Article

Cardiac Depression Scale: Validation of a new depression scale for cardiac patients

May 1996
Journal of Psychosomatic Research 40(4):379-86

May 1996
40(4):379-86

DOI:10.1016/0022-3999(95)00612-5

Source
PubMed

Authors:

David Hare

University of Melbourne

Assessing the effect of interventions on quality of life in cardiac patients lacks sensitivity because there is no specifically validated scale for measuring depression in cardiac patients. A questionnaire of 35 items (selected for face validity) was given to 246 cardiac outpatients (age 59.3 +/- 14.1 years, 159 male, 87 female). The Beck Depression Scale was then administered, followed by blinded clinical rating of depression. The item scores were subjected to common factor analysis. Internal consistency was assessed using alpha reliability coefficients and clinical validity using Spearman correlation coefficients. The final scale consisted of 26 items (alpha reliability coefficient 0.90) in 2 robust dimensions and 7 subscales. The scale correlated well with clinical rating and with the Beck Depression Scale, but without the marked skewness of the latter. The behavior of the new Cardiac Depression Scale suggests that it will be an excellent measure for studies of outcome in cardiac patients.

Psychometric Properties of the Slovenian Version of the Cardiac Depression Scale

Article

Full-text available

Dec 2022

Introduction The aim of this study was to translate the Cardiac Depression Scale into the Slovenian language and test its validity and reliability on Slovenian patients with heart disease. Methods A total of 272 patients with heart disease who underwent elective coronary angiography at Celje General Hospital participated in this study. We used the Slovenian Cardiac Depression Scale (S-CDS), the Spielberger State Anxiety Inventory (STAI-S), and the Center for Epidemiologic Studies Depression Scale-20 (CES-D) to collect data. An exploratory and confirmatory factor analysis, internal consistency, test-retest reliability, and concurrent validity were performed. Results Cronbach’s alpha for the total scale was 0.92 and the test-retest reliability was 0.71. Exploratory factor analysis confirmed six factors, accounting for 61% of the total variance. The confirmatory factor analysis indicated that a two- and one-factor solution had acceptable goodness-of-fit measures. However, we kept a more parsimonious one-factor method, given a high correlation between the two factors and the theoretical background in previous studies. Concurrent validation against the CES-D and the STAI-S showed moderate to strong correlations. Conclusions The S-CDS is a reliable and valid instrument for screening for depression in Slovenian patients with heart disease.

Tingkat depresi pada pasien sindrom koroner akut di Unit Perawatan Intensif Jantung : analisis menggunakan skala depresi jantung

Article

Full-text available

Sep 2022

Depresi dalam kondisi akut akan berdampak fatal pada pasien, seperti memperburuk keadaan infark, meningkatkan morbiditas dan mortalitas. Angka kejadian depresi pada pasien Sindrom Koroner Akut (SKA) dalam fase akut di berbagai negara cukup tinggi. Namun, di Indonesia sendiri belum diketahui bagaimana hasil pengkajian depresi. Penelitian ini bertujuan untuk melihat tingkat depresi pasien Sindrom Koroner Akut (SKA) yang menjalani perawatan di Unit Intensif Jantung RSUP dr. Hasan Sadikin Bandung. Penelitian ini menggunakan desain deskriptif analitik dengan pendekatan cross-sectional. Jumlah sampel 84 responden yang diambil dengan purposive sampling. Pengumpulan data menggunakan instrumen Cardiac Depression Scale (CDS). Hasil penelitian didapatkan bahwa sebagian besar responden laki-laki (75%) dan berusia ≤60 tahun (64.3%), menikah (83.3%), dan mayoritas suku sunda (79.8%). Responden dalam penelitian ini mengalami depresi ringan-sedang (21,4%), berat (14,3%), dan sebagian lainnya tidak mengalami depresi (64,3%). Tingkat depresi pasien sebagian besar berada dalam kategori sedang hingga berat, oleh karena itu perlu dilakukan skrining depresi sedini mungkin sehingga asuhan keperawatan untuk pencegahan depresi dapat ditingkatkan.

