Gender and sex differences in prevalence of major depression in coronary artery disease patients: a meta-analysis

A Potential Role for MAGI-1 in the Bi-Directional Relationship Between Major Depressive Disorder and Cardiovascular Disease

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.

Impact of depression on in-hospital outcomes for adults with type 2 myocardial infarction: A United States population-based analysis

BACKGROUND

Type 2 myocardial infarction (T2MI) is an ischemic myocardial injury in the context of oxygen supply/demand mismatch in the absence of a primary coronary event. However, though there is a rising prevalence of depression and its potential association with type 1 myocardial infarction (T1MI), data remains non-existent to evaluate the association with T2MI.

AIM

To identify the prevalence and risk of T2MI in adults with depression and its impact on the in-hospital outcomes.

METHODS

We queried the National Inpatient Sample (2019) to identify T2MI hospitalizations using Internal Classification of Diseases-10 codes in hospitalized adults (≥ 18 years). In addition, we compared sociodemographic and comorbidities in the T2MI cohort with vs without comorbid depression. Finally, we used multivariate regression analysis to study the odds of T2MI hospitalizations with vs without depression and in-hospital outcomes (all-cause mortality, cardiogenic shock, cardiac arrest, and stroke), adjusting for confounders. Statistical significance was achieved with a P value of < 0.05.

RESULTS

There were 331145 adult T2MI hospitalizations after excluding T1MI (median age: 73 years, 52.8% male, 69.9% white); 41405 (12.5%) had depression, the remainder; 289740 did not have depression. Multivariate analysis revealed lower odds of T2MI in patients with depression vs without [adjusted odds ratio (aOR) = 0.88, 95% confidence interval (CI): 0.86-0.90, P = 0.001]. There was the equal prevalence of prior MI with any revascularization and a similar prevalence of peripheral vascular disease in the cohorts with depression vs without depression. There is a greater prevalence of stroke in patients with depression (10.1%) vs those without (8.6%). There was a slightly higher prevalence of hyperlipidemia in patients with depression vs without depression (56.5% vs 48.9%), as well as obesity (21.3% vs 17.9%). There was generally equal prevalence of hypertension and type 2 diabetes mellitus in both cohorts. There was no significant difference in elective and non-elective admissions frequency between cohorts. Patients with depression vs without depression also showed a lower risk of all-cause mortality (aOR = 0.75, 95%CI: 0.67-0.83, P = 0.001), cardiogenic shock (aOR = 0.65, 95%CI: 0.56-0.76, P = 0.001), cardiac arrest (aOR = 0.77, 95%CI: 0.67-0.89, P = 0.001) as well as stroke (aOR = 0.79, 95%CI: 0.70-0.89, P = 0.001).

CONCLUSION

This study revealed a significantly lower risk of T2MI in patients with depression compared to patients without depression by decreasing adverse in-hospital outcomes such as all-cause mortality, cardiogenic shock, cardiac arrest, and stroke in patients with depression.

Symptom patterns in the co-occurrence of depressive and generalized anxiety symptoms: A network analysis of a Canadian nationally representative sample

BACKGROUND

This study aimed to investigate the symptom patterns of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a matched nationally representative sample of the Canadian population. We also tested whether childhood maltreatment (CM) exposures and sex would be linked with different symptom patterns.

METHODS

A total of 3296 participants from the Canadian Community Health Survey-Mental Health with complete information on MDD and GAD symptoms and being matched on the studied sociodemographic characteristics were included in the current study. Network analysis was performed to examine the MDD-GAD symptom network, network stability and centrality indices were also estimated. Finally, network comparison in connectivity patterns was conducted to explore the impact of maltreatment experience and sex differences in the MDD-GAD symptom networks.

RESULTS

The CM group had stronger network connections and showed differences in the network structures from the non-CM group. In the CM group, depressed mood and diminished interest were central symptoms and strongly connected with other symptoms. Additionally, females had stronger connections in the MDD-GAD symptom network than males, and sleep disturbance was a central symptom for females, alongside depressed mood and diminished interest.

LIMITATIONS

The cross-sectional design restricts our capacity to establish longitudinal or causal connections between symptoms.

CONCLUSIONS

Depressed mood was the most central node that was strongly connected with other symptoms in the network. Distinct MDD-GAD symptom networks were discovered in the CM and the female group when compared to their counterparts. Noteworthy, individuals with CM had a stronger correlation between worry and suicidal ideation. Clinical management and intervention efforts should pay close attention to these core symptoms to yield optimal treatment effects, particularly for females and individuals with CM.

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.

Spontaneous Coronary Artery Dissection Across the Health Care Pathway: A National, Multicenter, Patient-Informed Investigation

BACKGROUND

Clinical practice guidelines for the management and convalescence of patients with spontaneous coronary artery dissection (SCAD) have yet to be developed. The targeted content, delivery, and outcomes of interventions that benefit this population remain unclear. Patient-informed data are required to substantiate observational research and provide evidence to inform and standardize clinical activities.

METHODS AND RESULTS

Patients diagnosed with SCAD (N=89; 86.5% women; mean age, 53.2 years) were purposively selected from 5 large tertiary care hospitals. Patients completed sociodemographic and medical questionnaires and participated in an interview using a patient-piloted semistructured interview guide. Interviews were transcribed and subjected to framework analysis using inductive and then deductive coding techniques. Approximately 1500 standard transcribed pages of interview data were collected. Emotional distress was the most commonly cited precipitating factor (56%), with an emphasis on anxiety symptoms. The awareness and detection of SCAD as a cardiac event was low among patients (35%) and perceived to be moderate among health care providers (55%). Health care providers' communication of the prognosis and self-management of SCAD were perceived to be poor (79%). Postevent psychological disorders among patients were evident (30%), and 73% feared recurrence. Short- and longer-term follow-up that was tailored to patients' needs was desired (72%). Secondary prevention programming was recommended, but there were low completion rates of conventional cardiac rehabilitation (48%), and current programming was deemed inadequate.

CONCLUSIONS

This early-stage, pretrial research has important implications for the acute and long-term management of patients with SCAD. Additional work is required to validate the hypotheses generated from this patient-oriented research.

Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle-income setting: A randomized controlled trial protocol

Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments pre-intervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied. The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of women-focused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.

The non-negligible association between SYNTAX score and anxiety-depressive disorders

OBJECTIVE

Anxiety-depressive disorders are more common in patients with coronary artery disease (CAD) and are strongly associated with higher morbidity and mortality rates. The Hospital Anxiety and Depression Scale (HADS) is a wellvalidated diagnostic tool for screening of anxiety-depression disorders. The SYNTAX score (SS) is the angiographic scoring system and is commonly used to evaluate the severity and complexity of CAD. The aim of this study was to evaluate the association between the HADS and SS.

METHODS

The HADS questionnaire was filled in by subjects before the coronary angiography procedure. Biochemical, clinical and echocardiographic parameters, and SS were evaluated in all patients. Patients were assessed using the HADS. The patients were divided into two groups according to the SS [≥ 23: high SYNTAX score group (HSSG), < 23 low].

