Resource loss predicts depression and anxiety among patients treated with an implantable cardioverter defibrillator

The Association between Artificial Intelligence Awareness and Employee Depression: The Mediating Role of Emotional Exhaustion and the Moderating Role of Perceived Organizational Support

The combination of artificial intelligence (AI) technology with the real economy has dramatically improved the efficiency of enterprises. However, the replacement of AI for employment also significantly impacts employees' cognition and psychological state. Based on the Conservation of Resources Theory, the relationship between AI awareness and employee depression is explored in this article while examining the mediating role of emotional exhaustion, as well as the moderating role of perceived organizational support. Based on a sample of 321 respondents, the empirical results show that (1) AI awareness is significantly positively correlated with depression; (2) emotional exhaustion plays a mediating role between AI awareness and depression; (3) perceived organizational support negatively moderates the relationship between emotional exhaustion and depression; (4) perceived organizational support negatively moderates the mediating role of emotional exhaustion between AI awareness and depression. The research conclusions provide a theoretical basis for organizations to take measures to intervene in the negative impact of changes in AI technology on employees' mental health.

Parental migration status moderates the link between parent-child relationship and children's well-being through psychological distress

The effects of parental migration on the well-being of left-behind children (LBC) are varied. Several studies demonstrated that parental migration reduces children's psychological health but other research showed contradictory results. This study sought to clarify this issue by examining the mediating role of psychological distress and the moderating role of parental migration status in the association between the parent-child relationship and children's psychological distress. A total of 743 LBC and 688 non-LBC self-reported their parent-child relationship, psychological distress, and well-being. Findings showed that psychological distress mediated the association between parent-child relationship and children's well-being. This denotes that greater parent-child relationship results into lowered levels of psychological distress, and in turn, increases children's emotional, psychological, and social well-being. Moreover, the link between parent-child relationship and psychological distress was found to be contingent to parental migration status. Specifically, the negative association between parent-child relationship and psychological distress was especially strong among LBC in contrast to non- LBC. This implies that children with higher quality relationships with their parents tend to exhibit decreased severity of psychological distress symptoms, especially in children whose parents are working overseas. These results underscore the dynamic role of parent-child relationship in the well-being of LBC, and suggest ways to develop intervention programs that include cultivating skills in managing psychological distress and improving the emotional, psychological, and social well-being of LBC.

The prevalence of depression in patients living with implantable cardioverter defibrillator: a systematic review and meta-analysis

Depression is a common disorder in patients with implantable cardioverter defibrillator (ICD). There are a variety of studies estimated the prevalence of depression in these patients. The present study aimed to investigate the prevalence of depression in patients with ICD.

METHODS

In the present study, we conducted a systematic review of studies published in PubMed, Scopus, Web of Science (WoS), Medline, and EMBASE without any time filtration to obtain studies investigated the prevalence of depression in patients with ICD. Search terms consisted of "Implantable Cardioverter Defibrillator(s)" in combination with "depression," "depressive," "prevalence," "implanted cardioverter," "implantable," and "implantable defibrillator."

RESULTS

We identified 15 relevant studies, comprising data from 10,182 patients with ICD from whom 2400 (23.58%) (95% CI, 15.36-31.79) had depression. The results of the subgroup analysis showed that the prevalence of depression among middle-aged patients (28.58% with confidence interval of 95%, 21.51-35.65) was higher than elderly patients (22.23% with confidence interval of 95%, 11.21-33.24) and it was not significantly correlated with the mean age of samples (P = 0.255), sample size (P = 0.686), and the publication date (P = 0.784), although there was a significant correlation between the prevalence of depression and the quality of articles so that the prevalence was decreasing with an increase in the quality (P = 0.046).

CONCLUSION

Around 1 in 4 patients with ICD (23.58%) experiences depression progression after an ICD placement. This prevalence is comparable to that in the general population, and close to that of the patients with common chronic diseases.

Loss of resources and demoralization in the chronically ill

OBJECTIVE

The study examined whether the association between the severity of physical symptoms and demoralization is mediated by loss of resources in individuals with chronic conditions including conventional diagnoses, functional somatic syndromes, and medically unexplained symptoms.

