Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis

Doyle, Frank; Conroy, Ronán; McGee, Hannah; Delaney, Mary

doi:10.1016/j.jpsychores.2009.07.013

Cited by 74Cardiac Health and Mental HealthAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCancer survivorship and care

Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis

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Doyle, Frank, Conroy, Ronán, McGee, Hannah, Delaney, Mary·2010·Journal of Psychosomatic Research

DOI 10.1016/j.jpsychores.2009.07.013

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Abstract

Objective To determine which particular depressive symptom scales, derived from three scales, predicted poorer prognosis in persons with acute coronary syndrome (ACS).Methods Hospitalized ACS patients (n=408) completed questionnaires (depression, vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac events (cardiac mortality, ACS, unplanned revascularization) were assessed at median 67 weeks post event.Results Only depressive symptoms of fatigue-sadness predicted prognosis in univariate (hazard ratio [HR]=1.8, 95% CI 1.1-3.0, P=.025) and multivariate analysis (HR=1.8, 95% CI 1.1-2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 0.9-2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7-2.2, P=.402) did not.Conclusion Symptoms of fatigue-sadness, but not other symptoms, were associated with increased risk of major cardiac events. Depression should be considered as a multidimensional, rather than a unidimensional, entity when designing interventions.

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“The association between somatic, and not cognitive depressive symptoms, appear to be stronger among individuals with established heart disease (Doyle et al., 2010), but somatic complaints are also predictive of subclinical disease (Stewart et al., 2007) and cardio-metabolic conditions (Luppino et…”
Mokken scaling analysis of the Hospital Anxiety and Depression Scale in individuals with cardiovascular disease
Cosco, T. D., Doyle, F., Watson, R. A., Ward, M. D., & McGee, H. M. (2011) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2011.11.005 · Cited by 30 · see citing works
“Item 14 could be criticized as having lost its cultural relevance and ability to assess anhedonia as it is intended to and has been shown to have poor discriminative abilities [28,48].”
BackgroundSelf-citation
Network Analysis of Depressive Symptoms Among Residents of Wuhan in the Later Stage of the COVID-19 Pandemic
Zhao, N., Li, W., Zhang, S.-F., Yang, B. X., Sha, S., Cheung, T. C. C., Jackson, T., Zang, Y., & Xiang, Y. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.735973 · Cited by 30 · see citing works
Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial
Norlund, F., Olsson, E. M., Burell, G., Wallin, E., & Held, C. (2015) · Trials · doi:10.1186/s13063-015-0689-y · Cited by 33 · see citing works
“The depression subscale of HADS has been shown to have prognostic value for morbidity and mortality in patients with acute coronary syndrome, even though somatic-affective symptom-items are lacking [29].”
Background
Differential Predictive Value of Depressive Versus Anxiety Symptoms in the Prediction of 8-Year Mortality After Acute Coronary Syndrome
Doyle, F., Conroy, R. M., & McGee, H. M. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318268978e · Cited by 27 · see citing works
“Furthermore, the patients only completed one of the scales; however, we have shown similar findings in a 1-year follow-up of a different sample where patients completed both the HADS-D and the BDI-FS (6).”
BackgroundResultInfluentialSelf-citation
Depressive symptom clusters are differentially associated with atherosclerotic disease
Bus, B., Marijnissen, R., Holewijn, S., Franke, B., Purandare, N., de Graaf, J., den Heijer, M., Buitelaar, J., & Voshaar, R. O. (2010) · Psychological Medicine · doi:10.1017/s0033291710002151 · Cited by 25 · see citing works
“…and somatic symptom cluster have been associated with an increased risk of cardiovascular morbidity (Pedersen et al. 2007 ; Davidson et al. 2010 ; Doyle et al. 2010), although these results remain to be confirmed and contradicting results have been found for fatigue and anhedonia (Davidson et…”
ResultInfluential
Changes in Depressive Symptoms and Mortality in Patients With Heart Failure