RESULTS

The HADS scale was significantly higher in HSSG (24.8 ± 10.7 vs 11.3 ± 6.4 p < 0.001). There was no significant difference between the groups regarding laboratory parameters. On multivariate analysis, diabetes mellitus, hyperlipidaemia and the HADS were independent predictors of high SYNTAX score.

CONCLUSIONS

In our study, we found that diabetes mellitus, hyperlipidaemia and the HADS were independent predictors of a higher SS.

Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.

A systematic review and meta-analysis of serum and plasma cortisol levels in depressed patients versus control

Depression is associated with hyperactivity of the hypothalamo pituitary adrenal axis. Cortisol is a steroid hormone, released from the adrenal gland and is considered to be a biological marker of stress and anxiety. Serum or plasma cortisol levels have been previously studied in depressive patients but reported contradictory results. The present meta analysis aims to assess the serum or plasma concentration of cortisol in depressive patients compared with controls. We have conducted a systematic review with sequential meta analysis according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Web of Science, PubMed, Scopus, and PsycINFO databases, and published reference lists were searched up to January 2021. We have conducted a systematic review on PubMed for the following search (MeSH) terms ("Hydrocortisone"[Mesh]) AND "Depressive Disorder"[Mesh]). The RevMan 5.3 and Open Meta Analyst software was used with the standard mean difference (SMD) and 95% confidence intervals (CIs). The Jamovi and Open Meta Analyst Software were used to evaluate the publication bias, sensitivity analysis, and meta regression as possible sources of heterogeneity. Seventeen studies having a combined population (n) of 1400 (743 depressive patients and 657 controls) had satisfied the inclusion criteria for serum or plasma cortisol. The pooled SMD of the serum or plasma cortisol levels in depressive patients compared with controls was 1.18, (95% CI: 0.84, 1.52; P < 0.00001) with I2 = 85% (Ph < 0.00001). This meta analysis indicates a statistically significant mean difference in serum or plasma cortisol between depressed patients and controls. Meta analysis concluded that serum or plasma cortisol can differentiate depressed patients from nondepressed controls.

Neurovascular disease in Switzerland: 10-year trends show non-traditional risk factors on the rise and higher exposure in women

BACKGROUND

Effective risk factor modification is the prerequisite to prevent neurovascular disease such as stroke or vascular dementia. Non-traditional vascular risk factors (nt-vrf) including stress significantly add to risk of neurovascular disease arising from traditional vascular risk factors (t-vrf). In order to discover sex-specific changes that may underlie previously reported inclines in the prevalence of neuro- and cardiovascular disease in women, we assessed 10-year trends in the prevalence of vrf in Switzerland.

METHODS

We obtained anonymized data from 22'134 participants (51% women) of the governmental Swiss Health Survey, performed every five years (2007, 2012, and 2017). Epidemiological parameters, t-vrf and nt-vrf were analyzed in a cross-sectional study design.

RESULTS

Over the observation period, the number of women having full-time jobs increased considerably (2007: 38%, 2012: 39%, 2017: 44%). This was accompanied by a substantial rise in the prevalence of nt-vrf in women and men (w/m) including stress at work (2007: not available, 2012: 58%/60%, 2017: 66%/65%), low locus of control (w/m: 2007: 21%/19%, 2012: 22%/19%, 2017: 25%/22%), and sleep disorders (w/m: 2007: 30%/22%, 2012: 28%/20%, 2017: 32%/26%). Amongst t-vrf, only the prevalence of obesity and hypercholesterolemia increased over time in both sexes, while other t-vrf remained stable (hypertension [27%], diabetes [5%]) or decreased (smoking [9.4 cigarettes/day]).

CONCLUSIONS

A rise in women's economic participation alongside a higher affection with nt-vrf in the female Swiss population emphasizes the need to improve vascular risk stratification and implement effective preventive measures for neuro- and cardiovascular disease.

Sex differences in the blood-brain barrier: Implications for mental health

Prevalence of mental disorders, including major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SZ) are increasing at alarming rates in our societies. Growing evidence points toward major sex differences in these conditions, and high rates of treatment resistance support the need to consider novel biological mechanisms outside of neuronal function to gain mechanistic insights that could lead to innovative therapies. Blood-brain barrier alterations have been reported in MDD, BD and SZ. Here, we provide an overview of sex-specific immune, endocrine, vascular and transcriptional-mediated changes that could affect neurovascular integrity and possibly contribute to the pathogenesis of mental disorders. We also identify pitfalls in current literature and highlight promising vascular biomarkers. Better understanding of how these adaptations can contribute to mental health status is essential not only in the context of MDD, BD and SZ but also cardiovascular diseases and stroke which are associated with higher prevalence of these conditions.

Coping with COVID-19 Prolonged and Cumulative Stressors: the Case Example of Egypt

The current study aimed to explore how COVID-19-traumatized populations cope using a coping model based on wills to exist, live, and survive (WTELS) that leads to positive coping and posttraumatic growth (PTG). We used data from 11 Arab countries (N = 2732), including Egypt (N = 831), and included measures for COVID-19 stressors (COVID-fear, economic, lockdown, and grief stressors), WTELS, resilience, religiosity, spirituality, social support, and PTG. We conducted ANOVA on the main sample to explore the differences between Arab countries, hierarchical regressions, and path analysis on the Egyptian subsample to test a model of the effects on WTELS. In the path model, WTELS was the independent variable. Other coping strategies were mediating variables, and COVID-19 stressor types were outcome variables. ANOVA on the main sample indicated that Egypt was the highest on COVID-19 stressors (infection fears, economic, lockdown, and grief stressors), actual infection, and WTELS. Hierarchical regression indicated that social support, resilience, and WTELS were positive predictors of PTG, with WTELS had the highest effect size (β = .41) and WTELS being a negative predictor of COVID-19 stressors, while resilience and social support were not. Path analysis indicated that WTELS predicted higher religiosity, spirituality, social support, resilience, and lower COVID-19 stressors. Religiosity predicted higher spirituality, social support, and resilience and lower COVID-19 stressors. Interfaith spirituality predicted higher resilience and lower COVID-19 grief stressors. The results validated the central role of WTELS. Results helped to identify potentially effective interventions with COVID-19 victims that focus on WTELS, spirituality, and religiosity.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00712-x.

Depression, anxiety, and quality of life after percuataneous coronary interventions

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. However, some fascinating advances in the field of cardiology have not only added years to people's life but life to years as well. Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a nonsurgical procedure used to treat stenotic coronary arteries. In recent years, PCI has become the preferred modality of treatment for occluded coronary arteries. However, there has been growing interest in the quality of life (QOL) issues for those who undergo such procedures. Depression, anxiety, vital exhaustion, hostility, anger, and acute mental stress have been evaluated as risk factors for the development and progression of CAD. Further, they also have strong bearing toward recovery from an acute coronary event. The current article discusses the role of depression, anxiety, and QOL of patients undergoing PCI.

