Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.


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.





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Publication Info

Watkins, Lana L, Gary G Koch, Andrew Sherwood, James A Blumenthal, Jonathan RT Davidson, Christopher O'Connor and Michael H Sketch (2013). Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc, 2(2). p. e000068. 10.1161/JAHA.112.000068 Retrieved from

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Lana L. Watkins

Professor Emeritus 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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