Hwang, B., Moser, D. K., Pelter, M. M., Nesbitt, T. S., & Dracup, K. (2015) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000221 · Cited by 23 · see citing works
“(36), whereas the Beck Depression Inventory was used in most other studies (12,13,15,17).”
Method
Psychosocial vulnerabilities to depression after acute coronary syndrome: the pivotal role of rumination in predicting and maintaining depression
Denton, E.-G. D., Rieckmann, N., Davidson, K. W., & Chaplin, W. F. (2012) · Frontiers in Psychology · doi:10.3389/fpsyg.2012.00288 · Cited by 20 · see citing works
“TOTAL SAMPLE: PSYCHOSOCIAL VULNERABILITIES AND DEPRESSION Consistent with previous literature, these results show that 3 month psychosocial vulnerabilities are strong independent predictors of 3 month depression severity, controlling for the influence of cardiac disease severity, and initial depressive symptoms (Doyle…”
Result
Family-centredness of professionals who support people with profound intellectual and multiple disabilities: Validation of the Dutch ‘Measure of Processes of Care for Service Providers’ (MPOC-SP-PIMD)
Jansen, S. L. G., van der Putten, A. A. J., Post, W. J., & Vlaskamp, C. (2014) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2014.03.044 · Cited by 19 · see citing works
Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study
Reichardt, L. A., van Seben, R., Aarden, J. J., van der Esch, M., van der Schaaf, M., Engelbert, R., Twisk, J. W. R., Bosch, J. A., & Buurman, B. M. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.03.011 · Cited by 18 · see citing works
Mindfulness and Cardiovascular Risk in College Students
Kettler, K. (2010) · The Eagle Feather · doi:10.12794/tef.2010.51 · Cited by 18 · see citing works
Relationship between anxiety/depression and oral health-related quality of life in inpatients of convalescent hospitals
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Why the HADS is still important: Reply to Coyne & van Sonderen
Doyle, F., Cosco, T. D., & Conroy, R. M. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.04.003 · Cited by 17 · see citing works
“Gen Hosp Psychiat 2011; 33(3): 203-16.”
Self-citation
New Perspectives on Treatment of Depression in Coronary Heart Disease
Carney, R. M., & Freedland, K. E. (2023) · Psychosomatic Medicine · doi:10.1097/psy.0000000000001219 · Cited by 16 · see citing works
The Relationship between Smoking and Depression Post-Acute Coronary Syndrome
Busch, A. M., Borrelli, B., & Leventhal, A. M. (2011) · Current Cardiovascular Risk Reports · doi:10.1007/s12170-011-0198-9 · Cited by 15 · see citing works
“[50] followed 408 ACS patients for a median of 67 weeks post-event.”
Anhedonic depression, history of depression, and anxiety as gender-specific risk factors of myocardial infarction in healthy men and women: The HUNT study
Langvik, E., & Nordahl, H. M. (2014) · Health Psychology Open · doi:10.1177/2055102914557658 · Cited by 15 · see citing works
“, 2013) and whether some aspects or subtypes of depression are more cardiotoxic than others (Doyle et al., 2010).”
Background
Symptoms of depression and anxiety before and after myocardial infarction: The HUNT 2 and HUNT 3 study
Langvik, E., & Hjemdal, O. (2014) · Psychology Health & Medicine · doi:10.1080/13548506.2014.989864 · Cited by 14 · see citing works
Residual Symptoms After Treatment for Depression in Patients With Coronary Heart Disease
Carney, R. M., Freedland, K. E., Steinmeyer, B. C., Rubin, E. H., & Rich, M. W. (2018) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000570 · Cited by 14 · see citing works
Types of multidimensional vulnerability and well-being among the retired in the U.S
Shin, O., Park, S., Kang, J. Y., & Kwak, M. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1768212 · Cited by 13 · see citing works
Factor Structure of Hospital Anxiety and Depression Scale in Malaysian Patients With Coronary Artery Disease
Kaur, S., Zainal, N. Z., Low, W. Y., Ramasamy, R., & Sidhu, J. S. (2014) · Asia Pacific Journal of Public Health · doi:10.1177/1010539514533719 · Cited by 13 · see citing works
Depression Symptom Patterns as Predictors of Metabolic Syndrome and Cardiac Events in Symptomatic Women with Suspected Myocardial Ischemia: The Women's Ischemia Syndrome Evaluation (WISE and WISE-CVD) Projects
Virzi, N. E., Krantz, D. S., Bittner, V., Merz, C. N. B., Reís, S. E., Handberg, E. M., Pepine, C. J., Vaccarino, V., & Rutledge, T. R. (2022) · Heart and Mind · doi:10.4103/hm.hm_35_22 · Cited by 12 · see citing works