The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman

Women have unique sex- and gender-related risk factors for cardiovascular disease (CVD) that can present or evolve over their lifespan. Pregnancy-associated conditions, polycystic ovarian syndrome, and menopause can increase a woman’s risk of CVD. Women are at greater risk for autoimmune rheumatic disorders, which play a role in the predisposition and pathogenesis of CVD. The influence of traditional CVD risk factors (eg, smoking, hypertension, diabetes, obesity, physical inactivity, depression, anxiety, and family history) is greater in women than men. Finally, there are sex differences in the response to treatments for CVD risk and comorbid disease processes. In this Atlas chapter we review sex- and gender-unique CVD risk factors that can occur across a woman’s lifespan, with the aim to reduce knowledge gaps and guide the development of optimal strategies for awareness and treatment.

Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation

This pre-post study examined sex-differences in peak aerobic power (V̇O2peak) and physical- and mental-health outcomes in adults with cardiovascular disease who completed high-intensity interval training (HIIT)-based cardiac rehabilitation. HIIT consisted of 25 minutes of alternating higher- (4×4 minutes 85-95% heart rate peak (HRpeak)) and lower- (3×3 minutes 60-70% HRpeak) intensity intervals twice weekly for 10 weeks. V̇O2peak estimated from a graded exercise test using the American College of Sports Medicine equation, body mass index (BMI), waist circumference, blood pressure, blood biomarkers and anxiety and depression were assessed at baseline and follow-up. Linear mixed-effects models for repeated measures were performed to examine differences over time between sexes. Of 140 participants (mean ± standard deviation: 58 ± 9 years), 40 were female. Improvements in V̇O2peak did not differ between sexes (interaction: p = 0.273, females: 28.4 ± 6.4 to 30.9 ± 7.6; males: 34.3 ± 6.3 to 37.4 ± 6.0 mL/kg/min). None of the time by sex interactions were significant. Significant main effects of time showed reductions in waist circumference, triglycerides, low-density lipoprotein (LDL), total cholesterol (TC)/high-density lipoprotein (HDL) and anxiety, and increases in V̇O2peak and HDL from baseline to follow-up. Significant main effects of sex revealed smaller V̇O2peak, BMI and waist circumference, and higher LDL, TC and HDL in females than males. HIIT led to similar improvements in estimated V̇O2peak (females: 8.8%, males: 9.0%) and additional health outcomes between sexes. Novelty: HIIT-based cardiac rehabilitation led to similar improvements in estimated V̇O2peak and other physical and mental health outcomes between sexes. The number of sessions attended was high (>70%) and did not differ by sex. Both sexes showed good compliance with the exercise protocol (HR target).

Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center

PURPOSE OF REVIEW

Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD).

RECENT FINDINGS

HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.

Neglected cardiovascular risk factors: Relationship of anxiety and depression with percutaneous coronary angioplasty

Introduction:

Coronary artery disease (CAD) is the leading cause of mortality in Malaysia. Psychological risk factors are associated with detrimental outcomes in CAD. Our study aimed to evaluate procedural anxiety and depression levels among subjects who underwent coronary angioplasty.

Methods:

A single-centre prospective cohort study was conducted on patients electively admitted to a tertiary hospital in Malaysia for percutaneous coronary intervention (PCI) over a half-year period. The Hospital Anxiety and Depression Scale (HADS) and the EuroQol-5 Dimension (EQ5D) Health Questionnaire were used to evaluate subjects’ psychological statuses. The EQ Visual Analogue Scale was used for the global assessment of their health.

Results:

The analysis included 65 patients with a mean age of 63 years from a predominately educated population ( n=54; 83.1%). Before the PCI procedure, female sex was found to be protective against depression, with an odds ratio (ORs) of 0.29 (95% confidence interval (CI) 0.08–1.03). A high level of education was protective against anxiety (OR=0.21; 95% CI 0.06–0.83). After the PCI, females were more likely to be depressed (OR=3.89; 95% CI 1.13–13.37), and those of Malay ethnicity were more likely to be anxious (OR=4.2; 95% CI 1.03–17.07). Using the HADS, subjects were significantly less anxious and depressed (pre-PCI: median (IQR) score=4 (7.0)); post-PCI: median (IQR) score=3 (5.0), p=0.02), measured by the HADS. Using the EQ5D, subjects had an improved mean VAS score (post-PCI: 75±14.9; pre-PCI: 68±12.6; p<0.05).

Conclusions:

PCI may predispose patients with CAD to psychological stressors. Female patients and those of Malay ethnicity are more likely to experience psychological stress. Being highly educated is protective against such stress.

Community-Dwelling Individuals with Coronary Artery Disease Have Higher Risk of Depression than the General Population in Female, But Not in Male

Few studies have been conducted to evaluate the sex difference in the risk of depression in patients with coronary artery disease (CAD), compared with those without CAD in a community-dwelling population. Females with CAD had a 2.68-fold higher risk for depression than females without CAD, while no significant association between CAD diagnosis and depression was observed in males. The contribution of sex should be more intensively considered in the association between CAD status and depression, not only in clinical settings but also in community settings.

Background and Objectives

The aim of this study was to assess sex difference in the association between coronary artery disease (CAD) status and depression in a representative nationwide Korean population.

Methods

In total, 4,620 male and 6,151 female aged ≥40 years, who participated in the Korea National Health and Nutrition Examination Survey conducted in 2014, 2016, and 2018, were included in the analysis. Depression was defined as ≥10 points on the 9-item Patient Health Questionnaire.

Results

Among male participants, no significant association between CAD status and depression was observed. However, female with CAD had higher odds ratio (OR) for depression (OR, 2.68; 95% confidence interval [CI], 1.78–4.03) compared with those without CAD in a multiple logistic regression analysis after adjustment for covariates. Younger age at diagnosis of CAD was a significant relating factor for depression in female; OR (95% CI) was 1.73 (0.88–3.40), 3.01 (1.52–5.97), and 4.11 (2.04–8.28) for age ≥65 years, 55–64 years, and ≤54 years, respectively, compared with that in non-CAD controls. In addition, shorter duration of CAD was a significant relating factor for depression in female; OR (95% CI) was 2.42 (1.26–4.67), 2.61 (1.32–5.16), and 3.13 (1.54–6.34) for duration ≥10 years, 5-9 years, and ≤4 years, respectively, compared with that in non-CAD controls.

Conclusions

Consistent screening and psychosocial supports for depression after discharge are required to improve the mental health care of CAD survivors in the community, especially for female diagnosed at a younger age and recently diagnosed.

COVID-19 pandemic - Inequities and inequalities to exercise and their consequences on the physical and mental health of women with cardiovascular disease: recommendations on how to address the needs of women

The coronavirus disease (COVID-19) pandemic disproportionately affects those with pre-existing conditions and has exacerbated gender inequalities. Cardiovascular disease (CVD) is the leading cause of death among Canadian women. Exercise improves physical and mental health and CVD management. Amid the pandemic, women are experiencing an increase in caregiving responsibilities, job insecurities, and domestic violence creating competing demands for prioritizing their health. Recommendations on how to meet the unique needs of Canadian women with CVD through exercise are provided. Novelty: Exercise recommendations amid the pandemic for women with CVD need to be flexible, feasible, and fun.

