34.4% of patients had a reduced LVEF ≤ 45% on presentation. Almost half (47.0%) of patients had BDI ≥ 10 and 18.0% had major depressive disorder. Platelet serotonin response was found to be augmented in depressed patients with low LVEF compared to depressed patients with normal LVEF (p < 0.020). However, the presence of LV dysfunction was found to be similar in both depressed (32.3%) and non-depressed (36.2%) patients (p = 0.714). This suggests alternative factors contribute to poor cardiovascular outcomes in depressed patients that are independent of LV function in post ACS patients.
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Affiliation(s)
- Jacob Sama
- Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, USA.
| | - Dhananjay Vaidya
- Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, USA
| | - Marlene Williams
- Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, USA
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20
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Bobo WV, Ryu E, Petterson TM, Lackore K, Cheng Y, Liu H, Suarez L, Preisig M, Cooper LT, Roger VL, Pathak J, Chamberlain AM. Bi-directional association between depression and HF: An electronic health records-based cohort study. JOURNAL OF COMORBIDITY 2021; 10:2235042X20984059. [PMID: 33489926 PMCID: PMC7768856 DOI: 10.1177/2235042x20984059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/21/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
Objective: To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs). Methods: This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions. Results: 2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4–6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89–2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17–1.54) after adjusting for all 16 comorbid chronic conditions. Conclusion: These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses.
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Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Tanya M Petterson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace Lackore
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Yijing Cheng
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Division of Digital Health Science, Mayo Clinic, Rochester, MN, USA
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Veronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jyotishman Pathak
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Population Health Sciences, Weill Cornell Medicine, NY, NY, USA
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The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases. CNS Drugs 2020; 34:1133-1147. [PMID: 33064291 PMCID: PMC7666056 DOI: 10.1007/s40263-020-00763-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Depression is common in older adults and those with cardiovascular disease. Although selective serotonin reuptake inhibitors generally have been shown to be safe to treat depression in these patients, it is important to identify additional antidepressants when selective serotonin reuptake inhibitors are not effective. This qualitative narrative review summarizes what is known about the cardiovascular side effects of some of the newer antidepressants. Twelve novel non-selective serotonin reuptake inhibitor antidepressants were identified from the literature: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran, mirtazapine, bupropion, vilazodone, vortioxetine, agomelatine, moclobemide, and ketamine-esketamine. A search restricted to publications written in English was conducted in PubMed and Google Scholar with the following search criteria: the specific antidepressant AND (QT OR QTc OR "heart rate" OR "heart rate variability" OR "hypertension" OR "orthostatic hypotension" OR "cardiovascular outcomes" OR "arrhythmia" OR "myocardial infarction" OR "cardiovascular mortality") AND (geriatric OR "older adults" OR "late life depression" OR "cardiovascular disease" OR "hospitalized" OR "hospitalized"). The recommended use, dosing ranges, cardiovascular effects, and general advantages and disadvantages of each of the drugs are discussed. Levomilnacipran and vilazodone have not received enough study to judge their safety in older patients or in those with, or at high risk for, cardiovascular disease. There is at least some evidence for possible adverse events with each of the other newer antidepressants that could be of concern in these patients. Nevertheless, with careful administration and attention to the potential adverse reactions for each drug, these may provide safe effective alternatives for older adults and patients with cardiovascular disease who do not respond to selective serotonin reuptake inhibitor antidepressants. However, more research on the safety and efficacy of these drugs in these specific patient populations is urgently needed.
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Knapik A, Dąbek J, Gallert-Kopyto W, Plinta R, Brzęk A. Psychometric Features of the Polish Version of TSK Heart in Elderly Patients with Coronary Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E467. [PMID: 32933100 PMCID: PMC7559263 DOI: 10.3390/medicina56090467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/29/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Recommendations for the control of stable patients with coronary artery disease (CAD) related to an adequate level of physical activity (PA). Practical experience shows that the PA level in most people with CAD is definitely too low in relation to the guidelines. The cause may be psychological factors and among them the fear of movement-kinesiophobia. The aim of this project was to examine the evaluation of psychometric features of the Polish version of the Tampa Scale for Kinesiophobia Heart (TSK Heart), used in people with CAD. Materials and methods: The study involved 287 patients with stable CAD: 112 women and 175 men. Age: 63.50 (SD = 11.49) years. Kinesiophobia was assessed using TSK Heart, physical activity (PA)-using the International Physical Activity Questionnaire (IPAQ), and anxiety and depression was examined using the Hospital Anxiety and Depression Scale (HADS). The structure of TSK was examined using principal component analysis (PCA), internal cohesion (Cronbach's alpha, AC), and content validity was calculated by linear regression. Results: PCA showed a three-factor TSK structure. One-dimensionality and satisfactory reliability were found: TSK Heart: AC = 0.878. Kinesiophobia as a predictor of PA: R2 = 0.162 (p = 0.000000). Anxiety and depression-TSK: R2 = 0.093 (p = 0.00000). Conclusions: The Polish version of TSK Heart for cardiac patients is characterized by good psychometric features. The use of it can improve the cooperation of rehabilitation teams for patients with CAD.