METHOD

This cross-sectional study evaluated N = 194 patients (mean age = 46, 83.5% female) who reported at least 3 months of persistent physical symptoms using the following self-report instruments: PHQ-15 (modified), Loss of Resources Inventory, Psychosocial Questionnaire - Demoralization Subscale, and PHQ-8. The mediation hypothesis was tested by multiple regression analyses controlling for age, race, employment status, income, educational attainment, and depression.

RESULTS

Participants experienced M = 9.3 out of 16 possible health-related losses (SD = 4.4). Average to severe demoralization scores were indicated by 59.1% of individuals, of which only 17.1% experienced high demoralization. Loss of resources fully mediated the effect of symptom severity on demoralization, explaining 56% of the variance of demoralization and inhibiting the initially significant effect of symptom severity on demoralization to nonsignificant levels [from b = 0.67, 95% CI (0.26, 1.07) to b = 0.03, 95% CI (-0.27, 0.32)].

CONCLUSION

Early recognition of the loss of resources phenomena and interventions to reduce its progression through the introduction of resource gains may diminish, or even prevent, the installation of demoralization in individuals with chronic symptoms.

Psychological distress in patients with an implantable cardioverter defibrillator and their partners

OBJECTIVES

Adjustment to life with an implantable cardioverter defibrillator (ICD) may be challenging for some patients and their partners, with disease and individual characteristics likely influencing the process. We examined whether perceived social support and clinical patient characteristics are associated with change in couples' symptoms of anxiety and depression in the first year after ICD implantation, and explored whether the associations differ between patients and partners.

METHOD

A cohort of consecutively implanted patients (n = 286; 21% women) and their partners completed questionnaires on social support and symptoms of anxiety and depression prior to ICD implantation and 12 months later. Information on demographic and clinical characteristics were captured from patients' medical records or purpose-designed questions. Data were analyzed using multilevel models accounting for the interdependency of scores within couples with adjustment for possible confounders.

RESULTS

Higher ratings of perceived social support prior to ICD implantation were associated with greater reductions in couples' symptoms of anxiety and depression, whereas having received an ICD shock was associated with less improvement. Secondary prevention indication for ICD implantation and symptomatic heart failure were associated with less improvement in anxiety symptoms. These associations applied to both patients' and partners' levels of distress.

CONCLUSION

The patient's heart disease affects both patients' and partners' psychological adjustment in the first year after ICD implantation. Interventions are warranted that address this issue not only in patients but also in partners. Targeting social support as a resource for both could be one avenue to pursue.

Who is afraid of ISIS? ISIS anxiety and its correlates

Islamic State of Iraq and the Levant (ISIS) is a relatively small organization, yet it wields its terror and media campaigns efficiently. Its presence has altered security measures in many western counties. In the current study, I assess anxiety of the ISIS threat and its correlates in a convenience sample of 1,007 adult Israelis (mean age = 29.61, SD = 7.16). Findings show that being female, a lower socioeconomic status, and having elevated post-traumatic stress disorder (PTSD) symptom levels were all associated with ISIS anxiety. Likewise, exposure to ISIS media, as well as having low resilience, was also correlated with ISIS anxiety. The correlations between ISIS anxiety on the one hand and ISIS media exposure, PTSD symptoms, and resilience on the other hand remained significant even after controlling for general anxiety symptoms. Finally, the PTSD- ISIS anxiety relationship was especially pronounced when resources (resilience/optimism) were low. This critical interaction also remained significant after controlling for general anxiety. Theoretical and practical ramifications of ISIS anxiety are discussed. Both resources for addressing current tasks (resilience), as well as those aimed at future outcomes (optimism), may be required for addressing ISIS anxiety, especially when PTSD symptoms are high.

Embodying a New Meaning of Being At Risk: Living With an Implantable Cardioverter Defibrillator for Arrhythmogenic Right Ventricular Cardiomyopathy

Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic condition that can cause fatal arrhythmias. The implantable cardioverter defibrillation (ICD) is a primary treatment for ARVC/D. Using a grounded theory approach, this study examines the experiences of 15 individuals living with an ICD. The ability to cope with and adjust to having an ICD is influenced by the acceptance of the ICD as something needed to survive, an understanding of the ICD's function, existing support networks, and ones' ability to manage everyday challenges. Coping well requires reshaping ideas about the meaning of being at risk and understanding how the ICD fits into that changing personal risk narrative. A thorough understanding of the unique needs of individuals with ARVC/D and of the specific factors contributing to the psychosocial distress related to having an ICD (vs. having the disease itself) is needed. Nurses must be prepared to provide ongoing support and education to this population.