The Importance of Gender to Understand Sex Differences in Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. There is robust evidence of heterogeneity in underlying mechanism, manifestation, prognosis, and response to treatment of CVD between male and female patients. Gender, which refers to the socially constructed roles, behaviours, expressions, and identities of individuals, is an important determinant of CV health, and its consideration might help in attaining a broader understanding of the observed sex differences in CVD. Established risk factors such as hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking are well known to contribute to CVD. However, despite the differences in CVD risk between male and female, most studies looking into the magnitude of effect of each risk factor have traditionally focused on male subjects. While biological sex influences disease pathophysiology, the psycho-socio-cultural construct of gender can further interact with this effect. Behavioural, psychosocial, personal, cultural, and societal factors can create, repress, or strengthen underlying biological CV health differences. Although mechanisms of action are largely unclear, it is suggested that gender-related factors can further exacerbate the detrimental effect of established risk factors of CVD. In this narrative review, we explore the current literature investigating the role of gender in CV risk and its impact on established risk factors as a fundamental step toward precision medicine.

The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem

Background

This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status.

Methods

CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group.

Results

Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada.

Conclusions

Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.

A cross-sectional gender-sensitive analysis of depressive symptoms in patients with advanced cancer

BACKGROUND

Patients with advanced cancer commonly report depressive symptoms. Examinations of gender differences in depressive symptoms in patients with advanced cancer have yielded inconsistent findings.

AIM

The objective of this study was to investigate whether the severity and correlates of depressive symptoms differ by gender in patients with advanced cancer.

DESIGN

Participants completed measures assessing sociodemographic and medical characteristics, disease burden, and psychosocial factors. Depressive symptoms were examined using the Patient Health Questionnaire, and other measures included physical functioning, symptom burden, general anxiety, death related distress, and dimensions of demoralization. A cross-sectional analysis examined the univariate and multivariate relationships between gender and depressive symptoms, while controlling for important covariates in multivariate analyses.

SETTING/PARTICIPANTS

Patients with advanced cancer (N = 305, 40% males and 60% females) were recruited for a psychotherapy trial from outpatient oncology clinics at a comprehensive cancer center in Canada.

RESULTS

Severity of depressive symptoms was similar for males (M = 7.09, SD = 4.59) and females (M = 7.66, SD = 5.01), t(303) = 1.01, p = 0.314. Greater general anxiety and number of cancer symptoms were associated with depressive symptoms in both males and females. Feeling like a failure (β = 0.192), less death anxiety (β = -0.188), severity of cancer symptoms (β = 0.166), and older age (β = 0.161) were associated with depressive symptoms only in males, while disheartenment (β = 0.216) and worse physical functioning (β = 0.275), were associated with depressive symptoms only in females.

CONCLUSIONS

Males and females report similar levels of depressive symptoms but the pathways to depression may differ by gender. These differences suggest the potential for gender-based preventive and therapeutic interventions in this population.

Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort

BACKGROUND

Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions.

METHODS

Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately.

RESULTS

In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO_2peak), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO_2peak, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married.

CONCLUSIONS

Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.

Depression predicts the risk of adverse events after percutaneous coronary intervention: A meta-analysis

BACKGROUND

Depression is correlated with poor prognosis in patients with coronary artery disease (CAD). The goal of this meta-analysis was to assess the influence of depression on the risks of major adverse cardiovascular events (MACEs) and all-cause mortality after percutaneous coronary intervention (PCI).

METHODS

Cohort studies were obtained by searching PubMed and Embase databases. Cohort studies regarding the association between depression and risks of MACEs and mortality after PCI were included. Heterogeneity was determined using the Cochrane's Q test and calculated using I². A fixed-effect model was used if no significant heterogeneity was detected; otherwise a random-effect model was applied. The adjusted risk ratio [RR] for the incidences of MACEs and all-cause mortality in patients with depression were compared to those without depression.

RESULTS

Nine cohorts including 4,555 CAD patients who underwent PCI were included in this meta-analysis, and 1,108 of these patients were diagnosed with depression. There were no significant differences among studies evaluating MACEs and mortality risks (I² = 25% and 0%, respectively). Pooled results showed that depression was associated with higher risk of MACEs (RR: 2.10, 95% confidence interval [CI]: 1.59 to 2.77, p <  0.001) and all-cause mortality (RR: 1.76, 95% CI: 1.45 to 2.13, p < 0.001) during follow-up after PCI.

LIMITATIONS

Available full text peer reviewed studies were limited and only studies in English were included in this analysis.

CONCLUSIONS

Depressive symptoms were independently associated with adverse cardiovascular outcomes in patients who received PCI. Psychological therapy that does not increase cardiac burden or induce pharmacological side effects may be a better strategy to treat depression associated with PCI.

Depressive Symptoms in Women With Coronary Heart Disease: A Systematic Review of the Longitudinal Literature

BACKGROUND

Interpreting studies about women with coronary heart disease and depressive symptoms is challenging: women continue to be underrepresented in research; data are often not presented separately by sex; many studies do not examine depressive symptoms longitudinally, leaving our understanding incomplete; and the use of multiple depressive symptom assessment instruments makes comparisons between studies problematic.

PURPOSE

The authors of this systematic review examined 20 longitudinal descriptive studies on women with coronary heart disease and depressive symptoms, including prevalence of elevated symptoms, changes in symptoms over time, findings in women versus men, and findings based on assessment instruments.

CONCLUSIONS

The prevalence of elevated depressive symptoms in women was 35.75% at baseline (hospitalization). The Beck Depression Inventory II yielded the highest baseline prevalence (40.3%), slightly higher than the Depression Interview and Structured Hamilton Scale (36%). The Hospital Anxiety and Depression Scale and the Kellner questionnaire yielded much lower prevalence (21.45% and 23%, respectively). Higher prevalence was linked to inclusion of somatic symptoms on measurement instruments except in post-coronary bypass surgery patients. Symptoms trended toward improvement, particularly in the first 6 months, although a few studies measured beyond this time. Women demonstrated higher prevalence than men initially (35.75% vs 23.46%, respectively) and over 24 months (22.71% vs 19.82%, respectively).

CLINICAL IMPLICATIONS

Women experienced significantly more depressive symptoms than men initially and over time, although most women's symptoms improved. Measurement varies widely based on instrument and the inclusion/exclusion of somatic symptoms. More longitudinal studies beyond 6 months with prevalence data and analysis by sex/gender are needed.

Women-Only Cardiac Rehabilitation Delivery Around the World

BACKGROUND

Women utilise cardiac rehabilitation (CR) significantly less than men. Gender-tailored CR improves adherence and mental health outcomes when compared to traditional programs. This study ascertained the availability of women-only (W-O) CR classes globally.