Depression and Adherence to Healthy Lifestyle Behaviors among Patients with Coronary Artery Diseases

Article

Full-text available

Jun 2022

Background It is well-established in the literature that coronary artery disease (CAD) is a risk factor for depression and that depressive symptoms inversely affect the development and progression of CAD. No published studies have examined the relationship between depression and adherence to healthy lifestyle behaviors among patients with CAD in Jordan. Therefore, the purpose of this study is to investigate the impact of depression on adherence to healthy lifestyle behaviors among CAD patients in Jordan. Methods A correlational, cross-sectional study of convenience sample of 130 patients with CAD was conducted from out-patient cardiac clinics in a university-affiliated hospital and government-operated hospital in Northern Jordan. Data were collected using self-administered questionnaires on depression and adherence to healthy lifestyle behaviors among CAD patients. Results Our data showed that 41% of the participants were non-adherent to healthy lifestyle behaviors, especially in the areas of physical activity (6.2%), maintaining a healthy diet (24.6%), and weight loss (26.15%). Gender, smoking status, and number of cardiac catheterization procedures were found to be significant predictors of patient adherence to healthy lifestyle behaviors. Although depressive symptoms were present in 56.9 % of the participants, depression was not found to be a significant predictor of adherence to healthy lifestyle behaviors among our sample. Conclusion There was no significant relationship between depression and adherence to healthy lifestyle behaviors among CAD patients in Jordan. Physical activity, maintaining a healthy diet, and weight loss were the least lifestyle behaviors that were adopted, while quitting smoking and medication compliance were the most adopted behaviors among the patients. Our study provides valuable data regarding the levels and predictors of adherence to healthy lifestyle behaviors among CAD patients with CADs. Implications for future research and practice are addressed.

Depression and Adherence to Healthy Lifestyle Among Patients with Coronary Artery Diseases

Preprint

Full-text available

Dec 2020

Background: It is well-established in the literature that coronary artery disease (CAD) is a risk factor for depression and that depressive symptoms inversely affect the development and progression of CAD. No published studies have examined the relationship between depression and adherence to healthy lifestyle behaviors among patients with CAD in Jordan. Therefore, the purpose of this study is to investigate the impact of depression on adherence to healthy lifestyle behaviors among CAD patients in Jordan. Methods: A convenience sample of 130 patients with CAD was recruited from out-patient cardiac clinics in a university-affiliated hospital and government-operated hospital in Northern Jordan. Data were collected using self-administered questionnaires on depression and adherence to healthy lifestyle behaviors among CAD patients. Results: Our data showed that 41% of the participants were non-adherent to healthy lifestyle behaviors, especially in the areas of physical activity (6.2%), maintaining a healthy diet (24.6%), and weight loss (26.15%). Gender, smoking status, and number of cardiac catheterization procedures were found to be significant predictors of patient adherence to healthy lifestyle behaviors. Although depressive symptoms were present in 56.9 % of the participants, depression was not found to be a significant predictor of adherence to healthy lifestyle behaviors among our sample. Conclusion: Our study provides valuable data regarding the levels and predictors of adherence to healthy lifestyle behaviors among CAD patients with CADs. Implications for future research and practice are addressed.

Psychometric Properties of the Arabic Version of the Cardiac Depression Scale tested on Jordanian Patients with Cardiovascular Diseases

Article

Full-text available

May 2020
BMC PSYCHIATRY

Background: The Cardiac Depression Scale (CDS) is an instrument to screen for depression, specifically in patients with cardiovascular diseases (CVD). The purpose of this study was to evaluate the psychometric properties of the Arabic version of the CDS in the Jordanian population. Method: A cross-sectional design was used for 304 participants diagnosed with CVD. An exploratory factor analysis (EFA) was performed to explore the underlying structure of the new Arabic version of the CDS tool. Results: Cronbach's alpha for the total scale was 0.87. An EFA suggested a two-factor solution. The first factor has 18 items, measuring "My tolerance" of CVD, and the second factor has seven items, measuring "My activities" in the context of CVD. Based on the EFA simple structure, one item was removed due to its low factor loading (< 0.3). A confirmatory factor analysis (CFA) supported a two-factor model with the root mean square error of approximation (RMSEA = 0.06), comparative fit index (CFI = 0.856), and Tucker-Lewis index (TLI = 0.83) indicating acceptable fit. The Cronbach's alpha values for the first and second factors were 0.86 and 0.84, respectively. Conclusion: The Arabic version of the CDS is a reliable and valid instrument to screen for depression among Jordanian patients with CVD.