Job demands and driving anger: The roles of emotional exhaustion and work engagement

This study aimed to examine the effects of both hindrance and challenge demands on driving anger within the framework of the job demands-resources (JD-R) model. We collected self-reported data from 411 office workers driving to and from work each day in five cities in China. The results from a structural equation modeling analysis indicated that both hindrance and challenge demands were positively related to emotional exhaustion, which was in turn positively correlated with driving anger. Moreover, work engagement was positively correlated with driving anger. Implications of the present findings regarding both the JD-R model and driving safety research are discussed.

Prolonged physiological reactivity and loss: Association of pupillary reactivity with negative thinking and feelings

Prolonged psychophysiological reactions to negative information have long been associated with negative thinking and feeling. This association is operationalized in the RDoC negative affect construct of loss, which is nominally indexed by prolonged physiological reactivity, cognitive loss-related constructs such as rumination and guilt, and more feeling-related constructs such as sadness, crying, and anhedonia. These associations have not been tested explicitly. If thinking and feeling aspects of loss reflect different physiological mechanisms, as might be suggested by their putative neurobiology, different intervention pathways might be suggested. Here we examined the extent to which self-reported negative thinking and feeling constructs were associated with prolonged pupillary reactivity following negative words and a subsequent cognitive distractor in a diverse heterogeneously diagnosed sample of N=84 participants. We also considered indices of abuse and variables associated with borderline personality disorder as possible moderators. Consistently, feeling-related negative affect constructs were related to prolonged pupillary reactivity during the distractor after a negative stimulus whereas thinking-related constructs were not. These data suggest that people who have sustained physiological reactions to emotional stimuli may be more strongly characterized by non-linguistic negative feelings than explicit cognitions related to loss. Sustained physiological reactions could reflect efforts to regulate feeling states. In contrast to cognitive and affective variables, abuse was associated with decreased physiological reactivity, consistent with decreased neural engagement. Interventions that target mechanisms underlying feelings and their regulation may be more mechanistically specific to sustained reactivity than those which directly address cognitions.

Psychological effects of implantable cardioverter defibrillator shocks. A review of study methods

Background: The implantable cardioverter defibrillator (ICD) saves lives but clinical experience suggests that it may have detrimental effects on mental health. The ICD shock has been largely blamed as the main offender but empirical evidence is not consistent, perhaps because of methodological differences across studies.

Objective: To appraise methodologies of studies that assessed the psychological effects of ICD shock and explore associations between methods and results.

Data Sources: A comprehensive search of English articles that were published between 1980 and 30 June 2013 was applied to the following electronic databases: PubMed, EMBASE, NHS HTA database, PsycINFO, Sciencedirect and CINAHL.

Review Methods: Only studies testing the effects of ICD shock on psychological and quality of life outcomes were included. Data were extracted according to a PICOS pre-defined sheet including methods and study quality indicators.

Results: Fifty-four observational studies and six randomized controlled trials met the inclusion criteria. Multiple differences in methods that were used to test the psychological effects of ICD shock were found across them. No significant association with results was observed.

Conclusions: Methodological heterogeneity of study methods is too wide and limits any quantitative attempt to account for the mixed findings. Well-built and standardized research is urgently needed.

Comparison of male and female psychological outcomes related to implantable cardioverter defibrillators (COMFORTID)

BACKGROUND

While randomised, controlled trials have established the efficacy of the implantable cardioverter defibrillator (ICD) for primary and secondary prevention of life threatening arrhythmias, psychosocial responses remain complex and poorly understood, especially across Europe. There appears to be a greater need to understand differences in the experience of men and women.

AIM

The aim of this prospective study was to explore differences in psychosocial adjustment over a 12 month period following ICD implantation.

METHODS

Fourteen female and thirty three male device recipients completed a series of questionnaires over a 12 month period. Instruments included a generic and an ICD specific Quality of Life (QOL) measure and the state-trait anxiety inventory.

RESULTS

Women reported higher levels of anxiety than men at discharge but over time demonstrated a significant improvement such that at 4, 8 and 12 months men were more anxious. Women reported significantly poorer emotional wellbeing at discharge, however by 12 months this was significantly improved with no difference in the perceptions held by men and women. Women consistently across the 12 months worried more than men about the impact of the device on appearance.