METHODS

In this cross-sectional study, an online survey was administered to CR programs globally, assessing delivery of W-O classes, among other program characteristics. Univariate tests were performed to compare provision of W-O CR by program characteristics.

RESULTS

Data were collected in 93/111 countries with CR (83.8% country response rate); 1,082 surveys (32.1% program response rate) were initiated. Globally, 38 (40.9%; range 1.2-100% of programs/country) countries and 110 (11.8%) programs offered W-O CR. Women-Only CR was offered in 55 (7.4%) programs in high-income countries, versus 55 (16.4%) programs in low- and middle-income countries (p<0.001); it was offered most commonly in the Eastern Mediterranean region (n=5, 55.6%; p=0.22). Programs that offered W-O CR were more often located in an academic or tertiary facility, served more patients/year, offered more components, treated more patients/session, offered alternative forms of exercise, had more staff (including cardiologists, dietitians, and administrative assistants, but not mental health care professionals), and perceived space and human resources to be less of a barrier to delivery than programs not offering W-O CR (all p<0.05).

CONCLUSION

Women-Only CR was not commonly offered. Only larger, well-resourced programs seem to have the capacity to offer it, so expanding delivery may require exploiting low-cost, less human resource-intensive approaches such as online peer support.

Sex-discrete role of depressive symptomatology on 10-year first and recurrent cardiovascular disease incidence: results from ATTICA and GREECS prospective studies

OBJECTIVE

The sex-specific effect of depressive symptomatology on 10-year first and recurrent cardiovascular disease (CVD) events was evaluated.

METHODS

The Greek samples from ATTICA (2002-2012, n = 845 free-of-CVD subjects) and GREECS (2004-2014, n = 2,172 subjects with acute coronary syndrome (ACS)) prospective epidemiological studies with baseline psychological assessments were used for the first and the recurrent event, respectively. Depressive symptomatology was assessed at baseline, through Zung Self-Rating Depression Scale in the ATTICA study, and through the Center for Epidemiological Studies-Depression scale in the GREECS study.

RESULTS

ACS as well as free-of-CVD women scored significantly higher for depressive symptomatology. Men scored higher than women against first (19.7% vs. 11.7%) and subsequent CVD events (38.8% vs. 32.9%). In participants with depressive symptoms man-to-woman first and recurrent CVD event rate ratio was below 1, confirming that depressive women were more likely to have a CVD event than depressive men. Multiadjusted analysis revealed that depressive symptomatology had an independent aggravating effect on the first (hazard ratio (HR) = 2.72, 95% confidence interval (95% CI) 1.50, 9.12) and recurrent (HR = 1.31, 95% CI 1.01, 1.69) CVD events only in women. Mediation analysis in women revealed that 35% (23%, 44%) of excess first-CVD-event risk of depressive symptoms was attributed to conventional risk factors. The respective number for recurrent CVD events was 46% (23%, 53%); different patterns of ranking regarding the mediating effect corresponding to each adjustment factor were observed.

CONCLUSIONS

The present work augments prior evidence that psychological stressors possess important drivers of CVD onset and progression mainly in women, while it gives rise to research toward unidentified paths behind this claim.

Gender differences in associations of depressive symptoms and anxiety with inflammatory markers in patients with non-obstructive coronary artery disease

OBJECTIVE

The aim of this study was to examine gender differences of the associations between depressive symptoms and anxiety with inflammatory markers in patients with non-obstructive coronary artery disease (NOCAD).

METHODS

Depressive symptoms and anxiety (Beck Depression Inventory BDI and Hospital Anxiety and Depression Scale HADS) were examined in 524 patients with NOCAD (52% women, mean age 64 ± 9 years) as part of the TweeSteden Mild Stenosis (TWIST) observational cohort study. Blood samples were analyzed for neutrophil gelatinase-associated lipocalin (NGAL) levels, high-sensitive C-reactive protein (hsCRP), and leukocyte differentiation. Multivariate analysis for the inflammatory markers with main effects of depressive symptoms or anxiety, gender, and their interactions were observed.

RESULTS

Women had elevated levels of hsCRP, and a lower monocyte and eosinophil count than men, with small to medium effect sizes (range η_(p)² = 0.019-0.047). After Holm-Bonferroni correction depressive symptoms according to the BDI were associated with an overall elevated hsCRP level explaining 2.4% of the hsCRP variance. A significant positive association between BDI cognitive symptoms with elevated hsCRP level was observed in men (R² = 0.045), but not in women (R² < 0.001). Adjustment for age, body mass index, smoking, and physical activity attenuated this finding.

CONCLUSION

Small associations of inflammatory markers with depressive symptoms and anxiety were confounded by lifestyle factors, predominantly smoking. The interacting roles of gender, smoking, and psychological factors on inflammatory markers may point toward different behavioral and inflammatory pathways for women and men with NOCAD, which remains to be further explored.

OBSERVATIONAL COHORT REGISTRATION

ClinicalTrials.gov identifier: NCT01788241.

Mediators of gender effects on depression among cardiovascular disease patients in Palestine

BACKGROUND

Among patients suffering from coronary heart disease (CHD) and comorbid depression, women experience a higher burden compared to men. Little is known on the characteristics that differentiate men and women with both diseases and whether these factors mediate gender effects on depression. This study assessed whether women are more likely to suffer from depression and which characteristics mediate gender effects on depression among a cardiac population in Palestine, specifically addressing the role of post-traumatic stress disorder (PTSD).

METHODS

Using a cross-sectional design, patients consecutively admitted with a CHD to one of the four main hospitals in Nablus, Palestine, were interviewed using a structured questionnaire with validated instruments. Data was also obtained from hospital medical records. Patients were assessed for depression using the Cardiac Depression Scale (CDS). Bivariate analysis was conducted to compare characteristics of women and men with and without depressive symptoms. Mediators (direct and indirect effects) of the association between gender and depression were evaluated using a structural equation model (SEM).

RESULTS

Women were more likely to suffer from severe depression than men (28.7% vs. 18.8%). Female gender was positively associated with higher PTSD symptoms, comorbidities, somatic symptoms and income, and with lower resilience, self-esteem, quality of life, education, prevalence of smoking and physical activity. Structural equation modeling revealed negative indirect effects of gender on depression (CDS score) through resilience, self-esteem and physical activity, whereas positive indirect effects of gender on depression were observed through PTSD, comorbidities, somatic symptoms and smoking. There was no direct effect of gender on depression.

CONCLUSION

This study found a higher prevalence of severe depression in female patients with cardiac disease compared to male cardiac patients. Our findings provide novel information on mediating factors of the association between gender and depression among cardiac patients, in particular PTSD. The results emphasize the need for further research on potential mediating factors that could account for gender differences in depression and the need to provide support programs for female patients with comorbid CHD and depression to improve their psycho-social well-being.

