Identifying the Internalizing Disorder Clusters Among Recently Hospitalized Cardiovascular Disease Patients: A Receiver Operating Characteristics Study.

Megan Grech,Gary A Wittert,Phillip J Tully,Deborah A Turnbull

doi:10.3389/fpsyg.2019.02829

Abstract

Depression and anxiety disorders are common among cardiovascular disease (CVD) populations, leading several cardiology societies to recommend routine screening to streamline psychological interventions. However, it remains poorly understood whether routine screening in CVD populations identifies the broader groups of disorders that cluster together within individuals, known as anxious-misery and fear. This study examines the screening utility of four anxiety and depression questionnaires to identify the two internalizing disorder clusters; anxious-misery and fear. Patients with a recent hospital admission for CVD (n = 85, 69.4% males) underwent a structured clinical interview with the MINI International Neuropsychiatric Interview. The participants also completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, Overall Anxiety Severity Impairment Scale (OASIS), and the stress subscale of the Depression Anxiety Stress Scale (DASS). The PHQ-9 and the GAD-7 yielded appropriate screening properties to detect three different iterations of the anxious-misery cluster (sensitivity >80.95% and specificity >82.81%). The GAD-7 was the only instrument to display favorable screening properties to detect a fear cluster omitting post-traumatic stress disorder (PTSD) but including obsessive-compulsive disorder (OCD; sensitivity 81.25%, specificity 76.81%). These findings indicate that the PHQ-9 and GAD-7 could be implemented to reliably screen for anxious-misery disorders among CVD in-patients, however, the receiver operating characteristics (ROC) to detect fear disorders were contingent on the placement of PTSD and OCD within clusters. The findings are discussed in relation to routine screening guidelines in CVD populations and contemporary understandings of the internalizing disorders.

Highlights

Depression and anxiety disorders are prevalent in between 15 and 20% of cardiovascular disease (CVD) patients, representing a substantial morbidity burden globally (Rutledge et al, 2006; Thombs et al, 2008; Magyar-Russell et al, 2011; Tully et al, 2014)
The identification of psychiatric disorders in CVD populations is typically based on screening for depression (Thombs et al, 2013), with less attention paid to anxiety disorders and the comorbidity between depression and anxiety disorders
Subsequent research demonstrates that the internalizing domain can bifurcate into two lower order groups characterized by anxious-misery [e.g., Major Depressive Disorder, Dysthymia, Generalized Anxiety Disorder (GAD), and Post Traumatic Stress Disorder (PTSD)], or, by fear [e.g., Panic Disorder, Agoraphobia, Specific Phobia, Social Anxiety Disorder, and Obsessive-Compulsive Disorder (OCD)] (Slade et al, 2009; Watson, 2009; Eaton et al, 2013; Waszczuk et al, 2017)

Summary

Introduction

Depression and anxiety disorders are prevalent in between 15 and 20% of cardiovascular disease (CVD) patients, representing a substantial morbidity burden globally (Rutledge et al, 2006; Thombs et al, 2008; Magyar-Russell et al, 2011; Tully et al, 2014). The identification of psychiatric disorders in CVD populations is typically based on screening for depression (Thombs et al, 2013), with less attention paid to anxiety disorders and the comorbidity between depression and anxiety disorders One limitation of this approach is that depression and anxiety disorders are comorbid in up to 50% of patients (Kessler et al, 2005, 2012; Slade and Watson, 2006; Beesdo-Baum et al, 2009) including among CVD populations (Serber et al, 2009; Tully et al, 2014). GAD is considered to be a part of the anxious-misery cluster compared to the other anxiety disorders subsumed under fear, which are generally characterized by phobias and somatic arousal (Watson, 2005)

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Conclusion