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Affiliation(s)
- Andrzej Knapik
- Department of Adapted Physical Activity and Sport, Chair of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40–055 Katowice, Poland; (A.K.); (R.P.)
| | - Józefa Dąbek
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40–055 Katowice, Poland;
| | - Weronika Gallert-Kopyto
- Department of Kinesiology, Chair of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40–055 Katowice, Poland;
| | - Ryszard Plinta
- Department of Adapted Physical Activity and Sport, Chair of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40–055 Katowice, Poland; (A.K.); (R.P.)
| | - Anna Brzęk
- Department of Physiotherapy, Chair of Physiotherapy, School of Health Sciences in Katowice, Medical University of Silesia, 40–055 Katowice, Poland
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Yang L, Wang X, Cui X. Patients' Intensive Telephone-Based Care Program Reduces Depression in Coronary Artery Disease Patients and May Contribute to Favorable Overall Survival by Decreasing Depression. J Cardiovasc Nurs 2020; 34:236-243. [PMID: 30973493 DOI: 10.1097/jcn.0000000000000571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of patients' intensive telephone-based care program (PITC) on depression and its correlation with overall survival in patients with coronary artery disease who have depression. METHODS A total of 224 patients with coronary artery disease who were complicated with depression were allocated randomly to the PITC group and control group in a 1:1 ratio. In the PITC group, PITC and usual care were performed, whereas in the control group, only usual care was given. Depression was assessed using Hospital Anxiety and Depression Scale-Depression (HADS-D) score and Zung Self-Rating Depression Scale (SDS) score. RESULTS No difference in baseline characteristics was found between the PITC and control groups (all P > .05). There were changes the HADS-D score (P = .002) and SDS score (P = .019) from baseline (M0) to month 12 (M12) in the PITC group. Those in the PITC group had a reduced depression rate (assessed by HADS-D score <8 at month 12) (P = .005). As for overall survival analysis, Kaplan-Meier curves revealed that overall survival was numerically longer in the PITC group compared with the control group but displayed no statistical significance (P = .061), whereas patients without depression at month 12 presented with better overall survival compared with patients with depression at month 12, as assessed by HADS-D (P = .041) or SDS (P = .014). CONCLUSIONS A PITC could serve as an effective means to decrease depression, and it might contribute to favorable overall survival by decreasing depression in patients with coronary artery disease.
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Affiliation(s)
- Lanju Yang
- Lanju Yang, MB Department of Catheterization, Liaocheng People's Hospital, China. Xuemei Wang, MB Department of Catheterization, Liaocheng People's Hospital, China
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Assessment of the Level of Pain Intensity and the Level of Anxiety Treated as State and Trait in Patients with Osteoarthritis of the Limbs. Pain Res Manag 2020; 2020:5904743. [PMID: 32377287 PMCID: PMC7195646 DOI: 10.1155/2020/5904743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022]
Abstract
Introduction Osteoarthritis of the musculoskeletal system is accompanied with chronic pain which is the main factor in mood lowering, causing anxiety. Rehabilitation conducted in the framework of spa therapy and outpatient care aims at eliminating or reducing pain and improving physical fitness. Pain relief is an expected phenomenon because it improves the quality of life. Aim of the study. The aim of the study was to evaluate the effect of rehabilitation in the spa and in outpatient clinic on the level of pain and anxiety in patients with degenerative joints and disc disease. Material and methods. The study included a comprehensive treatment conducted in the spa and in outpatient clinic. Observation included 120 persons with disorders of the musculoskeletal system treated in the spa Przerzeczyn-Zdrój. The second group of patients was treated in the rehabilitation clinic. The examinations were performed before and after treatment. The scope of the observations included self-evaluation of anxiety treated as a state and a trait, the level of intensity of pain, medical history, and sociodemographic background interview. In the observations, there were VAS scale and State Trait Anxiety Inventory STAI used. Result As a result of the spa therapy and therapy performed in an outpatient clinic, there was an improvement in lowering the level of pain and anxiety noted. Conclusions 1. Spa therapy and treatment performed in an outpatient clinic reduce the level of pain and anxiety in patients with degenerative disease of the musculoskeletal system. 2. It was found that the therapy conducted in the spa was more effective in lowering the level of pain and anxiety. This trial is registered with NCT03405350.
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Ravona-Springer R, Lutski M, Schnaider Beeri M, Goldbourt U, Tanne D. C-reactive protein in midlife is associated with depressive symptoms two decades later among men with coronary heart disease. Nord J Psychiatry 2020; 74:226-233. [PMID: 31769325 DOI: 10.1080/08039488.2019.1695284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aim: We investigated the relationship between midlife C-reactive protein (CRP) levels in men with coronary heart disease (CHD) and depressive symptoms at old age. CRP levels were measured in a subset of patients with CHD, who previously participated in a secondary prevention trial.Methods: Depressive symptoms were evaluated in survivors of the original cohort 15.0 ± 3 and 19.9 ± 1 years later (T1, n = 463 and T2, n = 314 respectively) using the Geriatric Depression Scale (GDS), 15-item version. Logistic regression was used to estimate ORs and 95%CIs for presence of potentially clinically significant depressive symptoms (GDS ≥5) at T1 and T2.Results: Adjusting for demographic and health-related variables, the OR (95%CI) for GDS ≥5 was 1.23 (0.65-2.33); p = .53 at T1 and 2.36 (1.16-4.83); p = .018 at T2 in the top CRP tertile compared to the others. Similarly, consistently high CRP levels in the top tertile at baseline and 2 years later, were associated with OR of 2.85 (95%CI 1.29-6.30); p = .01 for GDS ≥5 at T2.Conclusions: Presence and persistence of low-grade inflammation in men with CHD during midlife are associated with increased risk of depressive symptoms twenty years later. Among middle aged men with CHD, low-grade inflammation may provide an important added value for prediction of depression in old age.
