Depressive symptoms are associated with in-hospital complications following acute myocardial infarction

Pathological Changes and Metabolic Adaptation in the Myocardium of Rats in Response to Chronic Variable Mild Stress

Chronic variable mild stress (CVS) in rats is a well-established paradigm for inducing depressive-like behaviors and has been utilized extensively to explore potential therapeutic interventions for depression. While the behavioral and neurobiological effects of CVS have been extensively studied, its impact on myocardial function remains largely unexplored. To induce the CVS model, rats were exposed to various stressors over 40 days. Behavioral assessments confirmed depressive-like behavior. Biochemical analyses revealed alterations in myocardial metabolism, including changes in NAD+ and NADP+, and NADPH concentrations. Free amino acid analysis indicated disturbances in myocardial amino acid metabolism. Evaluation of oxidative DNA damage demonstrated an increased number of abasic sites in the DNA of rats exposed to CVS. Molecular analysis showed significant changes in gene expression associated with glucose metabolism, oxidative stress, and cardiac remodeling pathways. Histological staining revealed minor morphological changes in the myocardium of CVS-exposed rats, including increased acidophilicity of cells, collagen deposition surrounding blood vessels, and glycogen accumulation. This study provides novel insights into the impact of chronic stress on myocardial function and metabolism, highlighting potential mechanisms linking depression and cardiovascular diseases. Understanding these mechanisms may aid in the development of targeted therapeutic strategies to mitigate the adverse cardiovascular effects of depression.

The Prevalence of Depression in Survivors of Acute Myocardial Infarction and Gender Differences in King Abdulaziz Medical City (KAMC), Riyadh

BACKGROUND

Myocardial infarction (MI) stands as a prevalent worldwide cause of mortality. The aftermath of an MI often entails an unpleasant experience for individuals, who frequently find themselves overwhelmed. Extensive literature suggests that a significant proportion of patients develop depressive symptoms subsequent to MI. Consequently, the primary objective of this study is to ascertain the prevalence of post-MI depression among affected individuals.

METHODS

This is a cross-sectional study involving a survey distributed to patients admitted to the King Abdulaziz Medical Center (KAMC) located in Riyadh, Saudi Arabia. The study involved 210 patients; 72.1% of the sample were men and 27.9% were female.

RESULTS

The average age of the participants in this study was 61.96 years old. The mean age of the male participants was 61.10 years old, while the females' mean age was 64.35 years old. Males made up 75.27% of the participants, while 24.73% were females. Overall, 33.64% of the participants had an abnormal score (depression). The majority of male patients had a normal score, which means that they do not suffer from depression. Among the female patients, 38.60% had an abnormal score.

CONCLUSION

Mental illness is a significant concern, particularly depression. Individuals should go for depression screening post-MI as it will determine their compliance with visiting the hospital, caring for themselves, and taking medications.

Evaluating Death Anxiety and Death Depression Levels among Patients with Acute Myocardial Infarction

This study aimed to assess death anxiety and death depression levels among patients with acute myocardial infarction. This was a descriptive correlational study, which was conducted on patients who were treated on an outpatient clinic or cardiology clinics a training and research hospital in Istanbul, Turkey between January and August 2020. The sample of study included 300 patients, who met the inclusion criteria and agreed to participate in the study. The Sociodemographic Form, Death Anxiety Scale and Death Depression Scale served as data collection tools. The patients obtained a mean score of 12.260 ± 3.315 from Death Depression Scale and a mean score of 12.506 ± 2.915 from Death Anxiety Scale. The patients had a death-related depression mood and a severe death anxiety level. The correlation between the patients' Death Depression Scale and Death Anxiety Scale mean scores was statistically significant and moderate positive (r = .590; p = 0.000). As patients' death anxiety increased, their death-related depression levels also increased was determined. The death anxiety levels of the patients were mostly severe, to the point of panic. Their depression scores were also above average.

Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study

BACKGROUND

Coronary artery bypass graft surgery (CABG) is an intervention directed toward improving the Quality of Life (QoL) for patients with coronary artery disease. Depression can affect QoL negatively among this population. Perceived control (PC) decreased the effect of anxiety on QoL, however, this effect has not been well-studies regarding depression. Therefore, the purpose of this study was to check the effect of depression on QoL among CABG patients and to determine if preoperative PC moderates this effect.