Longitudinal modelling of theory-based depressive vulnerabilities, depression trajectories and poor outcomes post-ACS.
Keegan, C., Conroy, R., & Doyle, F. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.11.030 · Cited by 11 · see citing works
“The baseline sample, depressive trajectories and 1-year mortality have been previously reported (Doyle et al., 2010; Doyle et al., 2011a; Doyle et al., 2011b).”
Self-citation
Symptoms that remain after depression treatment in patients with coronary heart disease
Carney, R. M., Freedland, K. E., Steinmeyer, B. C., & Rich, M. W. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2022.111122 · Cited by 12 · see citing works
Depressive symptoms in patients with obstructive sleep apnea: biological mechanistic pathways
Chirinos, D. A., Gurubhagavatula, I., Broderick, P., Chirinos, J. A., Teff, K. L., Wadden, T. A., Maislin, G., Saif, H., Chittams, J. L., Cassidy, C., et al. (2017) · Journal of Behavioral Medicine · doi:10.1007/s10865-017-9869-4 · Cited by 13 · see citing works
“…have also been shown to bear stronger associations with other chronic medical conditions, such as cardiovascular disease (Jonge et al. 2006; Doyle et al. 2010; Hoen et al. 2010; Linke et al. 2009; Martens et al. 2010; Roest et al. 2011; Schiffer et al. 2009; Smolderen et al. 2009), than…”
Background
Exhaustion, depression and hopelessness in cardiac patients: a unidimensional hierarchy of symptoms revealed by Mokken scaling
Doyle, F., Kowalczyk, A., McGee, H. M., & Conroy, R. M. (2011) · Irish Journal of Psychological Medicine · doi:10.1017/s0790966700011939 · Cited by 11 · see citing works
Self-citation
Sadness: Diagnosis, Evaluation, and Treatment
Lokko, H. N., & Stern, T. A. (2014) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.14f01709 · Cited by 10 · see citing works
Correlates of depression in caregivers of Ultra-Orthodox frail older adults.
Band‐Winterstein, T., Edelstein, O. E., & Bachner, Y. G. (2018) · American Journal of Orthopsychiatry · doi:10.1037/ort0000337 · Cited by 10 · see citing works
The Inter-Relationships Between Depressive Symptoms and Suicidality Among Macau Residents After the “Relatively Static Management” COVID-19 Strategy: A Perspective of Network Analysis
Lam, M. I., Cai, H. X., Chen, P., Lok, K.-I., Chow, I. H. I., Si, T. L., Su, Z., Ng, C. H., An, F., & Xiang, Y. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s451031 · Cited by 8 · see citing works
“106 Fatigue is a crucial influencer of other depressive symptoms, such as 107,108 hopelessness, and impaired concentration, 109 as well as a contributor to the development of psychiatric disorders (ie, depression and psychotic disorders).”
Background
Importance of Depressive Symptoms in Patients With Coronary Heart Disease – Review Article
Tatishvili, S., Kandashvili, T., & Gordeladze, D. (2023) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2023.101646 · Cited by 6 · see citing works
Self‐reported depressive symptoms in women hospitalized for acute coronary syndrome
Sanner, J. E., Frazier, L. Q., & Udtha, M. (2013) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12038 · Cited by 6 · see citing works
“Depression is a heterogeneous construct of somatic and cognitive symptoms making screening and detection difficult, especially in ACS populations, as somatic cardiovascular symptoms may over shadow the somatic symptoms of depression (Doyle et al. 2010).”
Background
Perceived Experience of Fatigue in Clinical and General Population: Descriptors and Associated Reactivities
Fuentes-Márquez, S., Senín‐Calderón, C., Testal, J. F. R., & Carrasco, M. Á. (2015) · The Spanish Journal of Psychology · doi:10.1017/sjp.2015.11 · Cited by 6 · see citing works
Psychometric properties of the Spanish version of the Chalder Fatigue Scale in clinical and general populations
Ceballos-Munuera, C., Senín‐Calderón, C., Becerra, Á. R., & Testal, J. F. R. (2024) · Anales de Psicología · doi:10.6018/analesps.570181 · Cited by 5 · see citing works
“This is in line with cross-sectional and longitudinal results obtained in previous studies (Doyle et al., 2010; ter Wolbeek et al., 2011), which found a clear association and covariance between fatigue and symptoms of depression or anxiety.”
Result