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Affiliation(s)
- Ramit Ravona-Springer
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Psychiatric Division, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Miri Lutski
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
| | - Michal Schnaider Beeri
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uri Goldbourt
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Tanne
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Stroke and Cognition Institute, Rambam Health Care Campus, Haifa, Israel
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Nagibina YV, Kubareva MI, Knyazeva DS. Medical and social features of patients with coronary artery disease and depression. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-1930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Chronic medical conditions and metabolic syndrome as risk factors for incidence of major depressive disorder: A longitudinal study based on 4.7 million adults in South Korea. J Affect Disord 2019; 257:486-494. [PMID: 31319340 DOI: 10.1016/j.jad.2019.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The assessment of comorbid physical illness and metabolic or cardiovascular risk factors as potential risk factors for onset of major depressive disorder (MDD) is crucial. We aimed to investigate potential risk factors for the development of MDD among individuals with chronic medical conditions and metabolic and behavioral risk factors using a large population-based retrospective cohort from the data of the National Health Insurance Service (NHIS) in South Korea. METHODS The population-based retrospective cohort included data from 2,370,815 adults (age ≥20 years) diagnosed with MDD between January 1, 2010, and December 31, 2016 and age- and gender-matched 2,370,815 healthy controls obtained from the claims data of the NHIS. The data of the regular health checkup provided by the NHIS were also included (age ≥40 years). Logistic regression analyses were performed to investigate the potential risk factors for the incidence of MDD. RESULTS Chronic medical conditions such as Parkinson's disease (odds ratio [OR] = 7.808, 95% confidence interval [CI] = 7.517-8.11), epilepsy (OR = 6.119, 95% CI = 6.019-6.22), multiple sclerosis (OR = 5.532, 95% CI = 4.976-6.151), Huntington's disease (OR = 5.387, 95% CI = 3.258-8.909), migraine (OR = 4.374, 95% CI = 4.341-4.408), stroke (OR = 4.074, 95% CI = 4.032-4.117), and cancer; metabolic syndrome (OR = 1.049, 95% CI = 1.041-1.057) and several of its components including central obesity, elevated fasting blood glucose and triglyceride levels, and reduced high-density lipoprotein level; and cigarette smoking, frequent alcohol consumption, and low physical activity are potential risk factors for the development of MDD. CONCLUSION Our results may support previous evidence on the association between physical conditions and the incidence of MDD as reported by individual population-based studies with modest sample sizes.
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Williams MS, Ziegelstein RC, McCann UD, Gould NF, Ashvetiya T, Vaidya D. Platelet Serotonin Signaling in Patients With Cardiovascular Disease and Comorbid Depression. Psychosom Med 2019; 81:352-362. [PMID: 30855555 PMCID: PMC6499626 DOI: 10.1097/psy.0000000000000689] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Depression in patients with cardiovascular disease is associated with increased risk of adverse clinical outcomes. Investigators have searched for potential biobehavioral explanations for this increased risk. Platelet activation and response to serotonin is an attractive potential mechanism. The aim of the study was to examine platelet serotonin signaling in a group of patients with coronary artery disease (CAD) and comorbid depression to define the relationship between platelet serotonin signaling and cardiovascular complications. METHODS A total of 300 patients with CAD were enrolled (145 with acute coronary syndrome and 155 with stable CAD). Depression was assessed using the Structured Clinical Interview for DSM-IV as well as Beck Depression Inventory II in a dichotomous and continuous manner. Platelet serotonin response was measured by serotonin augmented aggregation, direct platelet serotonin activation, platelet serotonin receptor density, and platelet serotonin uptake. Cardiovascular outcomes were assessed at 12-month follow-up. RESULTS One third of enrolled participants had at least minimal depressive symptoms and 13.6% had major depressive disorder. Depressed cardiovascular patients had significantly higher incidence of major (odds ratio = 3.43, 95% confidence interval = 1.49-7.91, p = .004) and minor (odds ratio = 2.42, 95% confidence interval = 1.41-4.13, p = .001) adverse cardiac events. Platelet serotonin response was not significantly different in patients with depression. Participants with major depressive disorder had higher serotonin receptor density (997.5 ± 840.8 vs 619.3 ± 744.3 fmol/ug, p = .009) primarily found in ACS patients. Depressed patients with minor adverse cardiac events had increased platelet response to serotonin. CONCLUSIONS Depressed cardiovascular patients had higher serotonin receptor density and significantly higher incidence of major and minor cardiac adverse events. Future studies with larger sample sizes including patients with more severe depression are needed to expand on the present hypothesis-generating findings.
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Brostow DP, Warsavage TJ, Abbate LM, Starosta AJ, Brenner LA, Plomondon ME, Valle JA. Mental illness and obesity among Veterans undergoing percutaneous coronary intervention: Insights from the VA CART program. Clin Obes 2019; 9:e12300. [PMID: 30793500 DOI: 10.1111/cob.12300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 12/22/2022]
Abstract
Mental illness and obesity are highly prevalent in patients with coronary disease and are frequently comorbid. While mental illness is an established risk factor for major adverse cardiac and cerebrovascular events (MACCEs), prior studies suggest improved outcomes in people with obesity. It is unknown if obesity and mental illness interact to affect cardiac outcomes or if they independently influence MACCE. We identified 55 091 patients undergoing percutaneous coronary intervention (PCI) between 2009 and 2014, using the Veterans Affairs (VA) Clinical Assessment Reporting and Tracking (CART) program. Cox methods were used to assess the risk of MACCE by weight status and psychiatric diagnosis, and assessed for interaction. Compared to normal weight status, higher weight was associated with reduced MACCE events after PCI (mean follow-up of 2 years) for both stable angina and acute coronary syndromes (ACSs; reduction of >13% in stable angina, >17% in ACS; P < 0.01 for both after adjustment). Having a non-substance abuse mental illness diagnosis increased risk of MACCE compared to patients without mental illness in stable angina over 17%; P < 0.05, but not in ACS. When analysed for interaction, obesity and mental illness did not significantly impact MACCE over their independent influences. These results suggest that mental illness along with weight status have significant impact on MACCE, post-PCI. Clinicians should be aware of patients' mental health status as a significant cardiovascular risk factor after PCI, independent of weight status.