Factors Associated with Depression among Heart Failure Patients at Cardiac Follow-Up Clinics in Northwest Ethiopia, 2017: A Cross-Sectional Study

Background

Depression is a comorbid disorder in patients with heart failure and it is a major public health problem worldwide. Little is known about the depression among heart failure patients in low-income countries, while, in Ethiopia, none was studied.

Objective

This study is to assess the prevalence of depression and associated factors among heart failure patients at cardiac follow-up clinics at Amhara Region Referral Hospitals, Northwest Ethiopia, 2017.

Methods

A hospital based cross-sectional study was conducted between March 30, 2017, and May 15, 2017, G.C., by using a systematic random sampling technique to select 422 of 1395 HF patients. Structured interviewer-administered questionnaires and patient card review with a checklist that incorporates the PHQ-9 tool for depression measurement were used. The collected data were checked, coded, and entered into Epi-info version 7 and exported to SPSS version 20. Bivariate logistic regression at p-value <0.2 was exported to multivariate logistic regressions and p-value <0.05 was considered statistically significant.

Results

A total of 403 were included with a response rate of 95.5%. Among the participants, 51.1% had depressive symptoms. Factors associated with depressive symptoms were poor self-care behavior 1.60 [AOR (95% CI=1.01, 2.55)], poor social support 1.90 [AOR (95% CI=1.16, 3.12)], being female 2.70 [AOR (95% CI=1.44, 5.07)], current smoking history 4.96 [AOR (95% CI=1.54, 15.98)], and duration of heart failure (>1 year) 1.64 [AOR (95% CI=1.04, 2.59)].

Conclusions

Around half of the patients were depressive. The patients who had poor self-care behavior, were females, had poor social support, had a current history of smoking, and had duration of chronic heart failure >1 year need special attention. Therefore, all referral hospitals need efforts to focus on those problems and target improvements of depressive symptoms.

Oral Chinese Herbal Medicine for Depressive Disorder in Patients after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the effectiveness and safety of oral Chinese herbal medicines (CHMs) on post-percutaneous coronary intervention (PCI) patients with depressive disorder in coronary heart disease (CHD).

METHODS

A literature search was conducted through databases including PubMed, Cochrane Library, Chinese National Knowledge Infrastructure Databases (CNKI), Chinese Biomedical Literature Database (SinoMed), Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and Wanfang Database up to August 2018. Randomized controlled trials (RCTs) comparing CHMs with placebo or no additional treatments on the basis of standard conventional pharmacological therapies were included. Data extraction, analyses and quality assessment were performed according to the Cochrane standards. RevMan 5.3 software was used to synthesize the results.

RESULTS

A total of 16 RCTs enrolling 1,443 participants were included in this systematic review. When compared with antidepressants alone, CHMs showed similar benefits with less side effects [risk ratio=0.54, 95% confidence interval (CI) 0.43 to 0.69, 582 patients]; meanwhile, the combination therapy may have more advantages than antidepressants alone [mean difference (MD)=-1.03, 95%CI-1.81 to-0.25, 267 patients). When identified with placebo, CHMs seem to have more advantages in relieving depressive symptoms (MD=-19.00, 95%CI-20.02 to-17.98, 189 patients). However, when compared with basic treatment of post- PCI, CHMs showed different results in two trials. In terms of post-PCI related clinical symptoms, CHMs seem to have more advantages in relieving chest pain and other general clinical symptoms. However, the heterogeneity in this review was generally high, it may be caused by different interventions used in each trial and the low quality of the trials.

CONCLUSIONS

In total, CHMs showed potentially beneficial effects on depressive symptoms and post-PCI related clinical symptoms. However, because of small sample size and potential bias of most trials, this result should be interpreted with caution. More rigorous trials with larger sample size and higher quality are warranted to give high quality of evidence to support the use of CHMs for CHD complicated with depression.

Longitudinal changes in depression screening results in cardiac surgery patients

Background

The aim was to investigate longitudinal changes in depression screening results by sex up to one year following cardiac surgery.

Methods

We introduced a depression screening project using the Patient Health Questionnaire (PHQ-9) including patients between 2013-2016. Patients received the PHQ-9 prior to surgery, and at follow-up one year after surgery. We analyzed changes in PHQ-9 scores and screening status from baseline to 1-year follow-up.

Results

Screening results were obtained in 1,133 patients prior to surgery, and after one year, 1,084 patients were alive and of those 897 (83%) patients completed the follow-up PHQ-9 questionnaire. A positive depression screen at baseline was twice as common in women compared to men. A total of 547 (92%) men and 173 (91%) women who were screening negative at baseline were still screening negative at 1-year follow-up. There was no difference between men and women. A lower proportion of men compared with women (44% vs. 61%) improved from screening positive at baseline to screening negative at 1-year follow-up (P=0.069). The total PHQ-9 score difference between baseline and one year had increased with 0.23 points among men and decreased with 0.68 points in women.

Conclusions

We found that twice as many women as men had a positive depression screen at baseline, and that almost 10% of all who were screening negative at baseline, were screening positive after one year. An improvement in depressive symptoms (transition from a screening positive state to a negative screening state) was more common among women than men after one year of follow up.

Dreams content and emotional load in cardiac rehabilitation patients and their relation to anxiety and depression

Background

The assessment of a dream and its mechanisms and functions may help us to percept cognitions, emotions, and complex behaviors of patients. Hence, the present study aimed to assess (i) the rate of perceived dream and its emotional load and content and (ii) the relationship between functions of dream with anxiety and depression.

Methods

In this cross-sectional study, 167 cardiac patients who had undergone rehabilitation in the western part of Iran were assessed during May-October 2016. Research instrument included Beck depression inventory, Beck anxiety inventory, Schredl's dream emotions manual, and content analysis of dreams manual. The findings were analyzed through Pearson's correlative coefficient and multiple regression analysis.

Results

The mean age of participants (66.5% men) was 59.1 ± 9 years. The results indicated that the emotional content of patients' dreams included happiness (49.1%), distress (43.1%), sad (13.8%), fear (13.2%), and anger (3%). Although women report more sad dreams than men (P = 0.026), there was no difference between them in terms of other components of dreams, anxiety, and depression. Regression models showed that anxiety and depression were significantly able to predict perceived dream rates (P = 0.030) and emotionally negative dreams (P = 0.019).

Conclusion

The increased rates of depression, especially anxiety, are related to increasing perceived dreams with negative and harmful emotional load. Regarding severity and negative content of dreams are reflexes of stressful emotional daily experiences, the management of experienced psychological symptoms such as depression and anxiety is concerned as an undeniable necessity.

A Systematic Review of the Diagnostic Accuracy of Depression Questionnaires for Cardiac Populations: IMPLICATIONS FOR CARDIAC REHABILITATION

PURPOSE

Depression is overrepresented in patients with cardiovascular disease and increases risk for future cardiac events. Despite this, depression is not routinely assessed within cardiac rehabilitation. This systematic review sought to examine available depression questionnaires to use within the cardiac population. We assessed each instrument in terms of its capability to accurately identify depressed patients and its sensitivity to detect changes in depression after receiving cardiac rehabilitation.