Depression in Nonhospitalized Jordanian Patients With Coronary Artery Disease

Article

Full-text available

Aug 2019
J Nurs Res

Background: Patients with coronary artery disease (CAD) are likely to experience depression, which contributes to the burden of disease and is a risk factor for mortality. Patients in outpatient clinics in Jordan are not routinely screened for depression. Significant relationships among patient characteristics must be determined to ascertain the predictors of depression. Purpose: The aims of this research were to assess the level of depression symptoms in nonhospitalized patients with CAD; to examine the relationships between depression and relevant sociodemographic, self-reported health history, and patient health perception variables; and to identify possible predictors of depression in Jordan. Methods: This cross-sectional study recruited a convenience sample (N = 174) of nonhospitalized outpatients who had been diagnosed with CAD. Self-reported demographic, health history, and health perception information (independent variables) were provided by the participants. The depression scores (dependent variable) for the participants were assessed using the Cardiac Depression Scale. Data were analyzed using descriptive statistics, the chi-square test, Pearson's correlations, and multiple linear regressions. Results: Half of the participants reported mild to moderate depression, with 37% reporting severe depression. Predictors of depression included gender (being female), having a concomitant chronic disease, prior surgery, irregular exercise, impaired sexual activity, and self-perceived poor psychological health. Conclusions/implications for practice: To improve patient outcomes, clinical personnel should screen patients with CAD for depression and offer a combined pharmaceutical and therapeutic treatment intervention. An easy-to-administer instrument to detect depression may be included in the standard patient checkup routine used in clinics. Several patient characteristics were found to significantly affect depression and health outcomes.

Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population

Article

Full-text available

Feb 2019
BMC PUBLIC HEALTH

Background: Mental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population. Methods: This cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety. Results: In total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience. Conclusion: There was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.

Depression Assessment: Spouses are Poor Proxies for Cardiovascular Disease Patients

Article

Full-text available

Jul 2018

Background: Patients are frequently assisted by proxies, usually a spouse, to complete health and medical surveys, including depression assessments. Objective: The objective of this study was to examine whether spousal assessments of patient depression concord with those of the patient. Materials and Methods: Consecutive adult cardiac patients attending an outpatient cardiovascular disease clinic accompanied by an adult were enrolled. Patient–spousal pairs independently completed the Cardiac Depression Scale (CDS) on behalf of the patient. Proxies provided demographic and medical history information and also completed the Physical Health Questionnaire. Results: A total of 72 patients (males 75%; mean age = 67.18 ± 11.35 years) and 72 spouses (mean age = 65.19 ± 11.49 years) met enrollment and analysis criteria. Most spouses were female (75%). Proxies rated patients significantly higher on the CDS (mean = 93.14 ± 29.33) than did patients of themselves (mean = 87.93 ± 26.79), t(71) = –2.05, P < 0.05. Patient–spousal concordance was low to moderate on the total CDS (concordance correlation coefficient [CCC] = 0.69) and CDS symptoms including mood (CCC = 0.35), anhedonia (CCC = 0.63), anxiety (CCC = 0.71), irritability (CCC = 0.55), hopelessness (CCC = 0.50), cognitive dysfunction (CCC = 0.41), and sleep disturbance (CCC = 0.64). Conclusions: These results suggest that spouses have limited insight into patient’s psychological status, as self-reported by patients. Proxy assessments should be interpreted with caution and, wherever possible, patients should be encouraged to complete depression assessments on their own.

Sex-Specific Differences in Percutaneous Coronary Intervention Outcomes After a Cardiac Event: A Cohort Study Examining the Role of Depression, Worry and Autonomic Function

