Higher Self-rating Depression Scale Scores Research Articles

Impact of closed-off management due to COVID-19 rebound on maternal depression during pregnancy

BackgroundThis study aimed to assess the impacts of closed-off measures with different strictness levels (lockdown, partial lockdown and non-lockdown) and geographic proximity to patients with coronavirus disease 2019 (COVID-19) on prenatal depression during an epidemic rebound of COVID-19.MethodsThis was a cross-sectional web-based survey including 880 pregnant women. Depressive symptoms were measured by Self-Rating Depression Scale (SDS) and geographic proximity was calculated using Geographic Information Systems. Linear and logistic regression were used to assess the associations of closed-off measures and geographic proximity with SDS scores and depressive symptoms. Restricted cubic splines were used to model non-linear associations between geographic proximity and depression symptoms.ResultsCompared with those living in non-lockdown areas, women in lockdown areas had higher SDS scores (adjusted β: 3.51, 95% CI: 1.80, 5.21) and greater risk of depressive symptoms (adjusted OR: 4.00, 95% CI: 2.18, 7.35), but evidence for partial lockdown was not obvious. A progressive increase in the risk of depressive symptoms was found with decreasing distance to COVID-19 patients when geographic proximity was <8 kilometers. Compared to those in the 5th quintile of geographic proximity, women in the first, second and third quintiles had at least 6 times higher risk of depressive symptoms.ConclusionsPregnant women under strict closed-off management during COVID-19 epidemic have high risk of depression. A specific range around the residences of reported COVID-19 patients should be underlined as potential clustering of high prenatal depression levels. Our findings highlight the importance of enhancing mental health management during the COVID-19 epidemic for pregnant women.

Anxiety prevalence and associated factors among frontline nurses following the COVID-19 pandemic: a large-scale cross-sectional study.

Nurses are more likely to experience anxiety following the coronavirus 2019 epidemic. Anxiety could compromise nurses' work efficiency and diminish their professional commitment. This study aims to investigate nurses' anxiety prevalence and related factors following the pandemic in multiple hospitals across China. An online survey was conducted from April 16 to July 3, 2023, targeting frontline nurses who had actively participated in China. Anxiety and depression symptoms were assessed using the Self-rating Anxiety Scale and the Self-rating Depression Scale (SDS), respectively. Multivariable logistic regression analysis was employed to identify factors linked with anxiety. A total of 2,210 frontline nurses participated in the study. Overall, 65.07% of participants displayed clinically significant anxiety symptoms. Multivariable logistic regression revealed that nurses living with their families [2.52(95% CI: 1.68-3.77)] and those with higher SDS scores [1.26(95% CI: 1.24-1.29)] faced an elevated risk of anxiety. Conversely, female nurses [0.02(95% CI: 0.00-0.90)] and those who had recovered from infection [0.05(95%CI: 0.07-0.18)] demonstrated lower rates of anxiety. This study highlights the association between SDS score, gender, virus infection, living arrangements and anxiety. Frontline nurses need to be provided with emotional support to prevent anxiety. These insights can guide interventions to protect the mental well-being of frontline nurses in the post-pandemic period.

The association between social support and depression among patients with vitiligo in China.

Vitiligo is a common depigmenting skin disease with profound psychosocial impacts. Depression is one of the most common mental distress. Social support has a significant impact on the psychological status of patients. The aim of this study is to investigate the depression and social support status of patients with vitiligo in China, and further explore the correlation between social support and depression. The outpatients with vitiligo were investigated face to face with SDS (Self-rating depression scale) and SSRS (Social support rate scale). The mean SDS score of the patients was 44.05 ± 6.76, which was significantly higher than Chinese norms (p = 0.000). Female patients, unmarried, disease at rapid progressive stage and skin lesions at the exposed site had higher SDS scores (all p < 0.05). The scores of total social support, subjective support, objective support and support availability were lower than Chinese norms (all p < 0.01), and all were negatively correlated with SDS scores (all p < 0.001). In conclusion, low social support is one of the risk factors for depression in patients with vitiligo in China. More support and acceptance should be given to the patients.

Early Changes in the White Matter Microstructure and Connectome Underlie Cognitive Deficit and Depression Symptoms After Mild Traumatic Brain Injury.