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Affiliation(s)
- Diana P Brostow
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
- Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
| | - Theodore J Warsavage
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, Rocky Mountain VA Medical Center, Aurora, CO, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amy J Starosta
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lisa A Brenner
- Department of Physical Medicine and Rehabilitation, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
- Rocky Mountain VA Medical Center, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO, USA
- Department of Psychiatry, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
- Department of Neurology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
| | - Mary E Plomondon
- Rocky Mountain Regional VA Medical Center, Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO, USA
| | - Javier A Valle
- Division of Cardiology, Anschutz School of Medicine, University of Colorado, Aurora, CO, USA
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Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population. BMC Public Health 2019; 19:232. [PMID: 30808333 PMCID: PMC6390372 DOI: 10.1186/s12889-019-6561-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/18/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Mental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population. METHODS This cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety. RESULTS In total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience. CONCLUSION There was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.
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Biffi A, Scotti L, Rea F, Lucenteforte E, Chinellato A, Vetrano DL, Vitale C, Agabiti N, Sultana J, Roberto G, Mugelli A, Corrao G. Adherence to Antidepressants and Mortality in Elderly Patients with Cardiovascular Disease. Clin Drug Investig 2018; 38:593-602. [PMID: 29589292 DOI: 10.1007/s40261-018-0642-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE: Conflicting findings from studies evaluating the association between use of antidepressant drugs and mortality have been reported. We tested the hypothesis that better adherence to antidepressant therapy may reduce mortality. METHODS The cohort included 29,845 individuals aged ≥ 65 years from several Italian health units who were newly treated with antidepressant drugs after hospital discharge with a diagnosis for cardiovascular disease during 2008-2010. These individuals were observed from the first prescription until the end of data availability (i.e. 2012-2014, depending on the local database). During this period, information on (1) prescription of antidepressants and other medications and (2) death from any cause (outcome) was recorded. Proportional hazards models were fitted to estimate the association between better adherence to antidepressants (defined as proportion of days covered ≥ 75%) and outcome, by adjusting and stratifying for several covariates. RESULTS Patients with better adherence to antidepressants had a reduced mortality of 9% (95% CI 3-14). Patients who did not use other medicaments during follow-up had reduced mortality associated with better adherence to antidepressants of 21% (- 1-38), 14% (7-20), 20% (13-26) and 13% (7-19) for no users of antihypertensive agents, lipid-lowering agents, other cardiovascular drugs and antidiabetics, respectively. CONCLUSIONS Better adherence to antidepressants is associated with reduced all-cause mortality, mainly in patients who did not use other pharmacological treatments. Behavioural changes to enhance adherence among the elderly with cardiovascular disease might offer important benefits in reducing their mortality.
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Affiliation(s)
- Annalisa Biffi
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Lorenza Scotti
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | | | - Davide L Vetrano
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.,Aging Research Center, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Cristiana Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service, Roma, Italy
| | - Janet Sultana
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Roberto
- Epidemiology Unit, Regional Agency for Healthcare Services of Tuscany, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Giovanni Corrao
- Laboratory of Healthcare Research and Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Asnis GM, Majeed K, Henderson MA, Sylvester C, Thomas M, La Garza RD. An Examination of the Relationship Between Insomnia and Tinnitus: A Review and Recommendations. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1179557318781078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tinnitus is a prevalent medical disorder which frequently becomes chronic and severe. Furthermore, quality of life can become compromised with many experiencing comorbid insomnia. We hypothesize that insomnia is a highly prevalent symptom and diagnostic category accompanying tinnitus. Our article reviews the tinnitus literature examining the prevalence of insomnia, the sleep disturbances found, and any methodological issues. Our literature search included a number of databases such as PubMed, Cochrane, and Embase. We found that 16 prior studies had sufficient data presented that allowed for an assessment of the prevalence rate of insomnia in tinnitus; the prevalence rate ranged from 10% to 80% (most rates were over 40%). The overwhelming majority of these studies inadequately defined insomnia as a diagnosis but described it only as a symptom. They focused predominantly on questionnaires (sent via the mail) asking only 1 to 4 questions on whether tinnitus disturbs sleep. Frequently, the only question asked was whether tinnitus disturbed a patient’s sleep without clarifying whether there were problems with daytime functioning. Thus, a valid insomnia diagnosis could not be established. Even in the few studies that asked the necessary information to establish a diagnosis of insomnia, only 1 study provided it. The presence of insomnia in tinnitus was associated with a more severe form of tinnitus. Alarmingly, insomnia was mainly untreated despite evidence supporting that successful treatment of insomnia might also help comorbid tinnitus. Because insomnia is significantly prevalent in tinnitus patients and appears to potentially further impact negatively on one’s quality of life, clinicians should address this possibility with a detailed clinical evaluation; incorporating self-rating questionnaires on sleep could be clinically helpful. If insomnia is present, therapy should be considered.