METHODS

This was a prospective observational cohort study conducted on a consecutive sample of 200 patients from three hospitals in Amman, Jordan. Depression Anxiety and Stress Scale, Short-Form Health Survey-36, and Arabic version of the Control Attitude Scale-Revised were used to measure depressive symptoms, QoL and PC respectively. Data were analyzed using t test and step wise multiple regression followed by simple slope analysis.

RESULTS

Postoperative Physical Component Summary (PCS) was better than preoperative PCS (mean ± SD: 38.2 ± 9.4 vs. 36.6 ± 9.5, P < 0.001). Postoperative Mental Component Summary (MCS) was better than preoperative MCS (mean ± SD: 44.3 ± 11.5 vs. 41.4 ± 11.4, P < 0.001). Preoperative depression was higher than postoperative depression; (mean ± SD: 12.8 ± 6.8 vs.11.1 ± 6.7, P < 0.01). Simple slope analysis was significant (simple slope = 0.41, t = 6.1, P < 0.001), indicating the moderating effect of PC.

CONCLUSION

Patients undergoing CABG surgery had poor QoL and high levels of depression. Perceived control moderated this relationship and improve QoL. Assessing depression levels and implantation of interventions to enhance perceived control levels prior to operation might improve QoL.

Screening for depression and anxiety among patients with acute coronary syndrome in acute care settings: a scoping review

OBJECTIVE

The aim of this review was to scope the literature for publications on the practice of screening for depression and anxiety in acute coronary syndrome patients in acute care by identifying instruments for the screening of anxiety and/or depression; determining if screening for anxiety and/or depression has been integrated into cardiac models of care and clinical pathways; and identifying any evidence practice gap in the screening and management of anxiety and/or depression in this population.

INTRODUCTION

Depression in acute coronary syndrome is bidirectional. Depression is an independent risk factor for cardiovascular disease, and comorbid depression is associated with a twofold greater risk of mortality in patients with cardiovascular disease. The presence of acute coronary syndrome increases the risk of depressive disorders or anxiety during the first one to two years following an acute event, and both depression and anxiety are associated with a higher risk of further acute coronary health concerns. Clinical practice guidelines have previously recommended routine screening for depression following a cardiac event, although many current guidelines do not include recommendations for screening in an acute setting. To date there have been no previous scoping reviews investigating depression and anxiety screening in patients with acute coronary syndrome in the acute care setting.

INCLUSION CRITERIA

Adults (18 years and over) with acute coronary syndrome who are screened for anxiety and/or depression (not anxiety alone) in an acute care setting.

METHODS

A systematic search of the literature was conducted by a research librarian. Research studies of any design published in English from January 1, 2012, to May 31, 2018, were included. Data were extracted from the included studies to address the three objectives. Purposefully designed tables were used to collate information and present findings. Data are also presented as figures and by narrative synthesis.

RESULTS

Fifty-one articles met the inclusion criteria. Primary research studies were from 21 countries and included 21,790 participants; clinical practice guidelines were from two countries. The most common instruments used for the screening of depression and anxiety were: i) the Hospital Anxiety and Depression Scale (n = 18); ii) the Beck Depression Inventory (n = 16); and iii) the nine-item Patient Health Questionnaire (n = 7). Eleven studies included screening for anxiety in 2181 participants (30% female) using the full version of the Hospital Anxiety and Depression Scale. The State-Trait Anxiety Inventory was used to screen 444 participants in three of the studies. Four studies applied an intervention for those found to have depression, including two randomized controlled trials with interventions targeting depression. Of the seven acute coronary syndrome international guidelines published since 2012, three (43%) did not contain any recommendations for screening for depression and anxiety, although four (57%) had recommendations for treatment of comorbidities.

CONCLUSIONS

This review has identified a lack of consistency in how depression and anxiety screening tools are integrated into cardiac models of care and clinical pathways. Guidelines for acute coronary syndrome are not consistent in their recommendations for screening for depression and/or anxiety, or in identifying the best screening tools.

The Association Between Depressive Symptoms and Length of Hospital Stay Following Coronary Artery Bypass Graft is Moderated by Perceived Control

PURPOSE

Depressive symptoms can negatively influence patient outcomes after coronary artery bypass graft surgery (CABG). Preoperative depressive symptoms can be associated with a longer hospitalization. Perceived control moderates the effect of anxiety on length of stay (LOS) among CABG patients, but its effect on depressive symptoms and LOS is not well studied. This study tests whether perceived control moderates the relationship between depressive symptoms and LOS among patients following CABG.

