Can anxiety and depression, separately or in combination predict subjective health status 10 years post-PCI?

Abstract

Signsandsymptomsofanxietyand/ordepressioncanbedetectedinpatients with coronary artery disease (CAD) relative frequently [1,2].Severalstudies investigated thepredictive valueof anxiety and depres-siononhealthstatusinpatientswithCAD.Bothanxietyanddepressionappeared to be significant predictors of poor health status [3–5].It is well known that anxiety and depression frequently co-occur [6,7].Theinfluenceofco-occurringanxietyanddepressioninpatientswhobecameapercutaneouscoronaryintervention(PCI)ishardlyexamined.The only study we know of [4] demonstrated that patients with co-occurring anxiety and depression reported poorer health status thanpatients with anxiety-only or depression-only. In their study, howeverthe maximum follow-up was 12 months [4].Thepresentstudyaimstofillinagapinknowledgebyinvestigating,at long term (i.e., with a follow-up of 10 years), the incremental pre-dictive value of (co-occurring) anxiety and depression on subjectivehealth status 10 years post-PCI.The initial study population of this study was part of the RESEARCHregistry which included 1411 consecutive patients treated with PCIbetween October 2001 and October 2002. Only patients (N = 1055)who did not die or were not lost between baseline assessment and10yearsfollow-up,wereselected.Allsurvivingpatientswerecontactedby mail at 6 months (referred to as baseline in the remainder of thepaper),1 year, 3 years, and 10 years post-PCI.They were asked to com-pletequestionnairesaboutanginalstatusandmedicationusage,andthe36-item Short-Form Health Survey (SF-36), assessing subjective healthstatus. The 14-item Hospital Anxiety and Depression Scale (HADS) wasadministered 6 months post-PCI.Survival status at each assessment moment was obtained from theMunicipalCivilRegistries.ThisstudywasnotsubjecttotheDutchMed-ical Research Involving Human Subjects Act. Therefore, approval fromthe local research ethics committee to conduct this retrospectivefollow-up study was not required. Importantly, the studywas conduct-ed according to theHelsinki Declaration. All patients consented partici-pation in this study.Anxiety and depressive symptoms were assessed with the HADS.TheHADSisavalidandreliableinstrument [8].SubjectivehealthstatuswasassessedwiththeSF-36HealthSurvey.Goodreliabilityandvalidityhave been reported for the Dutch version of the SF-36 [9].The clinical end point was defined as poor subjective health sta-tus at 10-year follow-up. To enhance clinical interpretability, wedichotomized the health status sub-domains into: poor health status(i.e., the lowest tertile) versus good health status (i.e., the other twotertiles).Prior to statistical analyses, four psychological symptom groupswere created based on baseline anxiety and depressive symptoms:(1) no symptoms, (2) anxiety, (3) depressive symptoms, and (4) co-occurring symptoms. The chi-square test (Fisher's exact test when ap-propriate) for nominal variables and the one-way analysis of variance(ANOVA) were used to compare the four psychological symptomgroups on baseline characteristics. Univariable and multivariable logis-tic regression analyses were performed to investigate the predictivevalue of anxiety, depression and co-occurring symptoms on health sta-tus 10 years post-PCI, using the no-symptom group as reference group.Inthemultivariateanalyses,weadjustedforSF-36scoreatbaseline,andbaseline characteristics as mentioned in Table 1. All tests were 2-tailed,using a probability value of p b 0.05. For logistic regression analyses,odds ratios (ORs) and their corresponding 95% confidence intervals(95% CIs) were reported. All data were analyzed using SPSS 20.0 forWindows (SPSS Inc, Chicago, IL).