Cognitive and emotional impairments are frequent among patients with mild traumatic brain injury (mTBI) and may reflect alterations in the brain structural properties. The relationship between microstructural changes and cognitive and emotional deficits remains unclear in patients with mTBI at the acute stage. The purpose of this study was to analyze the alterations in white matter microstructure and connectome of patients with mTBI within 7 days after injury and investigate whether they are related to the clinical questionnaires. A total of 79 subjects (42 mTBI and 37 healthy controls) underwent neuropsychological assessment and diffusion-tensor MRI scan. The microstructure and connectome of white matter were characterized by tract-based spatial statistics (TBSSs) and graph theory approaches, respectively. Mini-mental state examination (MMSE) and self-rating depression scale (SDS) were used to evaluate the cognitive function and depressive symptoms of all the subjects. Patients with mTBI revealed early increases of fractional anisotropy in most areas compared with the healthy controls. Graph theory analyses showed that patients with mTBI had increased nodal shortest path length, along with decreased nodal degree centrality and nodal efficiency, mainly located in the bilateral temporal lobe and right middle occipital gyrus. Moreover, lower nodal shortest path length and higher nodal efficiency of the right middle occipital gyrus were associated with higher SDS scores. Significantly, the strength of the rich club connection in the mTBI group decreased and was associated with the MMSE. Our study demonstrated that the neuroanatomical alterations of mTBI in the acute stage might be an initial step of damage leading to cognitive deficits and depression symptoms, and arguably, these occur due to distinct mechanisms.

Clinical Relevance of Blood Glucose and Gastroesophageal Reflux Symptoms to Depressive Status in Patients with Type 2 Diabetes Mellitus.

A relationship between diabetes and depression is apparent. To clarify the clinical relevance of diabetic patients' gastroesophageal symptoms to their psychological status, we retrospectively analyzed the data from a Selfrating Depression Scale (SDS) and a Frequency Scale for Symptoms of Gastroesophageal reflux disease (FSSG) among 143 type 2 diabetic patients who visited a general medicine department. Among the 45 Japanese patients enrolled, the group with relatively high SDS scores (≥ 36) showed higher (FSSG) dysmotility symptom scores versus the low-SDS (< 36) group, although the 2 groups' characteristics and laboratory data were not significantly different. Positive correlations of postprandial plasma glucose (PPG) levels with FSSG scores (R=0.321, p<0.05), particularly with reflux scores (R=0.455, p<0.01) were revealed. PPG and HbA1c levels were not correlated with SDS scores. The patients' SDS scores were significantly correlated with their FSSG scores (R=0.41, p<0.01), suggesting that depressive status is linked to GERD-related manifestations. Considering that the patients' PPG levels were correlated with GERD-related symptoms, diabetic patients' blood glucose levels are associated with depressive status. Collectively, key symptoms related to GERD and glucose level values would be helpful.

Preoperative Depressive Mood of Patients With Esophageal Cancer Might Delay Recovery From Operation-Related Malnutrition.

BackgroundWe investigated the relationship between the preoperative psychological state and the perioperative nutritional conditions of patients with esophageal cancer.MethodsSeventy-three participants underwent operations for esophageal cancer in our hospital. Depressive state was evaluated using the Self-Rating Depression Scale (SDS). General quality of life (QOL) was assessed using the SF-8™, and the nutritional assessments were evaluated through anthropometric analysis, bioelectrical impedance analysis (BIA) and some biochemical assessments.ResultsIn the preoperative stage, patients with higher SDS scores, representing a more depressive state, had low arm circumference, grip strength, serum albumin levels and prognostic nutritional index. Patients with higher SDS scores also had a tendency for a lower physical component summary, representing physical QOL by the Eight-Item Short Form Health Survey (SF-8™). At 3 months after surgery, patients with higher preoperative SDS scores had significantly lower body mass indexes (BMIs) and had a lower tendency of body fat masses. In the univariate and multivariate analyses on the recovery of BMI at 3 months after surgery, preoperative SDS score was the only independent risk factor (odd ratio (OR): 4.07, 95% confidence interval (CI): 1.15 - 14.35) in this study.ConclusionPreoperative depressive mood, as evaluated by the SDS, was the sole relevant factor for postoperative body weight recovery of patients with esophageal cancer. Preoperative depressive mood of patients with esophageal cancer might delay recovery from operation-related malnutrition. Some measures against preoperative depressive mood might be necessary for early recovery from postoperative malnutrition in patients with esophageal cancer.

Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: a randomized controlled trial.

ObjectiveThe aim of this study was to evaluate the efficacy of mindfulness-based stress reduction (MBSR) on health-related quality of life (QoL), depression, and anxiety in patients with differentiated thyroid cancer (DTC) receiving radioactive iodine therapy (RIT).Patients and methodsA randomized controlled trial of MBSR with 120 DTC patients was performed. They were randomly assigned into the MBSR intervention group and usual care (UC) group. An 8-week MBSR program was administered to the MBSR group starting 8 weeks before RIT. Health-related QoL, depression, and anxiety were measured immediately before the start of MBSR (T1), immediately after RIT hospitalization was concluded (1 week after concluding the last MBSR session, T2), and 3 months after RIT hospitalization (T3), using the QoL Questionnaire Core 30 Items (QLQ-C30), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS).ResultsFifty-three patients in the UC group and 49 patients in the MBSR group completed the study and were analyzed. Both the UC and MBSR groups reported low QoL and high SDS and SAS scores immediately after RIT hospitalization. Patients randomly assigned to the MBSR group showed significantly greater improvements in emotional function (P=0.012, d=–0.03 for T2 and d=1.17 for T3), fatigue (P=0.037, d=1.00 for T2 and d=–0.69 for T3), global QoL (P=0.015, d=1.61 for T2 and d=1.56 for T3), depression (P=0.027, d=–1.19 for T2 and d=–0.83 for T3), and anxiety (P=0.043, d=–1.00 for T2 and d=–0.86 for T3).ConclusionAn 8-week MBSR program significantly improved a wide range of scales in health-related QoL and mitigated depression and anxiety among DTC patients receiving RIT.

Psychological factors influencing choice of prenatal diagnosis in Chinese multiparous women with advanced maternal age

Objectives: To investigate the psychological predictors in Chinese multiparous pregnant women of advanced maternal age (AMA) for choosing aneuploidy screening or diagnostic testing.Methods: A total of 84 pregnant women of AMA were consecutively enrolled from Renming Hospital, Wuhan University. All participants completed three questionnaires: Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and Pregnancy Stress Rating Scale (PSRS). Demographic information and the choice of noninvasive prenatal testing (NIPT) versus invasive prenatal diagnosis (PND) were also collected.Results: Thirty-seven chose to have invasive PND, and 47 chose NIPT. Choosing invasive PND, as opposed to NIPT, was associated with lower educational background (χ2 = −2.269, p = .023), higher SAS scores (47.62 ± 7.96 versus 44.21 ± 6.10, p = .029), and higher SDS scores (50.41 ± 9.80 versus 45.96 ± 11.05, p = .058). Logistic regression analysis further showed that the decisive predictors for invasive PND are SAS (OR =1.106, p = .008) scores, scores of factor 3 in PSRS and the stress from changes of shape and motility (OR =0.471, p = .038). Subgroup analysis showed that women with previous negative pregnancy experience had higher scores in factor 2-stress (guarantee of maternal-fetal safety: 1.96 ± 0.63 versus 2.49 ± 0.65, p = .004) and total PSRS scores (1.60 ± 0.4 versus 1.83 ± 0.31, p = .044) than those without. Additionally, unemployment post pregnancy was associated with marginally significant higher PSRS scores (p = .083).Conclusions: The decision for invasive PND might be swayed by anxiety and attenuated by pregnancy stress originating from worry about changes in fetal shape and motility (measured by SAS and factor 3 score of PSRS, respectively).