CONCLUSION

This study confirmed that most individuals adjust positively to the ICD during the first 12 months. Some gender differences in adjustment were evident. Further studies across Europe are warranted to establish gender specific interventions to support men and women as they adapt to life with ICD implants.

Psychological functioning and disease-related quality of life in pediatric patients with an implantable cardioverter defibrillator

The objective of this multicenter study was to evaluate psychological functioning and disease-related quality of life (DRQoL) in pediatric patients with an implantable cardioverter defibrillator (ICD) in The Netherlands. Thirty patients were investigated; the mean age was 16.3 years, and the mean duration of implantation was 3.6 years. To assess psychological problems, three domains of the Symptom Checklist (SCL-90-R) were administered to the 25 patients[13 years old. DRQoL was assessed with a disease-specific pediatric questionnaire, the short-form 11-item Worries About (WA)ICDs Scale. Patients C13 years old scored significantly higher than the reference group on the domains of anxiety, depression, and sleeping problems of the SCL-90-R (T = 7.5, p\0.001; T = 5.4, p\0.001; and T = 7.8, p\0.001, respectively). Patients who had received an (in)appropriate shock reported more depressive symptoms (T = 2.1, p\0.03). Patients with [2 years implant duration (N = 19) or who had received an (in)appropriate shock (N = 13) showed lower DRQoL scores on the modified WAICD (T = 2.1, p\0.04; T = 2.1, p\0.5, respectively). Age at implantation or underlying disease did not influence psychological problems or DRQoL. Young ICD patients showed more anxiety, depression, and sleeping disorders. Worries were increased among patients with ICD shocks and in those who had their ICD implanted for[2 years. To determine psychological problems and help children to learn to cope with shocks, proper guidance and monitoring of young ICD patients are recommended.

The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: a systematic review

OBJECTIVE

The implantable cardioverter defibrillator (ICD) is used to treat life-threatening ventricular arrhythmias and in the prevention of sudden cardiac death. A significant proportion of ICD patients experience psychological symptoms including anxiety, depression or both, which in turn can impact adjustment to the device. The objective of this systematic review was to assess the prevalence of anxiety and depression or symptoms of anxiety and depression among adults with ICDs.

METHODS

Search of MEDLINE®, CINAHL®, PsycINFO®, EMBASE® and Cochrane® for English-language articles published through 2009 that used validated diagnostic interviews to diagnose anxiety or depression or self-report questionnaires to assess symptoms of anxiety or depression in adults with an ICD.

RESULTS

Forty-five studies that assessed over 5000 patients were included. Between 11% and 28% of patients had a depressive disorder and 11-26% had an anxiety disorder in 3 small studies (Ns=35-90) that used validated diagnostic interviews. Rates of elevated symptoms of anxiety (8-63%) and depression (5-41%) based on self-report questionnaires ranged widely across studies and times of assessment. Evidence was inconsistent on rates pre- versus post-implantation, rates over time, rates for primary versus secondary prevention, and for shocked versus non-shocked patients.

CONCLUSION

Larger studies utilizing structured interviews are needed to determine the prevalence of anxiety and depression among ICD patients and factors that may influence rates of anxiety and depressive disorders. Based on existing data, it may be appropriate to assume a 20% prevalence rate for both depressive and anxiety disorders post-ICD implant, a rate similar to that in other cardiac populations.

[Changes in depression, anxiety, and vital exhaustion in patients after ICD implantation. Comparison of clinical subgroups]

BACKGROUND

The psychological strain of an implantable cardioverter-defibrillator (ICD) is infrequently explored in prospective studies, which have until now generally focused on the dimensions anxiety and depression. Furthermore, vital exhaustion (VE; ICD10 F 48.0) is known as a very good predictor for negative outcome in patients with coronary heart disease. The influence of VE on patients with an ICD is presented and analyzed in a prospective study.

METHODS

A total of 249 patients with an ICD completed a set of questionnaires (HADS, EQ-5D, VE) at baseline and at the 1-year follow-up.

RESULTS

The patients with high levels of depression, anxiety, and VE after ICD implantation did not show spontaneous remission after 1 year.

DISCUSSION

As expected, the implanatation of an ICD is associated with high acceptance and increased life quality in about 3/4 of patients. However, there is a subgroup of patients (20-30%) who have difficulties and the measured dimensions remain at elevated levels after implantation, thus, indicating that these patients probably need competent psychological help.