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Affiliation(s)
- Gregory M Asnis
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kiran Majeed
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Temple University, Philadelphia, PA, USA
| | - Margaret A Henderson
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Clewert Sylvester
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Manju Thomas
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard De La Garza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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The Effect of Spiritual Care on Depression in Patients Following Coronary Artery Bypass Surgery: A Randomized Controlled Trial. RELIGIONS 2018. [DOI: 10.3390/rel9050159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Zhang X, Huo Q, Sun W, Zhang C, Wu Z, Xing B, Li Q. Rs2910164 in microRNA‑146a confers an elevated risk of depression in patients with coronary artery disease by modulating the expression of NOS1. Mol Med Rep 2018; 18:603-609. [PMID: 29749487 DOI: 10.3892/mmr.2018.8929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 01/13/2017] [Indexed: 11/06/2022] Open
Abstract
Depression has been well established as an independent predictor of mortality and cardiac morbidity rates in patients with coronary artery disease (CAD). Evidence has shown that single nucleotide polymorphisms located in pre‑microRNA (miRNA) or mature miRNA may modify various biological processes and affect the process of carcinogenesis, and the downregulation of neuronal nitric oxide synthase 1 (NOS1) can induce depression. It has been shown that NOS1 is the target gene of miR‑146a, and that the rs2910164 G/C polymorphism can downregulate the expression of miR‑146a. In the present study, computational analysis was used to identify the target of miR‑146a, and a luciferase reporter assay system was used to validate NOS1 as a target gene of miR‑146a. In addition, U251 cells were treated with miR‑146a mimics/inhibitors to verify the negative regulatory association between miR‑146a and NOS1. Reverse transcription‑quantitative polymerase chain reaction analysis and western blot analysis were used to estimate the mRNA expression of NOS1 and the expression of miR‑146a. The results showed that the 'seed sequence' was located within the 3'‑untranslated region of NOS1 by searching an online miRNA database (www.mirdb.org), and the luciferase reporter assay confirmed that NOS1 was a direct target gene of miR‑146a. It was also found that the mRNA and protein expression levels of NOS1 in U251 cells treated with miR‑146a mimics and NOS1 small interfering RNA were substantially downregulated, compared with cells treated with the scramble control. The cells treated with miR‑146a inhibitors showed increased expression of NOS1. In addition, the presence of a minor allele of the rs2910164 polymorphism was significantly associated with risk of depression in patients with CAD. Taken together, the findings indicated a decreased risk of depression in the patients with CAD who were carriers of the miR‑146a rs2910164 C allele, and this association may be attributed to its ability to compromise the expression of miR‑146a, and thereby increase the expression of its target gene, NOS1.
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Affiliation(s)
- Xinling Zhang
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
| | - Qianqian Huo
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
| | - Wei Sun
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
| | - Chunxiang Zhang
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
| | - Zongyin Wu
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
| | - Bing Xing
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
| | - Qiang Li
- Department of Cardiology, The First People's Hospital, Jining, Shandong 272011, P.R. China
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Mukeshimana M, Mchunu G. Management of Co-Morbidity of Depression and Chronic Non-Communicable Diseases in Rwanda. Ethiop J Health Sci 2018; 27:17-26. [PMID: 28458487 PMCID: PMC5390225 DOI: 10.4314/ejhs.v27i1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Chronic non-communicable diseases (NCDs) are a major global health problem of the 21 stcentury. They are now the world's leading cause of disease burden and high mortality. An even more alarming health problem is when depression coexists with chronic NCDs, as is frequently the case. Management of this co-morbidity with collaborative care has become a global topic of interest, with the World Health Organization (WHO) recommending implementation of collaborative care for this purpose. The study investigated existing protocols and/or interventions for managing this co-morbidity in Rwandan district hospitals. METHODS The study used an action research design involving a research team of 14 health care professionals to collaboratively identify existing protocols or interventions for managing co-morbidity of depression and NCDs in Rwanda. Focus group discussion using a structured interview guide was used to collect qualitative data, followed by qualitative content analysis using inductive approach. RESULTS We found no particular protocols or interventions in place to manage the co-morbidity of depression and chronic NCDs. Depression and chronic NCDs were found to be treated separately, in separate health care settings and by different health professionals. CONCLUSION The findings revealed a gap in management of co-morbid depression and chronic NCDs in Rwanda district hospitals. We recommend that health care providers follow the WHO collaborative care advisory for better quality care and better patient improvement in management of this co-morbidity.
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Affiliation(s)
- Madeleine Mukeshimana
- College of Medicine and Health Sciences, University of Rwanda, Rwanda.,Howard College, University of KwaZulu Natal, South Africa
| | - Gugu Mchunu
- Howard College, University of KwaZulu Natal, South Africa
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Hartmann R, Schmidt FM, Sander C, Hegerl U. Heart Rate Variability as Indicator of Clinical State in Depression. Front Psychiatry 2018; 9:735. [PMID: 30705641 PMCID: PMC6344433 DOI: 10.3389/fpsyt.2018.00735] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/13/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is a severe disease with great burdens for the affected individuals and public health care systems. Autonomic nervous system (ANS) dysfunction indexed by measures of heart rate variability (HRV) has repeatedly been associated with depression. However, HRV parameters are subject to a wide range of multi-factorial influences and underlying mechanisms in depression are still unclear. HRV parameters have been proposed to be promising candidates for diagnostic or predictive bio-markers for depression but necessary longitudinal design studies investigating the relationship between HRV and depression are scarce. Methods: The sample in this study consisted of 62 depressive individuals without antidepressant medication prior to assessment and 65 healthy controls. Fifteen minute blocks of resting ECGs were recorded 1-2 days before onset of antidepressant treatment and 2 weeks thereafter. The ECGs were pre-processed to extract inter-beat-intervals. Linear and non-linear methods were used to extract HRV parameters. ANOVAS were performed to investigate group differences between depressive patients and healthy controls. Associations between the change in severity of depression and HRV parameters were assessed in a repeated measurements design. Results: Analyses revealed HRV parameter differences between the groups of depressive patients and healthy controls at baseline. Further results show differences in HRV parameters within subjects after 2 weeks of antidepressant treatment. Change in HRV parameter values correlated with changes in symptom severity of depression. Discussion: The current results provide further insight into the relationship between HRV parameters and depression. This may help to underpin utilization of HRV parameters are bio-maker for disease state in depression. Results are discussed within a theoretical framework to link arousal and ANS regulation in depression.