Comparison of self-reported scales and structured interviews for the assessment of depression in an urban male working population in Japan: a cross-sectional survey

BackgroundThe present study aimed to analyze the association among depression, sleep quality, and quality of life using the Japanese version of the Structured Clinical Interview for DSM-IV Axis I Disorders Non-Patient Edition (SCID-I/NP), and to compare these findings with those obtained using self-reported scales, in an urban male working population in Japan.MethodsThe present study included 324 middle-aged participants (43.8 ± 8.37 years) (participation rate: 69.5%). The Japanese version of the SCID-I/NP was administered by a single physician. Self-reported scales, including the Zung Self-Rating Depression Scale (SDS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Assessment (PSQI), and 36-item Short-Form Health Survey (SF-36) were used to assess depression, sleepiness, sleep quality, and quality of life, respectively. Participants were then divided into a major depressive disorder (MDD) and control group based on the results of structured interviews, following which self-reported scale scores were compared between the two groups.ResultsA total of 24 participants met criteria for MDD based on responses during structured interviews (current: 4; past: 20). Patients with MDD did not report feeling sleepier than those without psychiatric disorders (controls) (ESS: P = 0.184), although they experienced slightly poorer sleep quality (PSQI: P = 0.052). In addition, participants of the MDD group exhibited lower SF-36 subscale scores for general health (P = 0.002), vitality (P < 0.001), social functioning (P < 0.001), role emotional (P = 0.004), and mental health (P < 0.001) domains, and higher SDS scores (P = 0.038) compared to controls. The area under the receiver (AUC) operating characteristic curve for the detection of MDD was 0.631 and 0.706 for the SDS and mental health subscales, respectively.ConclusionsOur findings indicate that patients with MDD exhibit slightly poorer sleep quality and significantly poorer quality of life compared to controls, and that the SF-36 may be used as an alternative to the SDS to screen for depression in an urban male working population in Japan.

The impact of therapeutic regimen on the depression in type 2 diabetes mellitus: A cross-sectional study

To explore the depression in type 2 diabetic patients treated with insulin and compared to those treated with oral anti-diabetic drugs. 283 type 2 diabetics were seclected randomly from outpatient and inpatient departments of endocrionology in Jiangsu Province Hospital of Traditional Chinese Medicine, with the self-designed questionnaire and Zung self-rating depression scale to conduct the survey. Comparisons between the two groups were carried out with t-test or χ2test for quantitative and qualitative data, respectively. Logistic regression were used for the analysis of the relationship between the therapeutic regimen and depression. Overall, 43.1% of the type 2 diabetic subjects showed depressive symptoms in different degrees. Compared to the oral drug group, the insulin group showed a significantly higher prevalence of depressive symptoms(insulin group, 53.5%, oral drug group, 30.5%; P<0.01)and higher self-rating depression scale scores(insulin group, 51.7±12.4, oral drug group, 44.8±10.6; P<0.01). Moreover, after an adjustment for age, sex, body mass index, diabetic duration, complications, HbA1Cand so on, the insulin group showed a significantly higher frequency of depression(OR=4.218, 95%CI 1.764-13.285, P=0.004), compared to the oral drug group. The data showed that insulin treatment is an independent risk factor to the presence of depressive symptoms in type 2 diabetics, and it is necessary to pay more attention to their psychological support. (Chin J Endocrinol Metab, 2015, 31: 346-348) Key words: Diabetes mellitus, type 2; Depression; Insulin; Oral drugs

The role of sleep disturbance and depression in patients with type 2 diabetes

The importance of sleep disturbance and depression in patients with type 2 diabetes is unclear. Our objective was to evaluate their effects on the quality of life (QOL) of patients with type 2 diabetes. For the study, 270 patients were recruited from the Shiga Prospective Observational Follow-up Study for Diabetic Complications. Depressive symptoms, sleep disturbance, and QOL were assessed by use of the Zung Self-Rating Depression Scale (SDS), the Pittsburgh Sleep Quality Index (PSQI), and SF-8, respectively, after evaluation of their metabolic control and complications. Furthermore, 141 patients were recruited to repeat the same study after 6–12 (mean 7.3) months. Significant correlations were found among sleep disturbance, depression, and QOL in patients with type 2 diabetes. Patients undergoing insulin therapy had significantly higher SDS scores, meaning more depressive symptoms, than those not undergoing insulin therapy. Patients with painful neuropathy had higher PSQI and SDS scores and lower physical component of the QOL score than patients without painful neuropathy. In the follow-up observation it was found that the presence of neuropathy and elevated HbA1c level were predictors of increasing PSQI score and SDS score, respectively. It was found that the presence of painful neuropathy was a risk factor for sleep disturbance for type 2 diabetic patients. Sleep disturbance and depressive symptoms correlated significantly with the QOL scores of patients with type 2 diabetes, suggesting the importance of these indices for better management of diabetic patients.