Gender disparities in psychological distress and quality of life among patients with an implantable cardioverter defibrillator

A subset of patients with an implantable cardioverter defibrillator (ICD) reports psychological distress and poor quality of life (QoL). Gender is one of the factors that has been proposed to explain individual differences in these outcomes. In this viewpoint, we (1) review the evidence for gender disparities in psychological distress and QoL in ICD patients by means of a systematic review, and (2) provide recommendations for future research and clinical implications. A systematic search of the literature identified 18 studies with a sample size ≥ 100 that examined gender disparities in anxiety/depression and QoL in ICD patients (mean prevalence of women = 21%; mean age = 62 years). Our review shows that there is insufficient evidence to conclude that gender per se is a major autonomous predictor for disparities in psychological distress and QoL in ICD patients. Women had a higher prevalence of anxiety and poorer QoL in some studies, but there was no statistically significant gender effect in relation to 80% (26/32) of the outcomes reported in the 18 studies. Studies are warranted that are designed a priori and sufficiently powered to examine gender disparities in distress and QoL outcomes in order to establish the exact gender-specific effect. Due to a need to explore the complexity of this issue further, at this time, caution is warranted with respect to the clinical implications.

Psychopathology in postinfarction patients implanted with cardioverter-defibrillators for secondary prevention. A cross-sectional, case-controlled study

OBJECTIVE

To determine (1) the incidence of anxiety and depression in patients implanted with defibrillators for secondary arrhythmia protection after myocardial infarction; (2) the effect of comorbidity and receipt of shock therapy on psychosocial maladjustment.

METHODS

Cross-sectional, one-off, questionnaire-based (HADS; MOS SF-36), case-controlled study of defibrillator recipients (n=100) from a 3-year implant period and three groups of matched controls [pacemaker (n=50), coronary intervention (n=50), atrial fibrillation (n=50)], sharing specific preselected previous health experiences. Spouses of each subgroup (n=106) were also studied. Although a cardiac rehabilitation program was available routinely for postinfarction patients, no specific rehabilitation was provided after defibrillator or pacemaker implant.

RESULTS

Mean scores for each assessment were similar for each group. Individual patient scores, however, revealed similarly high incidences of anxiety (24-34%) and depression (14-22%) in all groups. Experience of implantable cardioverter-defibrillator (ICD) 'shock(s)' and 'shock storm(s)' (≥ 3 shocks in 24 h) increased anxiety significantly. HADS criteria for anxiety 'caseness' or borderline 'caseness' were met in 63.6% of shock-storm recipients. Abnormal anxiety scores did not differ with interval from index event. Individual HADS scores also identified high incidences of anxiety in all spouse groups (25-48%).

CONCLUSIONS

Experience of shock storm precipitates pathological levels of anxiety in ICD recipients, and need for an ICD contributes to spouse anxiety. Individual CBT is indicated for patients who experience multiple shocks along with psycho-education for spouses. Anxiolytic and antidepressant medications may be indicated as part of their psychological rehabilitation.

Effect of a psychoeducational intervention on depression, anxiety, and health resource use in implantable cardioverter defibrillator patients

BACKGROUND

Psychological responses have been reported for some patients after the insertion of an implantable cardioverter defibrillator (ICD). This study tested the effects of a psychoeducational intervention on anxiety, depressive symptoms, functional status, and health resource use during the first year after ICD implantation.

METHODS

ICD patients (n = 246) were randomized to usual care (UC), group (GRP), or telephone counseling (TC) intervention that included education, symptom management, and coping skill training. Participants were 58 +/- 11 years, 73% men, and 23% minorities. Anxiety (State-Trait Anxiety Inventory [STAI]), depressive symptoms (Beck Depression Inventory II [BDI-II]), and functional status (Duke Activity Status Inventory [DASI]) were measured at baseline and after 1, 3, 6, and 12 months. Health resource use and disability days were tracked. Analyses were repeated-measures analysis of covariance to assess Group x Time effects,chi(2)for percentage with clinically significant anxiety and depression at each time point, and logistic regression.

RESULTS

All groups experienced decreased anxiety and depressive symptoms over the 12 months; GRP intervention had lower STAI (P = 0.03) than UC at 3 months. Logistic regression revealed group differences for predicted probability of having depressive symptoms at 12 months (UC = 0.31, GRP = 0.17, TC = 0.13, P = 0.03). UC had greater calls to providers at 1 and 6 months (P < 0.05) and more sick/disability days at 12 months (P = 0.01) than intervention groups.