METHODS

Citation searching of previous reviews, MEDLINE, PsycInfo, and PubMed was conducted.

RESULTS

The Beck Depression Inventory-II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS-D) are among the most widely used questionnaires. Screening questionnaires appear to perform better at accurately identifying depression when using cut scores with high sensitivity and specificity for the cardiac population. The BDI-II and the HADS-D showed the best sensitivity and negative predictive values for detecting depression. The BDI-II, the HADS-D, the Center for Epidemiological Studies-Depression Scale, and the 15-item Geriatric Depression Scale best captured depression changes after cardiac rehabilitation delivery.

CONCLUSIONS

The BDI-II is one of the most validated depression questionnaires within cardiac populations. Health practitioners should consider the BDI-II for depression screening and tracking purposes. In the event of time/cost constraints, a briefer 2-step procedure (the 2-item Patient Health Questionnaire, followed by the BDI-II, if positive) should be adopted. Given the emphasis on cut scores for depression diagnosis and limited available research across cardiac diagnoses, careful interpretation of these results should be done. Thoughtful use of questionnaires can help identify patients in need of referral or further treatment.

Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study

BACKGROUND

Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD.

METHODS

Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach.

RESULTS

Higher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results.

CONCLUSION

Our findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors.

TRIAL REGISTRATION

www.clinicaltrials.gov   NCT00705965 (registered 27th of June, 2008). www.isrctn.com   ISRCTN76240576 (registered 27th of March, 2008).

Prevalence of depression in myocardial infarction: A PRISMA-compliant meta-analysis

BACKGROUND

Depression is common in the aftermath of myocardial infarction (MI) and may not only lead to impaired long-term quality of life, but also cause increased mortality among patients with MI. The reported prevalence of depression among patients with MI varied considerably across studies, for which a pooled prevalence was obtained in the only 1 meta-analysis conducted in March 2004. Subsequently, numerous relevant studies have been published, indicating the need for an update on the pooled prevalence. Therefore, this study was aimed at updating the pooled prevalence of depression among patients with MI.

METHODS

A comprehensive literature search in 3 electronic databases, PubMed, Embase, and PsycINFO, was performed in April 2018. The heterogeneity across studies was examined by the Cochran's Q test and quantified by the I statistic. If significant heterogeneity was observed, meta-regression analyses and subgroup analyses were performed to identify the source of heterogeneity. Publication bias was assessed by a funnel plot and verified by the Egger's and Begg's tests.

RESULTS

Nineteen eligible studies conducted in 10 countries were included, which consisted of 12,315 patients with MI, among whom 3818 were identified with depression. High heterogeneity was observed across the eligible studies (I = 98.4%), with the reported prevalence of depression ranging from 9.17% to 65.88%. The pooled prevalence of depression among patients with MI was 28.70% (95% CI: 22.39-35.46%) by a random effects model. Subgroup analyses showed that the pooled prevalence differed significantly by region, tool used to identify depression, study quality, sex, race, anterior MI, and diabetes status (P < .05). Meta-regression analyses did not identify any moderators of heterogeneity, and the heterogeneity was high within most subgroups. Nonetheless, for unmarried subjects, the heterogeneity was low (I = 19.5). The Egger's test and the Begg's test indicated no evidence of publication bias (P > .05).

CONCLUSIONS

Given the high pooled prevalence of depression found in this study and the association between depression and adverse health outcomes among patients with MI, more psychological resources including early assessment and effective treatment of depression should be allocated to patients with MI.

The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies

BACKGROUND

Comorbid depression in the medically ill is clinically important. Admission to a general hospital offers an opportunity to identify and initiate treatment for depression. However, we first need to know how common depression is in general hospital inpatients. We aimed to address this question by systematically reviewing the relevant literature.

METHODS

We reviewed published prevalence studies in any language which had used diagnostic interviews of general hospital inpatients and met basic methodological quality criteria. We focussed on interview-based studies in order to estimate the proportion of patients with a diagnosis of depressive illness.

RESULTS

Of 158 relevant articles, 65 (41%) describing 60 separate studies met our inclusion criteria. The 31 studies that focussed on general medical and surgical inpatients reported prevalence estimates ranging from 5% to 34%. There was substantial, highly statistically significant, heterogeneity between studies which was not materially explained by the covariates we were able to consider. The average of the reported prevalences was 12% (95% CI 10-15), with a 95% prediction interval of 4-32%. The remaining 29 studies, of a variety of specific clinical populations, are described.

CONCLUSIONS

The available evidence suggests a likely prevalence high enough to make it worthwhile screening hospital inpatients for depression and initiating treatment where appropriate. Further, higher quality, research is needed to clarify the prevalence of depression in specific settings and to further explore the reasons for the observed heterogeneity in estimates.

Illness Perceptions in Patients with Premature Coronary Artery Disease: A Sex-Based Analysis 8 Years After the Diagnosis

To assess illness perceptions in patients with premature atherosclerotic coronary artery disease (CAD), 717 adults with premature CAD (diagnosis of CAD in men age < 45 years and women age < 55 years) completed sociodemographic indices, the Beck's Depression Inventory-II, Beck Anxiety Inventory and the Brief Illness Perceptions 8 years after the diagnosis. Mean age was 49.59 ± 3.57 years for men and 57.72 ± 4.90 years for women at the time of study. Both sexes were treated through coronary artery bypass graft surgery, percutaneous coronary intervention, or medical treatment. Depressive and anxiety symptoms were significantly more prevalent among women. Generally, the patients believed that their disease was chronic and well controlled and that it had no considerable negative impact on their routine life. Overall, patients had a low concern about their illness. Women had a more negative perception of their disease than did men which may indicate their need for higher psychological support.

Mental Health and Psychosocial Functioning Over the Lifespan of German Patients Undergoing Cardiac Catheterization for Coronary Artery Disease

Background: Psychological problems are common in patients with coronary artery disease (CAD) and are associated with poor outcome. However, data on the prevalence of distinct mental disorders and their relevance to patients' functioning in daily life are scarce. Method: In this retrospective study, a total of 514 German patients with CAD as diagnosed by cardiac catheterization were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (M.I.N.I.) and psychosocial functioning was evaluated using the Global Assessment of Functioning (GAF) scale. Results: Twenty-nine percent of the participants suffered from at least one mental disorder after the onset of their CAD (mean time since onset = 10.86 years, SD = 8.15). In comparison to the period before onset of CAD, elevated prevalence rates were found for severe depressive episodes, agoraphobia, dysthymia, panic disorder, and hypochondria. Predictors of mental disorders after the onset of CAD were female gender, younger age at onset of CAD as well as mental disorders and low GAF scores before onset. GAF scores decreased after the onset of CAD, recovered only partially, and were influenced by mental disorders before onset in women but not in men. Conclusions: Mental disorders-especially depression and agoraphobia-are frequent in patients with CAD, with women, patients with a younger age at onset of CAD and patients with any history of mental disorders especially at risk. Regardless of whether patients meet any specific diagnostic criteria, psychosocial functioning is markedly impaired after the onset of CAD, underscoring the need for specific mental health programs for this patient population. Future research, ideally using a prospective design, is necessary to confirm these findings and to further the knowledge of prevalence rates of mental disorders and of modifiable risk factors for the development of mental disorders in patients with CAD.