The Course of Migraine—A Diary Study in Unselected Patients

The course of disease and the predictive value of depression and anxiety in patients with migraine were prospectively examined. We recruited 393 migraineurs through articles in newspapers and performed a follow-up examination 30 months later. At baseline and follow-up, patients underwent a semistructured interview, filled out the Headache Impact Test (HIT-6), Self-rating Depression Scale (SDS) and Self-rating Anxiety Scale (SAS) and they kept a headache diary for 30 days. One hundred and fifty-one patients (38.6%) were seen at follow-up. The baseline data of patients with and without follow-up were comparable. At follow-up the number of headache days per month had decreased from 9.6 +/- 5.8 to 8.1 +/- 6.3 (P < 0.001) and the proportion of patients with chronic headache (15.4%) and medication overuse (13%) had remained stable. SDS and SAS scores were associated with a high migraine frequency and high initial SDS scores predicted high migraine frequency at follow-up. This longitudinal study in unselected patients with migraine not excluding subjects with chronic headache, medication overuse, depression or anxiety does not point towards migraine as a progressive disease in the vast majority of patients and confirms the importance of psychiatric comorbidity.

The relationship of pain and health-related quality of life in Korean patients with Parkinson’s disease

Parkinson's disease (PD) is a chronic progressive neurodegenerative disorder. Increasing attention has been focused on the pain and health-related quality of life (HrQOL) in patients with PD. Objective - To evaluate the relationship between pain and the HrQOL in patients with PD. Eighty-two patients with PD were included and classified into two groups according to the presence of pain. The Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale (UPDRS), the Modified Somatic Perception Questionnaire (MSPQ), the Zung Depression Inventory--Self-rating Depression Scale (SDS), the Visual Analogue Scale and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered. The factors influencing the pain, HrQOL and parkinsonian manifestations were evaluated. The PD with pain group had higher UPDRS part III scores, lower SF-36 scores, higher SDS scores and higher MSPQ scores than the PD without pain group. The presence of pain, high Hoehn and Yahr stage, advanced age and somatic perception were the factors that had a negative effect on the physical component of the HrQOL. Depression and somatic perception were the most important predictive factors for the mental component of the HrQOL. Depression and poor parkinsonian motor abilities were the leading factors contributing to pain. Pain and depression were major detrimental factors affecting the physical and mental aspects of the HrQOL respectively. Therefore, the treatment of pain and depression can be important to improve the HrQOL.

The relationship between internet addiction tendency and psychological health status of freshmen

Objective To investigate the differences between students with high intemet addiction tendency and common students ,and focused specifically on their psychological health status and the personality characteristic and explored the related factors which have effects on internet addiction tendency. Methods A total of 739 valid data samples of freshmen were collected. The Self-rating Anxiety Scale(SAS) and the Self-rating Depression Scale(SDS) were used to investigate the personality of the students, while the Self-report Symptom Inventory (SCL-90) was used to measure the psychological health status. Results Among this sample, 27 subjects (3.7%) were identified as students with high internet addiction tendency using the Chinese Intemet Addiction Scale(CIAS-R) designed by Professor Chen. The analytical results revealed that males got markedly higher scores (35.3±9.7 ) than females (31.4±7.0 ;x2= 74.649, P < 0.01 ) ; furthermore, students with high internet addiction tendency obtained significantly higher SAS, SDS and SCL-90 scores [ (47.4±9.8 ), (48.4±12.1 ), ( 184.8±72.5) ] than common students [ (40.1±6.7) ,(42.5±9.9) ,(133.0±34.2) ;x2 = -3.881, P<0.001 ;x2=-2.471, P<0.05 ; x2 = -3.850, P<0.01 ] ; the scale of CIAS-R and the other scales had significant correlation. The regression analysis showed that the anxiety scores ( t = 3.699, P < 0.01 ), depression scores( t = 2.356,P < 0.05 ), compulsion factor ( t = 2.023, P < 0.05 ), anxiety factor ( t = 2.046, P < 0.05 ) and the hostility factor (t =2.669, P<0.01 ) could effect the internet addiction scores significantly and the regression coefficient were 0.181, -0.113,0.196, -0.187,0.161 separately. Conclusions Males were more prone to have intemet addiction tendency; the students with high internet addiction had more psychological symptom. Students with personalities characterized by anxiety,depression, compulsion and hostility had a high tendency to become addicted. Key words: Internet addiction tendency; Anxiety; Depression; Psychological health status

Paroxetine, a selective serotonin reuptake inhibitor, reduces depressive symptoms and subjective handicaps in patients with dizziness.