CONCLUSIONS

A psychoeducational intervention reduced anxiety and depressive symptoms early after ICD implant, lowered probability of depressive symptoms at 1 year, and decreased disability days/calls to providers. These findings support further study and clinical use of both group and telephone interventions to yield better psychological outcomes after ICD implant.

Gender differences in anxiety and concerns about the cardioverter defibrillator

BACKGROUND

Little is known about gender differences in the response to implantable cardioverter defibrillator (ICD) therapy. We compared female and male ICD patients on anxiety, depression, health-related quality of life (HRQL), ICD concerns, and ICD acceptance.

METHODS

A cohort of consecutive, surviving patients (n = 535; mean age = 61.5 +/- 14.4, 81.9% male) implanted with an ICD between 1989 and 2006 completed the Hospital Anxiety and Depression Scale, the Short-Form Health Survey (SF-36), the ICD concerns questionnaire, and the Florida Patient Acceptance Survey.

RESULTS

High levels of anxiety (52% vs 34%, P < 0.001) and ICD concerns (34% vs 16%, P = 0.001) were more prevalent in women than men, whereas no significant differences were found on depression and device acceptance (Ps > 0.05). Women were more anxious (odds ratio [OR]: 2.60 [95% confidence interval (CI): 1.46-4.64], P < 0.01) and had more ICD concerns (OR: 1.81 [95% CI: 1.09-3.00], P < 0.05) than men, adjusting for demographic and clinical characteristics. Those ICD patients experiencing shocks were also more anxious (OR: 2.02 [95% CI: 1.20-3.42], P < 0.01) and had higher levels of ICD concerns (OR: 2.70 [95% CI: 1.76-4.16], P < 0.01). In multivariable analysis of variance, significant gender differences were found for only three of the eight subscales of the SF-36 (the physical social functioning and the mental health subscale), with women reporting poorer HRQL on all three subscales.

CONCLUSIONS

Women were more prone to experience anxiety and ICD concerns compared to men regardless of whether they had experienced shocks. In clinical practice, female ICD patients should be closely monitored, and if warranted offered psychosocial intervention, as increased anxiety has been shown to precipitate arrhythmic events in defibrillator patients.

The experiences and concerns of young adults (18-40 years) living with an implanted cardioverter defibrillator (ICD)

BACKGROUND

Although the implanted cardioverter defibrillator (ICD) is a widely accepted life-saving technology, adjusting to life after ICD implantation may vary according to the recipient's age. Few studies have investigated how young adults manage life with an ICD and there are no studies describing their concerns or experiences of living with an ICD.

AIM

The aim of the study was to describe the experiences and concerns of young adults (18-40 years) living with an ICD.

METHODS

Qualitative descriptive methodology was chosen incorporating interviews and written narrative responses to investigate twenty young adult's experiences of living with an ICD.

RESULTS

There were four descriptive categories: psychosocial, developmental, physical, and economical. Themes in the psychosocial category were: returning to normal, mood disturbances, and body image concerns. Themes in the developmental category were unique to young adults: childbearing and childrearing, while themes in the physical category were expectation regarding physical activity, and the economical category, the issue of financial security.

CONCLUSIONS

These data reveal that young adults with ICDs experience the unique concerns of childbearing, childrearing, and are worried about their financial security. These findings provide insight for the development of age-appropriate interventions for young adults before and after ICD implantation.

Depression and anxiety symptoms are associated with reduced dietary adherence in heart failure patients treated with an implantable cardioverter defibrillator

BACKGROUND

Heart failure (HF) patients treated with an implantable cardioverter defibrillator (ICD) are a growing patient population for whom the general treatment guidelines for HF still apply. Dietary recommendations, sodium and fluid restriction and daily weight monitoring, are a critical component of HF self-management. However, HF patients often report poor adherence to these recommendations. Studies that have investigated factors associated with poor diet adherence have focused on knowledge and beliefs. The current study extends previous research by examining the impact of psychosocial factors (depression, anxiety, and social support) on adherence to dietary recommendations in this growing subgroup of HF patients.