Article

Full-text available

Mar 2020

Background To determine whether differential all-cause hospital readmission exists for men and women 2 years after percutaneous coronary intervention (PCI) treatment for acute coronary syndrome (ACS), and to identify potential pathways contributing to this association. Methods Four hundred and sixteen (416) patients admitted with ACS were recruited from coronary care wards. Participants attended the study centre at one (T0) and 12 (T1) months following discharge. Heart rate variability (HRV) was used to assess autonomic functioning measured via a three-lead electrocardiogram. Pathological worry, depression, and phobic anxiety were measured using validated questionnaires. Percutaneous coronary intervention treatment data were collected from hospital records. The primary outcome was 2-year all-cause hospital readmission (yes/no). Logistic regression modelling using both complete case analysis (CCA) and multiple imputation (MI) was applied. Results Men who received PCI had a significant reduction in the odds of being rehospitalised over the following 2 years, relative to women who did not (OR=0.45, 95% CI=0.20, 0.98). No other group benefited to this extent. Adjustment for age, ACS severity and Very Low Frequency (VLF) Power appeared to strengthen the association in both the CCA and MI models. The inclusion of depression and worry also marginally explained these associations in the MI model. Conclusions Men who receive PCI after ACS were less likely to be readmitted to hospital over the following 2 years than their female counterparts. The small sample size of women and observational study design limit interpretation of the findings. However, heart rate variability, specifically VLF power, requires further investigation as a driver of such sex-specific outcomes.

Effect of Patient Education on Anxiety and Depression in Patients with Intracardiac Device

Article

Full-text available

May 2024

Aim: To learn about the effect of patient education on anxiety and depression in patients with intracardiac devices. Background: Advances in the management of arrhythmias and heart failure have resulted in the increasing use of cardiac implantable electronic devices (CIEDs). Surprisingly even though these devices may save the recipient's life, these are life changing implying multiple challenges in the process of psychosocial adaptation. Studies suggest almost a quarter of patients experience anxiety and depression after pacemaker implantation which in turn negatively impacts their quality of life. Lack of information may result in self-imposed restrictions affecting ordinary daily life, further increasing psychosocial issues and turning into a vicious cycle. An intervention in the form of patient education is critical for improving self-care abilities, patient outcomes and reducing avoidable hospitalizations. Methodology: In this experimental study, there were a total of 39 participants with intracardiac devices (post-operative patients who were hemodynamically stable and follow up patients to 1 to 2 months) aged between 18 to 80 years, the outcome measures used were Cardiac Anxiety Questionnaire and Cardiac Depression Scale. Results: The difference between the pre- and post-values within the group was determined by the Wilcoxon-signed rank test. There was a statistically significant difference in both CAQ (Z value -4.801, p- value< 0.0005) and CDS scores (Z value -5.306, p-value< 0.0005). The sub-scales of CAQ showed significant differences with Fear (Z value -4.809, p-value< 0.0005), Avoidance (Z value -3.798, p-value< 0.0005) and HFA (Z value -3.640, p-value< 0.0005). Conclusion: This study's findings concluded that patients with intracardiac devices had a significant decline in anxiety and depression post-patient education. Key words: CIEDs - Cardiac implantable electronic devices, PM - permanent pacemakers, ICD - implantable cardioverter defibrillators, AICD - Automatic implantable cardioverter defibrillator, CRT - Cardiac Re-synchronization Therapy, CVDs - cardiovascular diseases

Exploration of orthorexia nervosa and diagnostic overlap with eating disorders, anorexia nervosa and obsessive-compulsive disorder

Article

Full-text available

Aug 2023
INT J EAT DISORDER

Objective: Orthorexia nervosa (ON) is characterized as obsessional healthy eating that results in malnutrition and/or psychosocial impairment. Yet, ON shares theoretical overlap with eating disorders (EDs), especially anorexia nervosa (AN), as well as obsessive-compulsive disorder (OCD). This study aimed to further understand ON and its overlap with related disorders by assessing the ability of ON for detecting the presence/absence of threshold ED, AN, and OCD symptoms. Method: An observational survey was completed by 197 participants recruited through eating disorder, dieting, and mental health support groups. Receiver operating characteristic (ROC) curve analyses determined the predictive ability of ON symptoms (assessed by Eating Habits Questionnaire [EHQ] orthorexia nervosa [OrNe] and healthy orthorexia [HeOr] subscales, and the Orthorexia Nervosa Inventory [ONI]) for detecting disordered eating symptoms (determined by Eating Disorder Examination Questionnaire [EDE-Q] global cut-scores), probable AN (determined by EDE-Q cut-scores and body mass index [BMI] <18.5), and OCD symptoms and obsessional thinking (assessed by the Revised Obsessive-Compulsive Inventory [OCI-R]). Results: Results showed both the ONI and EHQ OrNe measures are able to adequately predict ED symptoms and AN; however, both were poor to moderate at detecting OCD symptoms and obsessional thinking. Healthy orthorexia was poor to moderate at detecting outcomes. Discussion: These results suggest that ON, as it is currently operationalized, may be more closely related to EDs than OCD, and that ON may represent a subtype of AN. Results also support healthy orthorexia as a distinct construct to ON. While results are limited by the lack of definitive ON diagnostic criteria, findings suggest that treatments developed for EDs might be most suited to ON. Public significance: ON has been proposed as a psychiatric disorder, and it shares theoretical overlap with several existing disorders. This study adopts a novel approach to assessing and exploring the overlap of ON with EDs, AN and OCD. Results suggest that ON shares more overlap with EDs and might best be understood as a subtype of EDs or AN.