When treating dizzy patients, the psychiatric aspect should be carefully addressed regardless of whether a well-defined organic disease is present. In this prospective study, we aimed to elucidate the role of paroxetine, a selective serotonin reuptake inhibitor, in the treatment of dizziness. Forty-seven patients who complained of dizziness were treated with 20 mg of paroxetine per day. The depressive state of the patient was evaluated by the Zung Self-Rating Depression Scale (SDS). Treatment outcomes were measured with self-assessment of subjective handicaps in daily life using a dizziness and unsteadiness questionnaire. The questionnaire consisted of five factors related to emotional or bodily dysfunction that could be affected by dizziness. Changes in Self-Rating Depression Scale scores and subjective handicaps were assessed at 4 and 8 weeks after the start of paroxetine. In patients having well-defined organic diseases with high Self-Rating Depression Scale scores, paroxetine improved all five subjective handicap factors as well as Self-Rating Depression Scale scores. The decline in Self-Rating Depression Scale scores showed a significant correlation with improvement of subjective handicaps, which was related to emotional problems but not factors related to bodily dysfunction. Paroxetine was also effective for an improvement of factors related to emotional problems and Self-Rating Depression Scale scores in patients not having organic diseases but with high Self-Rating Depression Scale scores. In patients either with or without organic diseases with low Self-Rating Depression Scale scores, paroxetine had no effect on any subjective handicap factors and Self-Rating Depression Scale scores. In the treatment of dizzy patients, paroxetine was effective at relieving subjective handicaps caused by dizziness, specifically, in patients with high Self-Rating Depression Scale scores.

Relationships between low-grade chronic depression, pain and personality traits among community-dwelling persons with traumatic spinal cord injury

To examine the relationships between low-grade chronic depression, pain and personality traits among community-dwelling persons with traumatic spinal cord injury (TSCI), 111 male and 11 female TSCI persons were administered questionnaires including Self-rating Depression Scale (SDS) and measures of pain and other mental health items, and were followed-up two years later. Nineteen persons (15%) meeting the criteria for low-grade chronic depression (both SDS scores > or = 48) were identified, while 30% of the sample population consistently showed normal mood (both SDS scores < or = 41). Both disabling pain and B type (emotionally labile, socially maladjusted, and extraverted personality characteristic) associated with lower IQ (90 and less) were significantly related to high SDS scores. However, age, sex, time-since-injury, levels of injury and marital status had no relationship with depression.

Depression and Long-Term Mortality Risk in Patients With Coronary Artery Disease

Previous research has established that patients with coronary artery disease (CAD) have an increased risk of death if they are depressed at the time of hospitalization. Follow-up periods have been short in these studies; therefore, the present investigation examined this phenomenon over an extended period of time. Patients with established CAD (n = 1,250) were assessed for depression with the Zung Self-Rating Depression Scale (SDS) and followed for subsequent mortality. Follow-up ranged up to 19.4 years. SDS scores were associated with increased risk of subsequent cardiac death (p = 0.002) and total mortality (p <0.001) after controlling for initial disease severity and treatment. Patients with moderate to severe depression had a 69% greater odds of cardiac death and a 78% greater odds of mortality from all causes than nondepressed patients. Increased risk was not confined to the initial months after hospitalization. Patients with high SDS scores at baseline still had a higher risk of cardiac death >5 years later (p <0.005). Compared with the nondepressed, patients with moderate to severe depression had an 84% greater risk 5 to 10 years later and a 72% greater risk after > 10 years. Patients with mild depression had intermediate levels of risk in all models. The heightened long-term risk of depressed patients suggests that depression may be persistent or frequently recurrent in CAD patients and is associated with CAD progression, triggering of acute events, or both.