Associations between depression and anxiety symptoms with quality of life in cardiac arrest survivors with good neurologic recovery and informal caregivers of cardiac arrest survivors

Abstract

• About 1 in 5 cardiac arrest survivors and caregivers showed significant depression. • Nearly 1 in 3 cardiac arrest survivors showed significant anxiety. • Over 1 in 3 informal caregivers showed significant anxiety. • Together, depression and anxiety were the strongest predictors of quality of life. Surviving cardiac arrest is characterized by cognitive, psychological, and functional impairments and apprehension over long-term prognosis. We first estimated the proportion of clinically significant depression and anxiety in cardiac arrest survivors and their informal caregivers, then examined the association between depression and anxiety with worse quality of life (QoL). In an online survey, cardiac arrest survivors and caregivers reported demographic and arrest characteristics, the Patient Health Questionnaire-4 (PHQ-4), and the WHOQOL-BREF physical, psychological, and social QoL subscales. Six multiple regression models (three for survivors and three for caregivers) tested associations between PHQ-4 scores with each QoL subscale, adjusted for the following: for survivors – functional dependence, self-reported memory problems, sex, income, months since arrest, and age; for caregivers – months since arrest, age, and income. We included 169 survivors (mean age: 50.8 years, 49.7% women, positive depression screen: 21.3%, anxiety: 29.6%) and 52 caregivers (mean age: 48.7 years, 86.5% women, positive depression screen: 21.2%, anxiety: 36.5%). In adjusted models, depression and anxiety were associated with worse QoL on each subscale (β: -0.39–-0.7, p < .01). We assessed depression and anxiety and QoL cross-sectionally, which cannot exclude bi-directionality. Further, there was a selection bias in our survey, as the majority of survivors were of good neurologic recovery. Depression and anxiety were moderately associated with worse QoL over functional dependence and memory problems in survivors, and worse QoL in caregivers. Future study should explore the feasibility of dyadic interventions in cardiac arrest survivors and informal caregivers.