Exploring the path between depression, anxiety and 10-year cardiovascular disease incidence, among apparently healthy Greek middle-aged adults: The ATTICA study

OBJECTIVES

Although there is substantial evidence that psychological factors play an important role in the onset and course of cardiovascular disease (CVD), less is known about their combined effect and the pathways by which they affect cardiovascular health. The present work aimed to prospectively explore the effects of depression and anxiety on the 10-year CVD incidence, in relation to other lifestyle determinants, as linking factors in the context of the ATTICA study. Study design/Main outcome measures: The ATTICA study is a population-based, health and nutrition prospective cohort study (2002-2012), during which 853 middle-aged participants without a history of CVD [453 men (aged 45±13years) and 400 women (aged 44±18years)], underwent psychological evaluations at enrollment. The latent trait of depression and anxiety combined measure was estimated and referred as "Psychological distress"; path analysis was applied to describe the relationships among the different factors.

RESULTS

"Psychological distress" was positively associated with the 10-year CVD incidence (adjusted OR per 10 units: 1.4, 95% CI: 1.1, 1.7). Three linking pathways were revealed: sedentariness, inflammation and metabolic syndrome. Moreover, "Psychological distress" mediated the association between socioeconomic status (SES) and CVD, with participants of low SES scoring higher on the psychological measure (adjusted linear regression coefficient b: -7.1, 95% CI: -9.7, -4.5).

CONCLUSIONS

Lifestyle and clinical factors seem to link psychological distress with CVD development. Joint psychological assessments should be considered for inclusion in CVD preventive strategies, which should incorporate interventions for interrupting the linking pathways.

Cardiac Rehabilitation Following Acute Coronary Syndrome in Women

OPINION STATEMENT

Acute coronary syndrome (ACS) is among the leading burdens of disease among women. It is a significant driver of morbidity and chronically undermines their quality of life. Cardiac rehabilitation (CR) is indicated for ACS patients in clinical practice guidelines, including those specifically for women. CR is a multi-component model of care, proven to reduce mortality and morbidity, including in women. However, women are significantly less likely to be referred to CR by providers, and if they are referred, to enroll and adhere to programs. Reasons include lack of physician encouragement, preference not to feel fatigue and pain, transportation barriers, comorbidities and caregiving obligations. Strategies to mitigate this under-use include systematic early inpatient referral, tailoring programs to meet women's needs and preferences (e.g., offering dance, opportunities for social interaction), and offering non-supervised delivery models. Unfortunately, these strategies are not widely available to women. Given the greater longevity seen in women, the critical role CR plays in augmenting quality of life in this population must be recognized and care providers must do more to facilitate referral to and encourage participating in CR programs.

Depression screening and treatment recall in male and female coronary artery disease inpatients: Association with symptoms one year later

BACKGROUND

This study examined whether cardiac inpatients recall depression screening and how it is related to depressive symptoms and treatment one year later.

METHODS

2635 cardiac inpatients from 11 hospitals completed a survey and were mailed a follow-up survey one year later; both surveys included the BDI-II.

RESULTS

Of the 1809 (68.7%) retained participants, 513 (30.0%) recalled depression screening. Recall was not significantly related to depressive symptoms at either time point (P > 0.05). Participants who were recommended antidepressants had higher BDI-II scores than those who were not, both as inpatients (P < 0.01) and one year later (P < 0.05). There was no significant change in depressive symptoms over time in patients who received any type of therapy.

CONCLUSION

Less than one-third of cardiac inpatients recalled being screened for depression. Recall of screening was not significantly related to depressive symptoms, and use of treatment was related to greater symptoms.

Impaired Health Status, Psychological Distress, and Personality in Women and Men With Nonobstructive Coronary Artery Disease: Sex and Gender Differences: The TWIST (Tweesteden Mild Stenosis) Study

BACKGROUND

Patients with nonobstructive coronary artery disease (NOCAD; wall irregularities, stenosis <60%), and women with NOCAD in particular, remain underinvestigated. We examined sex and gender (S&G) differences in health status, psychological distress, and personality between patients with NOCAD and the general population, as well as S&G differences within the NOCAD population.

METHODS AND RESULTS

In total, 523 patients with NOCAD (61±9 years, 52% women) were included via coronary angiography and computed tomography as part of the TWIST (Tweesteden Mild Stenosis) study. Generic health status (12-item Short Form physical and mental scales and fatigue), psychological distress (Hospital Anxiety and Depression Scale anxiety and depressive symptoms and Global Mood Scale negative and positive affect), and personality (Type D personality) were compared between patients with NOCAD and an age- and sex-matched group of 1347 people from the general population. Frequency matching was performed to obtain a similar sex distribution in each age-decile group. Both men and women with NOCAD reported impaired health status, more psychological distress, and Type D personality compared with men and women in the reference group. Women reported more psychosocial distress compared with men, but no significant sex-by-group interaction effects were observed. Women with NOCAD reported impaired health status, more anxiety, and less positive affect, but no differences in depressive symptoms, angina, or Type D personality when compared with men with NOCAD. Age, education, employment, partner, and alcohol use explained these S&G differences within the NOCAD group.

CONCLUSIONS

In both men and women, NOCAD was associated with impaired health status, more psychological distress, and Type D personality when compared with a reference population. Factors reflecting S&G differences explained these S&G findings in patient-reported outcomes.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01788241.

Is Symptomatic Long QT Syndrome Associated with Depression in Women and Men?

We examined whether long QT syndrome (LQTS) mutation carrier status or symptomatic LQTS are associated with depression, and whether there are sex differences in these potential relationships. The sample comprised 782 participants (252 men). Of the 369 genetically defined LQTS mutation carriers, 169 were symptomatic and 200 were asymptomatic. The control group consisted of 413 unaffected relatives. Depression was assessed using the Beck Depression Inventory-II (BDI-II). No association was found for LQTS mutation carrier status with depression. The multinomial logistic regression showed that LQTS mutation carrier men with arrhythmic events scored higher on depression compared with the control group, even when adjusting for age, β-blockers, antidepressants, and social support (OR = 1.09, 95 % CI [1.02, 1.15], p = .007). The binary logistic regression comparing symptomatic and asymptomatic LQTS mutation carriers showed that symptomatic LQTS was associated with depression in men (OR = 1.10, 95 % CI [1.03, 1.19], p = .009). The results were unchanged when additionally adjusted for education. These findings suggest that symptomatic LQTS is associated with depression in men but not in women. Overall, however, depression is more frequent in women than men. Thus, regular screening for depression in LQTS mutation carriers and their unaffected family members can be important.