Effects of the Strong Hearts program after a major cardiovascular event in patients with cardiovascular disease

Article

Full-text available

Mar 2023

Context Cardiac rehabilitation (CR) and intensive cardiac rehabilitation (ICR) are secondary prevention interventions for cardiovascular disease (CVD) with a class 1a indication yet suboptimal utilization. To date, there are only three approved ICR programs. Alternative programing should be explored to increase enrollment and adherence in these interventions. Objectives This study aims to evaluate the effectiveness of the Strong Hearts program in cardiovascular patients following a major cardiovascular event. Methods One hundred ninety-seven (n = 197) participants were enrolled in this prospective, nonrandomized study. Patients were eligible for participation if they were referred by a physician after a major cardiovascular event, defined as any of the following: (1) acute myocardial infarction (MI) within the preceding 12 months; (2) current stable or unstable angina pectoris; (3) heart valve procedure; (4) percutaneous intervention of any kind; (5) heart transplant; (6) coronary artery bypass grafting (CABG); or (7) congestive heart failure (CHF) with reduced or preserved ejection fraction. Participants were asked to attend program visits four times per week for 9 weeks. Visits consisted of individualized exercise and intensive healthy lifestyle education. Paired t tests were utilized to compare pre- and postprogram outcome measures. Results One hundred twenty-eight (n = 128) participants completed the program within the 9-week time frame and their outcome measures were included in the data analysis. Among this, 35.2% participants were female and 64.8% were male. The mean age was 65 (range, 19-88). Qualifying diagnoses were percutaneous coronary intervention (PCI; 60, 46.9%), CABG (33, 25.8%), angina (24, 18.8%), valve procedures (8, 6.2%), and CHF (3, 2.3%). After implementation of the intervention, statistically significant decreases in weight (P < .001), body mass index (BMI, P < .001), waist circumference (P < .001), triglycerides (P = .01), systolic blood pressure (SBP, P <.001), diastolic blood pressure (DBP, P = .002), total fat mass (P < .001), Dartmouth Quality of Life Index P < .001), and cardiac depression scores (P = .044) were detected. In other instances, there were statistically significant increases across time for the clinical parameters of high-density lipoprotein (HDL, P = .02), Vitamin D (P = .001), metabolic equivalents (METS, P < .001), Duke activity scores (P < .001), and Rate Your Plate nutrition scores (P < .001). There were no significant changes across time for total cholesterol (P = .17), low-density lipoprotein (LDL, P = .21), A1c (P = .27), or dual-energy X-ray absorptiometry (DXA) total lean mass (P = .86). Conclusions The 9-week structured program resulted in significant cardiovascular benefit to patients with CVD by reducing cardiac risk factors, increasing exercise capacity, and improving quality of life.

Improving depression and perceived social support enhances overall quality of life among myocardial infarction survivors: necessity for integrating mental health care into cardiac rehabilitation programs

