Abstract
Mental disorders (MD) are associated with an increased risk of developing coronary heart disease (CHD) and with higher CHD-related morbidity and mortality. There is a strong recommendation to routinely screen CHD patients for MDs, diagnosis, and treatment by recent guidelines. The current study aimed at mapping CHD patients' (1) state of diagnostics and, if necessary, treatment of MDs, (2) trajectories and detection rate in healthcare, and (3) the influence of MDs and its management on quality of life and patient satisfaction. The design was a cross-sectional study in three settings (two hospitals, two rehabilitation clinics, three cardiology practices). CHD patients were screened for MDs with the Hospital Anxiety and Depression Scale (HADS), and, if screened-positive, examined for MDs with the Structured Clinical Interview for DSM-IV (SCID-I). Quality of Life (EQ-5D), Patient Assessment of Care for Chronic Conditions (PACIC), and previous routine diagnostics and treatment for MDs were examined. Descriptive statistics, Chi-squared tests, and ANOVA were used for analyses. Analyses of the data of 364 patients resulted in 33.8% positive HADS-screenings and 28.0% SCID-I diagnoses. The detection rate of correctly pre-diagnosed MDs was 49.0%. Physicians actively approached approximately thirty percent of patients on MDs; however, only 6.6% of patients underwent psychotherapy and 4.1% medication therapy through psychotherapists/psychiatrists. MD patients scored significantly lower on EQ-5D and the PACIC. The state of diagnostic and treatment of comorbid MDs in patients with CHD is insufficient. Patients showed a positive attitude towards addressing MDs and were satisfied with medical treatment, but less with MD-related advice. Physicians in secondary care need more training inadequately addressing mental comorbidity.
Highlights
According to the Global Burden of Disease Study, cardiovascular disease, especially coronary heart disease (CHD), will be a leading burden of disease in the coming decades and remains the leading cause of mortality in Europe [1]
The current study aimed to explore (1) the current state of diagnostics and treatment of Mental disorders (MD) and non-MD in CHD patients, (2) patients’ trajectories and detection rate in secondary care, and (3) implications of mental comorbidity and its management on quality of life and patient satisfaction. Both hypotheses concerning the current state of diagnostics and treatment of MD and nonMD CHD patients were confirmed: It was found that approximately 33.8% of the sample was screened positive on the Hospital Anxiety and Depression Scale (HADS)
Findings regarding diagnostics are in accordance with the literature, as in general, 30% of patients experience depressive symptoms, 20% fulfill criteria for depressive disorders [5], and most MD patients were diagnosed with depression, anxiety disorder, or a combination of both [4, 5, 7]
Summary
According to the Global Burden of Disease Study, cardiovascular disease, especially coronary heart disease (CHD), will be a leading burden of disease in the coming decades and remains the leading cause of mortality in Europe [1]. Mental disorders (MD), such as major depression and anxiety disorders, are a significant contributor to the global burden of disease. MDs have an enormous impact on healthcare costs, are associated with an increased risk of developing CHD, and worsen prognosis in established disease [3]. Depression is associated with a nearly twofold risk for developing CHD (OR 1.6–1.9) and with higher CHD-related morbidity and mortality (OR 1.6–2.4) [4]. During the two years after a cardiac event, CHD patients with a comorbid depression disorder have two-fold greater mortality. The risk of dying can increase six-fold when depressive symptoms are severe [5]. Prevalence of anxiety is associated with a significant risk of cardiovascular mortality and CHD (OR 1.41) [6], especially phobic anxiety and panic disorders [5]. 39% of women and 22% of men experienced anxious symptoms 1.4 years after hospitalization for CHD [7]
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