Physical activity and core depressive symptoms in the older Irish adult population.
Morgan, K., O’Farrell, J., Doyle, F., & Mc Gee, H. (2019) · Lenus, The Irish Health Repository (Dr Steevens Hospital Library) · doi:10.25419/rcsi.10770443 · Cited by 5 · see citing works
Self-citation
The perception of the illness and the self-efficacy in the management of emotions in cardiac patients
Marogna, C., Russo, S., Caccamo, F., Pinton, A., Sava, V., & Carlon, R. (2018) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2018.310 · Cited by 5 · see citing works
Association Between Hospital Anxiety Depression Scale and Autonomic Recovery Following Exercise
Santana, M. D. R., Garner, D. M., de Moraes, Y. M., Mangueira, L. B., Alcântara, G. C., da Silva, J. R. A., Raimundo, R. D., Oliveira, F. R., & Valenti, V. E. (2019) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-019-09683-7 · Cited by 4 · see citing works
“The HADS is an important technique for evaluating individuals with psychosomatic illness, including coronary heart disorders and estimates of cardiovascular mortality (Doyle et al. 2010).”
Method
Components of Depression and 6-Year Mortality After an Acute Coronary Syndrome
Herbison, P., Tie, C., Tang, E. W., Bermingham, B., & Wong, C. (2014) · The American Journal of Medicine · doi:10.1016/j.amjmed.2014.11.029 · Cited by 4 · see citing works
Anhedonia predicts adverse cardiac events in people with acute coronary syndromes
Doyle, F. (2010) · Evidence-Based Mental Health · doi:10.1136/ebmh1092 · Cited by 4 · see citing works
Self-citation
Association Between Psychological Distress and Stress-Related Symptoms and Increased Risk of Type 2 Diabetes in Male Individuals: An Observational Study
Takahashi, K., Kamino, T., Yasuda, T., Suganuma, A., & Sakane, N. (2020) · Journal of Clinical Medicine Research · doi:10.14740/jocmr4392 · Cited by 3 · see citing works
“Sadness was often identified as part of depression scales and as a predictor of cardiac events [27].”
Background
The role of support in the physical and psychological health of coronary artery bypass graft surgery patients and their partners
Leigh, E. S. (2014) · UCL Discovery (University College London) · Cited by 3 · see citing works
The Techniques for Overcoming Depression Questionnaire: Mokken Scale Analysis, Reliability, and Concurrent Validity in Depressed Cardiac Patients
Freedland, K. E., Lemos, M., Doyle, F., Steinmeyer, B. C., Csik, I., & Carney, R. M. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9797-6 · Cited by 2 · see citing works
“Mokken scaling determines the dimensionality and hierarchy of scale items, and has previously been used with measures of depressive symptoms in cardiac patients (Cosco et al. 2012; Doyle et al. 2010).”
MethodSelf-citation
Efectos de la fatiga anticipatoria y la sintomatología emocional en la percepción de fatiga física y cognitiva
Fuentes-Márquez, S., Senín‐Calderón, C., Testal, J. F. R., & Carrasco, M. Á. (2017) · Anales de Psicología · doi:10.6018/analesps.33.3.263751 · Cited by 2 · see citing works
Anhedonia in Heart Disease
Loas, G. (2014) · Springer eBooks · doi:10.1007/978-94-017-8610-2_14 · Cited by 1 · see citing works
Revisiting causality in psychosomatic research
Mcnair, S., & Jindal, R. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2009.11.007 · Cited by 1 · see citing works
“[6] deconstruct commonly used depression rating scales to investigate which aspect of depressive symptomatology is most strongly correlated with major cardiac events; Brydon et al.”
BackgroundMethod
Why the HADS is still important: Reply to Coyne
Sonderen, V. E., Doyle, F., Cosco, D., & Conroy, R. M. (2012)
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FATTORI PSICOLOGICI ASSOCIATI ALLE MALATTIE CARDIOVASCOLARI. DIFFERENZE TRA CONDIZIONI ACUTE E CRONICHE E IMPATTO DELLA GRAVITA' DELLA MALATTIA SUL BENESSERE DEL PAZIENTE
M-Psi, S. S. D. (2011)
The weight of subclinical vascular disease & neuroticism in late-life depression
Marijnissen, R. M. (2014)
Beziehungen von positivem Affekt und Persönlichkeitsressourcen zu kardiologischen Untersuchungsergebnissen in einem kardiologischen Patientenkollektiv
Zech, B. (2016) · doi:10.53846/goediss-5899
Timing and selection of the type of revascularization procedure in acute coronary syndrome without ST-segment elevation with multivessel coronary artery disease
Hájek, P. (2010) · Cor et Vasa · doi:10.33678/cor.2010.119