PATIENTS AND METHODS

This prospective cohort study was conducted on 220 participants recruited from three hospitals in Jordan. Participants' depressive symptom levels were measured using the depression subscale of the Hospital Anxiety and Depression Scale. Perceived control was measured by the Arabic version of the Control Attitude Scale-Revised. Length of stay was obtained from medical records. Data were analyzed using multiple regression and simple slope analysis.

RESULTS

Females had higher levels of depressive symptoms (mean [SD]: 16.7 [5.2] vs 11.6 [5.6], P<0.05), and longer LOS (mean [SD]: 17.5 [12.7] vs 10.3 [9.0], P<0.001) compared to male patients. Being female increased the length of stay by 0.18 days. Every one-unit increase in preoperative depressive symptoms increased LOS by 0.37 days. Perceived control has a protective effect; every one unit increase in perceived control decreased LOS by 0.28 days. Moreover, perceived control moderates the relationship between depressive symptoms and LOS.

CONCLUSION

This study suggests that depressive symptoms and perceived control play an important role in the recovery among post-CABG patients. Application of policies to assess depressive symptoms and improve perceived control prior to CABG by health care providers might decrease morbidity and mortality.

Evidence of Arabic Version of the Control Attitude Scale-Revised Efficacy to Measure Perceived Control in Acute Myocardial Infarction Patients

BACKGROUND AND PURPOSE

Perceived control plays a vital role in controlling negative consequences during disease process. The purpose of this study was to test the psychometric properties of the Arabic version of the Control Attitudes Scale-Revised (CAS-R) among patients with acute myocardial infarction (AMI).

METHODS

375 patients with a confirmed diagnosis of AMI participated in this study. Reliability was assessed by Cronbach's alpha, item-total correlations, and interitem correlations. Construct validity was examined by hypotheses testing.

RESULTS

Cronbach's alpha was .85. All items were homogenous, since item-total correlation coefficients and interitem correlation coefficients were acceptable. Perceived control has a protective effect against anxiety and complications, supporting the construct validity.

CONCLUSIONS

The Arabic version of the CAS-R is a valid and reliable instrument to measure perceived control in patients with AMI.

Patients with ST segment elevation myocardial infarction: moderating effect of perceived control on the relationship between depression and in-hospital complications

BACKGROUND

Cardiovascular diseases remain the top global killer, with nearly 80% of related mortalities occurring in developing countries. Over half of cardiovascular diseases' mortality is due to coronary heart disease, which is commonly linked to acute myocardial infarction. Psychological factors (i.e., depression and anxiety) after acute myocardial infarction are associated with higher levels of complications and mortality. Perceived control moderated the effect of anxiety on complications in different cardiac populations, but impacts on depression and complications after acute myocardial infarction are not well studied. This study explores the moderating effect of perceived control on the relationship between depression and complications after ST segment elevation myocardial infarction.

METHODS

Three hundred patients with a confirmed diagnosis of ST segment elevation myocardial infarction participated in this prospective observational study. Patients answered socio-demographic data, the depression subscale of the Hospital Anxiety and Depression Scale (HADS), and the Control Attitude Scale-Revised (CAS-R) questionnaires. In-hospital complications and all other necessary data were extracted from medical records after discharge. Data were analyzed using logistic regression.

RESULTS

24% developed at least one complication. Patients with high depression scores (8-21) were more likely to develop complications (χ² = 34.15, p < .001) than those with low depression scores (0-7). Patients with high levels of perceived control had lower levels of depression than those with low perceived control (mean [SD], 9.47 [6.43] vs. 12.31 [6.66], p < .001). The results of logistic regression showed that perceived control moderated the association between depression and complications, since depression scores, perceived control scores, and the interaction between depression and perceived control were significant predictors of complications. Participants with high depression and low perceived control had the highest rate of complications (31.5% vs. 15.4%, P < .001).

CONCLUSIONS

Depression increased complications after ST segment elevation myocardial infarction. Perceived control moderated this relationship. Assessment of depression and enhancement of perceived control in patients with acute myocardial infarction can decrease complications and improve outcomes.

