Abstract
ObjectiveTo determine whether a one-off, baseline measure of depression and anxiety in a primary care, coronary heart disease (CHD) population predicts ongoing symptoms, costs, and quality of life across a 3-year follow-up.DesignLongitudinal cohort study.Setting16 General Practice surgeries across South-East LondonParticipants803 adults (70% male, mean age 71 years) contributing up to 7 follow-up points.Main outcome measuresOngoing reporting of symptoms, health care costs, and quality of life.ResultsAt baseline, 27% of the sample screened positive for symptoms of depression and anxiety, as measured by the Hospital Anxiety and Depression Scale (HADS). The probability of scoring above the cut-off throughout the follow-up was 71.5% (p<0.001) for those screening positive at baseline, and for those screening negative, the probability of scoring below the cut-off throughout the follow-up was 97.6% (p<0.001). Total health care costs were 39% higher during follow-up for those screening positive (p<0.05). Quality of life as measured by the SF-12 was lower on the mental component during follow-up for those screening positive (-0.75, CI -1.53 to 0.03, p = 0.059), and significantly lower on the physical component (-4.99, CI -6.23 to -.376, p<0.001).ConclusionsA one-off measure for depression and anxiety symptoms in CHD predicts future symptoms, costs, and quality of life over the subsequent three-years. These findings suggest symptoms of depression and anxiety in CHD persist throughout long periods and are detrimental to a patient’s quality of life, whilst incurring higher health care costs for primary and secondary care services. Screening for these symptoms at the primary care level is important to identify and manage patients at risk of the negative effects of this comorbidity. Implementation of screening, and possible collaborative care strategies and interventions that help mitigate this risk should be the ongoing focus of researchers and policy-makers.
Highlights
Depression and anxiety symptoms are common in Coronary Heart Disease (CHD) [1] [2]
27% of the sample screened positive for symptoms of depression and anxiety, as measured by the Hospital Anxiety and Depression Scale (HADS)
A one-off measure for depression and anxiety symptoms in CHD predicts future symptoms, costs, and quality of life over the subsequent three-years. These findings suggest symptoms of depression and anxiety in CHD persist throughout long periods and are detrimental to a patient’s quality of life, whilst incurring higher health care costs for primary and secondary care services
Summary
Depression and anxiety symptoms are common in Coronary Heart Disease (CHD) [1] [2]. It is both a causal factor [3,4] and poor prognostic indicator [5], being associated with a range of adverse outcomes, including mortality [6,7], but mechanisms for such associations are incompletely understood [8]. Management strategies in patients with comorbid mood disorders and CHD are problematic [9], partly because of the overlap of symptoms of depression and anxiety with the symptomatology of long-term heart conditions [10]. There may be insufficient evidence from RCTs to support the recommendation of screening in CHD [18], there is evidence that screening in conjunction with active management of depression in CHD and diabetes by means of collaborative care may be associated with improved physical and mental health outcomes [19]
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