Differential Predictive Value of Depressive Versus Anxiety Symptoms in the Prediction of 8-Year Mortality After Acute Coronary Syndrome
Doyle, F., Conroy, R. M., & McGee, H. M. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318268978e · Cited by 27 · see citing works
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Short-term depressive symptoms and 30-day prognosis of hospitalized patients with Acute Coronary Syndromes; the Greek Study of Acute Coronary Syndromes (GREECS)
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Anhedonia as predictor of clinical events after acute coronary syndromes: a 3-year prospective study
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Considerations of depression as risk factor in cardiovascular patients
Lemos, M., & Vélez, D. M. A. (2015) · El Repositorio Institucional de la Universidad EAFIT (Universidad EAFIT)
The correlation between depression and prognosis in patients with acute coronary syndrome
We, P., & Rsearch, C. (2007) · The Chinese Journal of Cardiac Pacing and Electrophysiology

Authors: Doyle, F., Conroy, R., McGee, H., & Delaney, M.
Affiliations: Royal College of Surgeons in Ireland (IE)
Corresponding author: Doyle, Frank
ORCID: Doyle, Frank
Conroy, Ronán
McGee, Hannah
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 2010-02
Volume: 68
Issue: 2
Pages: 121-130
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/j.jpsychores.2009.07.013
OpenAlex: W2020262981
Cited by: 74
References: 49
Citations by year: 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 3 · 2015: 6 · 2014: 11 · 2013: 8 · 2012: 7
FWCI: 4.97
Type: journal article
Language: en
Open access: green
figshare.com
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychosomatic Research (publishedVersion)
PubMed (publishedVersion)
Figshare (submittedVersion, cc-by-nc-nd)
Funders: Health Research Board
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: depressive symptoms, acute coronary syndrome, prognosis, anhedonia, depressive cognitions, vital exhaustion, Mokken scaling, major cardiac events, cardiac mortality, unplanned revascularization
MeSH terms: Aged, Depression, Fatigue, Female, Humans, Male, Middle Aged, Prognosis, Psychiatric Status Rating Scales, Surveys and Questionnaires, Regression Analysis, Severity of Illness Index, Sex Factors, Odds Ratio, Acute Coronary Syndrome

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Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis

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