Pre-operative depression predicted longer hospital length of stay among patients undergoing coronary artery bypass graft surgery

Purpose: Coronary artery bypass graft surgery (CABG) is a common and remarkably effective treatment for coronary heart disease, improving health status and enhancing quality of life. However, some outcomes after surgery remain unexplained, including psychological factors such as depression. The prevalence rates of pre- and post-operative depression among CABG patients are high, which is associated with negative short- and long-term outcomes. This study explores the impacts of pre-operative depressive symptoms on post-operative hospital length of stay (LOS) among patients undergoing CABG in Jordan. Patients and methods: This was a non-experimental, prospective observational study among 227 CABG patients recruited from 5 hospitals in Amman, Jordan. Depression was measured within an average of two weeks prior and one month after the operation using the Hospital Anxiety and Depression Scale. Length of stay was abstracted from medical records after discharge. Results: The average post-operative LOS was 11.40±10.41 days. The average pre-operative depression level was moderate; 12.76±6.80 and 42.47% complained of varying levels of depressive symptoms. The average post-operative depression level was moderate; 11.11±6.78 and 40.53% complained of varying levels of depressive symptoms. In stepwise regression models, depression scores and female gender were independent predictors that increased post-operative LOS. On the other hand, high income (≥1501$/month) and use of statins had protective effects and decreased post-operative LOS. The model explained 22.4% of the total variance regarding LOS. Conclusion: Pre-operative depressive symptoms increased post CABG LOS. Application of policies and depression assessment protocols prior to CABG by health care providers can identify high-risk groups (eg, females), so appropriate interventions can be designed and implemented to decrease morbidity and mortality.

Depressive Symptoms and Complications Early after Acute Myocardial Infarction: Gender Differences

Background:

Cardiovascular disease is the first leading cause of death worldwide. Coronary heart disease is the most common manifestation of cardiovascular disease. Acute myocardial infarction is the primary manifestation of coronary heart disease. Depression is a common and predicted complication after acute myocardial infarction. Limited studies evaluated gender differences in depressive symptoms after acute myocardial infarction especially in developing countries.

Objective:

The study aimed to determine whether there was a difference in depression levels and rate of complications based on gender early after acute myocardial infarction.

Method:

This was a prospective comparative study on 230 patients (150 men and 80 women) with a confirmed diagnosis of acute myocardial infarction. All participants signed an informed consent, filled sociodemographic and clinical questionnaire and the Depression Subscale of the Hospital Anxiety and Depression Scale. Clinical data were abstracted from the participants’ medical record after discharge.

Results:

Eighty-six participants (37.4%), 54 men and 32 women, developed 1 or more complications during hospitalization. Female patients were more depressed (14.4±3.5 vs. 8.3 ± 2.6) and developed more complications (1.9 ± 0.9 vs. 0.8 ± 0.5) than male patients did. Depressive symptoms increased the occurrence of complication by 40% and 33% for female and male patients respectively after controlling for sociodemographic and clinical variables.

Conclusion:

Depressive symptoms independently predicted complications after acute myocardial infarction in both men and women. The inclusion of depression assessment tools in acute myocardial infarction treatment protocols is highly recommended.

Perceived control moderates the relationship between anxiety and in-hospital complications after ST segment elevation myocardial infarction

Purpose

Anxiety is a common psychological response after acute myocardial infarction and might be associated with higher levels of in-hospital complications. Perceived control might moderate this relationship, but the effect of this method has not been checked in developing countries. Therefore, the objectives of this study were as follows: 1) to check if anxiety was an independent predictor of in-hospital complications after acute myocardial infarction; and 2) to check if perceived control moderates the relationship between anxiety and in-hospital complications after acute myocardial infarction.

Patients and methods

This was a prospective observational study among 500 patients with a confirmed diagnosis of ST segment elevation myocardial infarction recruited from three private hospitals in Amman, Jordan. Anxiety was measured by the Anxiety subscale of Hospital Anxiety and Depression Scale, and perceived control was measured by the Arabic version of the Control Attitude Scale-Revised.

Results

One hundred and forty patients (28%) developed at least one complication during hospitalization. Two hundred and fifty-five patients had low anxiety scores (≤7), and 245 patients had high anxiety scores (≥8). Patients with high levels of perceived control had lower levels of anxiety (mean [SD]; 5.3 [3.6] vs 14.1 [6.3], P<0.001) than those with low perceived control. In logistic regression, anxiety was an independent predictor of in-hospital complications after controlling for sociodemographic and clinical variables (odds ratio: 1.24, 95% CI, 1.08–1.41, P<0.01). Moreover, the interaction of anxiety and perceived control was a significant predictor of complications.

Conclusion

Anxiety was associated with increased risk of in-hospital complications after acute myocardial infarction independent of sociodemographic and clinical variables. Perceived control had a moderating effect for this association since the combination of low perceived control and high anxiety scores was associated with the greatest risk for complications. Supporting patients’ levels of perceived control can decrease complications, morbidities, and mortality after acute myocardial infarction.