Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.
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BACKGROUND: Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co-occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD. METHODS AND RESULTS: The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3-year follow-up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS-A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3-vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS-D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001). CONCLUSIONS: Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.
Aged, 80 and over
Cause of Death
Proportional Hazards Models
Surveys and Questionnaires
Published Version (Please cite this version)10.1161/JAHA.112.000068
Publication InfoWatkins, Lana L; Koch, Gary G; Sherwood, Andrew; Blumenthal, James A; Davidson, Jonathan RT; O'Connor, Christopher; & Sketch, Michael H (2013). Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc, 2(2). pp. e000068. 10.1161/JAHA.112.000068. Retrieved from https://hdl.handle.net/10161/13048.
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J. P. Gibbons Distinguished Professor of Psychiatry I
Psychosocial factors and coronary heart disease, including such factors as social support, Type A behavior and hostility, and depression, exercise training and depression in the elderly; behavioral approaches to the treatment of hypertension (e.g., weight loss and exercise); cardiac rehabilitation; neuropsychological outcomes following cardiac surgery; psychosocial aspects of heart and lung transplantation; exercise training and osteoarthritis and fibromyalgia; compliance.
Professor Emeritus of Psychiatry and Behavioral Sciences
Currently, my research focuses upon the theoretical aspects of homeopathy and its clinical utilization, as well as the broader field of alternative (complementary) medicine. this is a field which has traditionally been overlooked as a legitimate scientific discipline. Other areas of activity are as in the past, i.e., clinical treatment, epidemiology, risk factors, pathogenesis of posttraumatic stress, social phobia, other anxiety status, and depression. These are illustrated by recent pu
Richard Sean Stack, M.D. Distinguished Professor
Dr. O’Connor’s research interests include: acute heart failure; co-morbidities in heart failure; clinical trials; biomarkers; and novel pharmacological and non-pharmacological approaches for the treatment of heart failure.
Professor in Psychiatry and Behavioral Sciences
My current research focus is on biological, behavioral and sociocultural factors involved in the etiology and management of hypertension, coronary artery disease, and congestive heart failure. The role of stress and the sympathetic nervous system in disease onset and progression is of central interest. Current research issues being studied include: (i) Ethnicity and gender as factors related to the pathogenesis of hypertension; (ii) Mechanisms by which menopause increases the risk of card
Professor of Medicine
My current research interests are focused in the area of diagnostic and interventional cardiac catheterization. In the arena of diagnostic cardiac catheterization, I am currently evaluating the role of Prostaglandin E1 in the prevention of contrast induced renal dysfunction. In the arena of interventional cardiac catheterization, I have been actively involved in both the development and subsequent determination of potential niches for new interventional technologies in the management of coronary
Professor in Psychiatry and Behavioral Sciences
* Examination of the relationship between affective disorders and autonomic cardiovascular control. * Examination of the mechanisms underlying the increased cardiac mortality associated with anxiety disorders. * Examination of the role of behavioral factors (diet, exercise) as modulators of glycemic control and in the pathogenesis of cardiovascular autonomic neuropathy.
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