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Affiliation(s)
- Ralf Hartmann
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Frank M Schmidt
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Christian Sander
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Hegerl
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Leipzig, Germany
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Shirzadegan R, Gholami M, Hasanvand S, Birjandi M, Beiranvand A. Effects of geranium aroma on anxiety among patients with acute myocardial infarction: A triple-blind randomized clinical trial. Complement Ther Clin Pract 2017; 29:201-206. [DOI: 10.1016/j.ctcp.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/12/2017] [Indexed: 11/16/2022]
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Fangauf SV, Herrmann-Lingen C, Herbeck Belnap B. Ganzheitliche Langzeitbehandlung bei koronarer Herzkrankheit durch Team Care. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0237-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Soufer R, Burg MM. The interface of emotion and biology in myocardial ischemia: Can we progress using the traditional paradigm? J Nucl Cardiol 2017; 24:783-787. [PMID: 28155190 DOI: 10.1007/s12350-016-0762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Robert Soufer
- Department of Cardiology, Yale University, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Matthew M Burg
- Department of Cardiology, Yale University, 950 Campbell Avenue, West Haven, CT, 06516, USA
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Kiecolt-Glaser JK, Fagundes CP, Andridge R, Peng J, Malarkey WB, Habash D, Belury MA. Depression, daily stressors and inflammatory responses to high-fat meals: when stress overrides healthier food choices. Mol Psychiatry 2017; 22:476-482. [PMID: 27646264 PMCID: PMC5508550 DOI: 10.1038/mp.2016.149] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/27/2016] [Accepted: 07/18/2016] [Indexed: 02/07/2023]
Abstract
Depression, stress and diet can all alter inflammation. This double-blind, randomized crossover study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on inflammatory responses to high-fat meals. During two separate 9.5 h admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar controls), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. The Daily Inventory of Stressful Events assessed prior day stressors and the Structured Clinical Interview for DSM-IV evaluated MDD. As expected, for a woman with no prior day stressors, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were higher following the saturated fat meal than the high oleic sunflower oil meal after controlling for pre-meal measures, age, trunk fat and physical activity. But if a woman had prior day stressors, these meal-related differences disappeared-because the stressors heightened CRP, SAA, sICAM-1 and sVCAM-1 responses to the sunflower oil meal, making it look more like the responses to the saturated fat meal. In addition, women with an MDD history had higher post-meal blood pressure responses than those without a similar history. These data show how recent stressors and an MDD history can reverberate through metabolic alterations, promoting inflammatory and atherogenic responses.
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Affiliation(s)
- Janice K. Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State
University College of Medicine, Columbus, OH, USA
- Department of Psychiatry and Behavioral Health, The Ohio State
University College of Medicine, Columbus, OH, USA
| | - Christopher P. Fagundes
- Department of Psychology, Rice University, Houston, TX, USA
- Department of Symptoms Research, MD Anderson Cancer Center, Houston,
TX, USA
| | - Rebecca Andridge
- Division of Biostatistics, College of Public Health, The Ohio State
University, Columbus, OH, USA
| | - Juan Peng
- Center for Biostatistics, The Ohio State University, Columbus, OH,
USA
| | - William B. Malarkey
- Institute for Behavioral Medicine Research, The Ohio State
University College of Medicine, Columbus, OH, USA
- Department of Medicine, The Ohio State University Medical Center,
Columbus, OH, USA
| | - Diane Habash
- Health and Rehabilitation Sciences, The Ohio State University
Medical Center, Columbus, OH, USA
| | - Martha A. Belury
- Institute for Behavioral Medicine Research, The Ohio State
University College of Medicine, Columbus, OH, USA
- Department of Human Sciences, College of Education and Human
Ecology, The Ohio State University, Columbus, OH, USA
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Brinks J, Fowler A, Franklin BA, Dulai J. Lifestyle Modification in Secondary Prevention: Beyond Pharmacotherapy. Am J Lifestyle Med 2017; 11:137-152. [PMID: 30202327 PMCID: PMC6125029 DOI: 10.1177/1559827616651402] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/19/2016] [Accepted: 05/04/2016] [Indexed: 12/17/2022] Open
Abstract
Despite significant advances in medical technology and pharmacology, cardiovascular disease (CVD) remains a major contributor to health care expenses and the leading cause of death in the United States. Patients with established CVD and their health care providers are challenged with achieving cardiovascular risk reduction to decrease the likelihood of recurrent cardiovascular events. This "secondary prevention" can be achieved, in part, through adherence to prescribed pharmacotherapies that favorably modify major coronary risk factors (ie, hypertension, hypercholesterolemia, diabetes, and obesity). However, lifestyle modification can also be helpful in this regard, providing independent and additive benefits to the associated reductions in cardiovascular morbidity and mortality. Accordingly, physicians and other health care providers should routinely counsel their coronary patients to engage in structured exercise and increased lifestyle physical activity, consume a heart-healthy diet, quit smoking and avoid secondhand smoke, and purposefully address psychosocial stressors that may elevate cardiovascular risk. These lifestyle interventions, either as an adjunct to medication therapy or independently in those patients where medications may be poorly tolerated, cost prohibitive, or ineffective, can significantly decrease cardiovascular mortality and the risk of recurrent cardiac events.