METHODS

Eighty-eight HF patients, with a mean age of 70 years, treated with an ICD (77% male) completed questionnaires assessing depression and anxiety symptoms, social support, and dietary adherence.

RESULTS

Most patients reported following dietary recommendations in the past week most of the time (63%), whereas only 16% of patients reported following dietary recommendations all of the time. Greater depression and anxiety symptoms were associated with poorer dietary adherence, whereas social support did not predict reported dietary adherence.

CONCLUSIONS

Findings suggest that many HF patients treated with an ICD do not comply with dietary recommendations. Depression and anxiety symptoms were found to be associated with worse dietary adherence, whereas social support was not related to adherence. Further research is needed to understand the role of social support in dietary adherence in HF patients.

Changes in psychosocial distress in outpatients with heart failure with implantable cardioverter defibrillators

Patients given implantable cardioverter defibrillators (ICDs) after arrhythmic events or sudden cardiac arrest (SCA) experience psychosocial distress. ICDs now are inserted for the primary prevention of SCA in patients with heart failure; the psychosocial impact of ICDs on patients with heart failure is unknown. Changes in psychosocial status in these ICD recipients were examined. ICD recipients (n = 57) completed depression, anxiety, and social support inventories every 6 months for up to 2 years. Initially, 35% of recipients were depressed and 45% of recipients were anxious. In linear mixed models, depression decreased over time overall but increased in those who experienced ICD shocks. Anxiety decreased in New York Heart Association class III ICD recipients but not in class II ICD recipients. Decreases in social support were related to age: the younger the patient the greater the decrease. A significant proportion of ICD recipients were depressed or anxious, or had diminished social support even after 2 years. Investigation of strategies to improve ICD recipients' psychosocial status is warranted.

An updated review of implantable cardioverter/defibrillators, induced anxiety, and quality of life

During the past 2 years the number of studies examining psychopathology and quality of life after ICD implantation has increased dramatically. Variables assessed have included recipient age, gender, and social support network. How recipients respond to having the device, particularly after experiencing firing, has been evaluated in light of new depression and anxiety disorder diagnoses as well as premorbid personality structure. Now the picture of what is known is, if anything, cloudier than it was 2 years ago, with little definitive and much contradictory data emerging in most of these categories. It still seems clear that in a significant minority of ICD recipients the device negatively affects quality of life, probably more so if it fires. Education about life with the device before receiving it remains paramount. Reports continue to appear of patients developing new-onset diagnosable anxiety disorders such as panic and posttraumatic stress disorder. Until recently the strongest predictors of induced psychopathology were considered to be the frequency and recency of device firing. It now seems that preimplantation psychologic variables such as degree of optimism or pessimism and an anxious personality style may confer an even greater risk than previously thought. Certainly many variables factor into the induction of psychopathology in these patients. Among these factors are age, gender, and perception of control of shocks, as well as the predictability of shocks and psychologic attributions made by the patient regarding the device. Another source of variability is this population's medical heterogeneity. Some patients receive ICDs after near-death experiences; others get them as anticipatory prophylaxis. Some have longstanding and entrenched heart disease; others were apparently healthy before sudden dangerous arrhythmias. Diagnoses as diverse as myocardial infarction in the context of advanced coronary artery disease and dilated cardiomyopathy after acute viral infection may warrant ICD placement. Moreover the course of cardiac disease after ICD placement may vary from relative stability to continuing disease progression and severe functional compromise. Unless these and other pre- and postimplantation differences are taken into account, it is almost impossible to make meaningful comparisons between studies. Ideally, future research would consist either of large-scale, randomized, prospective studies using validated structured-interview tools to supplement a literature dominated by self-report measures, unstructured assessments, and anecdotal reports, or of smaller studies designed to focus on particular diagnostic subsets. As ICDs become the standard of care for potentially life-threatening arrhythmias, the rate of implantations continues to increase. Because negative emotions have been linked to an increased incidence of arrhythmias, and untreated or unrecognized psychiatric illness can interfere with adaptation to an ICD, assessing and managing both pre-existing and induced psychiatric disorders becomes even more critical. Greater research attention should be paid to determining which patients meet criteria for anxiety disorders before and after implantation and what premorbid traits predispose to postimplantation psychopathology. The authors predict that psychiatrists will be involved increasingly in caring for this population, offering insights into treatment options that increase the likelihood of successful ICD acceptance and decrease the psychosocial costs of these devices.