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Affiliation(s)
- Jenna Brinks
- Jenna Brinks, MS, Manager, Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Beaumont Health Center, Cardiac Rehabilitation, 4949 Coolidge Highway, Royal Oak, MI 48073, USA; e-mail:
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Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Prefer Adherence 2017; 11:547-559. [PMID: 28352161 PMCID: PMC5359120 DOI: 10.2147/ppa.s127277] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Correspondence: Carly M Goldstein, Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, USA, Tel +1 401 793 8960, Fax +1 401 793 8944, Email
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Sarah Garcia
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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44
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Gulati M, Buffomante AA, Wenger NK. Depression and Anxiety in Women with Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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Papasavvas T, Al-Amin H, Ghabrash HF, Micklewright D. Translation and validation of the Cardiac Depression Scale to Arabic. Asian J Psychiatr 2016; 22:60-6. [PMID: 27520895 DOI: 10.1016/j.ajp.2016.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Cardiac Depression Scale (CDS) has been designed to measure depressive symptoms in patients with heart disease. There is no Arabic version of the CDS. We translated and validated the CDS in an Arabic sample of patients with heart disease. METHODS Forward and back translation of the CDS was followed by assessment of cultural relevance and content validity. The Arabic version of the CDS (A-CDS) and the Arabic version of the Hospital Anxiety and Depression Scale (A-HADS) were then administered to 260 Arab in-patients with heart disease from 18 Arabic countries. Construct validity was assessed using exploratory factor analysis with polychoric correlations. Internal consistency was assessed using ordinal reliability alpha and item-to-factor polychoric correlations. Concurrent validity was assessed using Pearson's correlation coefficient between the A-CDS and the depression subscale of the A-HADS (A-HADS-D). RESULTS Cultural relevance and content validity of the A-CDS were satisfactory. Exploratory factor analysis revealed three robust factors, without cross-loadings, that formed a single dimension. Internal consistency was high (ordinal reliability alpha for the total scale and the three factors were .94, .91, .86, and .87, respectively; item-to-factor correlations ranged from .77 to .91). Concurrent validity was high (r=.72). The A-CDS demonstrated a closer to normal distribution of scores than the A-HADS-D. LIMITATIONS Sensitivity and specificity of the A-CDS were not objectively assessed. CONCLUSIONS The A-CDS appears to be a valid and reliable instrument to measure depressive symptoms in a representative sample of Arab in-patients with heart disease.
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Affiliation(s)
- T Papasavvas
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar; School of Biological Sciences, University of Essex, Colchester, UK.
| | - H Al-Amin
- Weill Cornell Medical College in Qatar, Doha, Qatar; Psychiatry Department, Rumeilah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - H F Ghabrash
- The Northern Hospital, Northwestern Mental Health, Melbourne Health, Melbourne, Australia
| | - D Micklewright
- School of Biological Sciences, University of Essex, Colchester, UK
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Martin DJ, Ul-Haq Z, Nicholl BI, Cullen B, Evans J, Gill JMR, Roberts B, Gallacher J, Mackay D, McIntosh A, Hotopf M, Craddock N, Deary IJ, Pell JP, Smith DJ. Cardiometabolic disease and features of depression and bipolar disorder: population-based, cross-sectional study. Br J Psychiatry 2016; 208:343-51. [PMID: 26795427 DOI: 10.1192/bjp.bp.114.157784] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 06/02/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The relative contribution of demographic, lifestyle and medication factors to the association between affective disorders and cardiometabolic diseases is poorly understood. AIMS To assess the relationship between cardiometabolic disease and features of depresion and bipolar disorder within a large population sample. METHOD Cross-sectional study of 145 991 UK Biobank participants: multivariate analyses of associations between features of depression or bipolar disorder and five cardiometabolic outcomes, adjusting for confounding factors. RESULTS There were significant associations between mood disorder features and 'any cardiovascular disease' (depression odds ratio (OR) = 1.15, 95% CI 1.12-1.19; bipolar OR = 1.28, 95% CI 1.14-1.43) and with hypertension (depression OR = 1.15, 95% CI 1.13-1.18; bipolar OR = 1.26, 95% CI 1.12-1.42). Individuals with features of mood disorder taking psychotropic medication were significantly more likely than controls not on psychotropics to report myocardial infarction (depression OR = 1.47, 95% CI 1.24-1.73; bipolar OR = 2.23, 95% CI 1.53-3.57) and stroke (depression OR = 2.46, 95% CI 2.10-2.80; bipolar OR = 2.31, 95% CI 1.39-3.85). CONCLUSIONS Associations between features of depression or bipolar disorder and cardiovascular disease outcomes were statistically independent of demographic, lifestyle and medication confounders. Psychotropic medication may also be a risk factor for cardiometabolic disease in individuals without a clear history of mood disorder.
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Affiliation(s)
- Daniel J Martin
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Zia Ul-Haq
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Barbara I Nicholl
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Breda Cullen
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Jonathan Evans
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Jason M R Gill
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Beverly Roberts
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - John Gallacher
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Daniel Mackay
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Andrew McIntosh
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Matthew Hotopf
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Nick Craddock
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Ian J Deary
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Jill P Pell
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Daniel J Smith
- Daniel J. Martin, MRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Zia Ul-Haq, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK and Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; Barbara I. Nicholl, PhD, Institute of Health and Wellbeing, General Practice and Primary Care, University of Glasgow, Glasgow, UK; Breda Cullen, DClinPsy, Jonathan Evans, PhD, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK; Jason M. R. Gill, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Beverly Roberts, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; John Gallacher, PhD, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Daniel Mackay, PhD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Andrew McIntosh, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, UK; Matthew Hotopf, MD, FRCPsych, Institute of Psychiatry, Kings College, London, London, UK; Nick Craddock, PhD, FRCPsych, National Centre for Mental Health, Institute of Neurosciences and Mental Health, Cardiff University, Cardiff, UK; Ian J. Deary, PhD, Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK; Jill P. Pell, MD, Institute of Health and Wellbeing, Public Health, University of Glasgow, Glasgow, UK; Daniel J. Smith, MD, FRCPsych, Institute of Health and Wellbeing, Mental Health, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Chou AY, Prakash R, Rajala J, Birnie T, Isserow S, Taylor CM, Ignaszewski A, Chan S, Starovoytov A, Saw J. The First Dedicated Cardiac Rehabilitation Program for Patients With Spontaneous Coronary Artery Dissection: Description and Initial Results. Can J Cardiol 2016; 32:554-60. [PMID: 26923234 DOI: 10.1016/j.cjca.2016.01.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction in women, but the role of rehabilitation after SCAD is unclear. METHODS We designed a dedicated SCAD cardiac rehabilitation (SCAD-CR) program for our SCAD survivors at Vancouver General Hospital. This program encompasses a multidisciplinary approach including exercise rehabilitation, psychosocial counselling, dietary and cardiovascular disease education, and peer group support. Exercise and educational classes were scheduled weekly with a targeted participation of 6 months. Psychosocial counselling, mindful living sessions, social worker and psychiatry evaluations, and peer-group support were offered. RESULTS We report our first consecutive cohort of 70 SCAD women who joined SCAD-CR from November 2011 to April 2015. The average age was 52.3 ± 8.4 years. Mean participation duration was 12.4 ± 10.5 weeks; 28 completed 6 months, 48 completed ≥ 1 month. At entry, 44 (62.9%) had recurrent chest pains and average metabolic equivalents on exercise treadmill test was 10.1 ± 3.3. At program exit, the proportion with recurrent chest pains was lower (37.1%) and average metabolic equivalents was higher 11.5 ± 3.5 (both P < 0.001). There was a significant improvement in the STOP-D depression questionnaire, with mean scores of 13.0 ± 1.4 before and 8.0 ± 1.7 after the SCAD-CR (P = 0.046). Twenty (28.6%) social worker referrals and 19 (27.1%) psychiatry referrals were made. Mean follow-up was 3.8 ± 2.9 years from the presenting SCAD event, and the major cardiac adverse event rate was 4.3%, lower than our non-SCAD-CR cohort (n = 145; 26.2%; P < 0.001). CONCLUSIONS This is the first dedicated SCAD-CR program to address the unique exercise and psychosocial needs of SCAD survivors. Our program appears safe and beneficial in improving chest pain, exercise capacity, psychosocial well-being and cardiovascular events.
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Affiliation(s)
- Annie Y Chou
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roshan Prakash
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Rajala
- Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Taira Birnie
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carolyn M Taylor
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Ignaszewski
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sammy Chan
- Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Starovoytov
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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49
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Ernstsen L, Rangul V, Nauman J, Nes BM, Dalen H, Krokstad S, Lavie CJ, Blair SN, Wisløff U. Protective Effect of Regular Physical Activity on Depression After Myocardial Infarction: The HUNT Study. Am J Med 2016; 129:82-88.e1. [PMID: 26302141 DOI: 10.1016/j.amjmed.2015.08.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE To study if physical activity within the recommended level over time was associated with risk of developing depression after the first myocardial infarction in older adults. METHODS Men (n = 143) and women (n = 46) who had reached the age of 60 years in 2006-2008 who participated in the Nord-Trøndelag Health Study (HUNT1, 1984-1986; HUNT2, 1995-1997; HUNT3, 2006-2008) without any mental illness or cardiovascular disease at baseline in HUNT2 and who experienced their first myocardial infarction before HUNT3 were included. Based on the patterns of physical activity from HUNT1 to HUNT2, the sample was divided into 4 groups: persistently inactive, from active to inactive, from inactive to active, and persistently active. The primary outcome, post-myocardial infarction depression symptoms, was measured with the Hospital, Anxiety and Depression Scale in HUNT3. RESULTS In HUNT3, 11% of participants had depression. After multivariable adjustment, those who were persistently active had significantly lower odds of being depressed (odds ratio 0.28; 95% confidence interval, 0.08-0.98) compared with those who were persistently inactive. Additionally, a significant test for trend (P = .033) of lowering odds of depression was observed across all 4 categories of physical activity patterns at baseline. CONCLUSIONS In this small sample of initially healthy adults, we observed a long-term protective effect of regular physical activity on the development of depression following myocardial infarction.
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Affiliation(s)
- Linda Ernstsen
- Department of Nursing Science, Faculty of Health and Social Science, Sør-Trøndelag University College, Trondheim, Norway; K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Vegar Rangul
- Faculty of Health Science, Nord-Trøndelag University College, Levanger, Norway; HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Javaid Nauman
- K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjarne M Nes
- K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- MI Lab & Department of Circulation & Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Psychiatric Department, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, La
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, SC
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine, Department Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Amiaz R, Asher E, Rozen G, Czerniak E, Glikson M, Weiser M. Do implantable cardioverter defibrillators contribute to new depression or anxiety symptoms? A retrospective study. Int J Psychiatry Clin Pract 2016; 20:101-5. [PMID: 27052573 DOI: 10.3109/13651501.2016.1161055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this retrospective cross-sectional study, we evaluated the existence of psychiatric symptoms which appeared after implantation of an implantable cardioverter defibrillator (ICD). METHODS Patients with ICDs were diagnosed using the Mini International Neuropsychiatric Interview (MINI) and were excluded if they had any psychiatric diagnosis prior to ICD implantation. Depression and anxiety were evaluated using the HAM-D and HAM-A rating scales and their attitude towards the ICD using a visual analog scale (VAS). Ninety five ICD patients with mean age of 66 years (±11.5) were recruited, 80 (84%) were men. RESULTS Four (4%) patients were diagnosed with new-onset MDD and one patient (1%) with anxiety. Twenty seven (28%) were found to have significant depressive symptoms (HAM-D >8), without MDD diagnosis; half of them attributing these symptoms to the device. Seven (8%) patients experienced phantom shocks and had relatively higher depressive scores (HAM-D 10.3 vs. 5.8; F = 3.696; p = 0.058). The MDD rates in our study were rather consistent with those reported for cardiac patients. CONCLUSIONS We suggest that ICD contributed little, if any, additional depressive or anxiety symptoms after implantation. We found that the overall attitude towards the device was positive and that shocks and phantom shocks were related to depressive symptoms.
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Affiliation(s)
- Revital Amiaz
- a Psychiatry Department , The Chaim Sheba Medical Center , Tel Hashomer , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Elad Asher
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Guy Rozen
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Efrat Czerniak
- a Psychiatry Department , The Chaim Sheba Medical Center , Tel Hashomer , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michael Glikson
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel ;,c Davidai Arrhythmia Center, Leviev Heart Center, The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Mark Weiser
- a Psychiatry Department , The Chaim Sheba Medical Center , Tel Hashomer , Israel ;,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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