Article

Full-text available

Jul 2022

Background Depression and low perceived social support (PSS) have been found to deleteriously affect quality of life (QoL) among myocardial infarction (MI) survivors. The complex relationship between these variables has not been assessed. We wanted to assess first the prevalence of depression among MI survivors and whether depression mediates the effect of PSS on QoL and, second, whether the physical and social domains of QoL mediated the effect of depression and PSS on the emotional domain. This cross-sectional study was done among MI survivors using Cardiac Depression Scale, MacNew Quality of Life After Myocardial Infarction Questionnaire and Multidimensional Scale of Perceived Social Support to assess for depression, QoL and PSS respectively. Results A total of 103 MI survivors were included in the study, and the mean age was 59.66 (± 10.42) years. Depression was found in 21.36% of the participants. The indirect effect of PSS on QoL with depression as a mediator was significant (b = 0.15, p < 0.001, 95% CI = 0.12, 0.18). The direct effect of PSS on QoL controlling for depression was also significant (b = 0.05, p < 0.001, 95% CI = 0.02, 0.07). Depression as a mediator in the relationship explained 75.3% of the effect of PSS on QoL. PSS and depression did not have a significant direct effect on emotional QoL, but it became significant when the physical and social domains were included in the model. The total indirect effects of PSS and depression on emotional QoL were b = 0.16, p < 0.001, 95% CI = 0.05, 0.17 and b = − 0.05, p < 0.001, 95% CI = − 0.06, − 0.03, respectively. Conclusion Depression and poor PSS impair physical and social domains, which impairs the emotional domain of QoL; as such, overall QoL is undermined. As limited physical and social activity because of depression and poor PSS may increase the risk of further cardiovascular events, a holistic approach which includes mental health care is warranted.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases

Article

Full-text available

Mar 2022

Factors influencing readmission among Thais with myocardial infarction

Article

Full-text available

Jan 2021

Background: Readmission among patients with myocardial infarction is costly, and it has become a marker of quality of care. Therefore, factors related to readmission warrant examination. Objective: This study aimed at examining factors influencing readmission in Thai with myocardial infarction. Methods: This was a cross-sectional study with 200 participants randomly selected from five regional hospitals in Thailand. All research tools used indicated acceptable validity and reliability. Linear Structural Relationship version 8.72 was used for the data analysis. Results: The findings showed that the hypothesized model with social support, depression, symptom severity, comorbidity, and quality of life could explain 4% (R2 = 0.04) of the variance in readmission (c2 = 1.39, df = 2, p < 0.50, c2/df = 0.69, GIF = 1.00, RMSEA = 0.00, SRMR = 0.01, and AGFI = 0.98). Symptom severity was the most influential factor that had a positive and direct effect on the readmission rate (0.06, p < 0.05). Conclusions: These findings serve as an input to decrease readmission in patients with myocardial infarction by reducing the symptom severity and comorbidity and promoting a better quality of life. Funding: The Ratchadaphiseksomphot Endowment Fund, Chulalongkorn University, Bangkok, Thailand (CU-GR_60_38_36_03).

Effectiveness of nurse-led clinics in the early discharge period after percutaneous coronary intervention: A systematic review

Article

Dec 2020
Aust Crit Care

Background Readmission after percutaneous coronary intervention is common in the early postdischarge period, often linked to limited opportunity for education and preparation for self-care. Attending a nurse-led clinic within 30 d after discharge has the potential to enhance health outcomes. Objective The aim of the study was to synthesise the available literature on the effectiveness of nurse-led clinics, during early discharge (up to 30 d), for patients who have undergone percutaneous coronary intervention. Review method used A systematic review of randomised and quasi-randomised controlled trials was undertaken. Data sources The databases included PubMed, OVID, CINAHL, EMBASE, the Cochrane Library, SCOPUS, and ProQuest. Review methods Databases were searched up to November 2018. Two independent reviewers assessed studies using the Cochrane risk-of-bias tool. Results Of 2970 articles screened, only four studies, representing 244 participants, met the review inclusion criteria. Three of these studies had low to moderate risk of bias, with the other study unclear. Interventions comprised physical assessments and individualised education. Reported outcomes included quality of life, medication adherence, cardiac rehabilitation attendance, and psychological symptoms. Statistical pooling was not feasible owing to heterogeneity across interventions, outcome measures, and study reporting. Small improvements in quality of life and some self-management behaviours were reported, but these changes were not sustained over time. Conclusions This review has identified an important gap in the research examining the effectiveness of early postdischarge nurse-led support after percutaneous coronary intervention on outcomes for patients and health services. More robust research with sufficiently powered sample sizes and clearly defined interventions, comparison groups, and outcomes is recommended to determine effectiveness of nurse-led clinics in the early discharge period.

Prevalence of depression and anxiety, and their association with quality of life and physical activity in South Asian patients undergoing coronary artery bypass graft surgery.

Preprint

Full-text available

Sep 2020

Protocol for the development and validation of a measure of persistent psychological and emotional distress in cardiac patients: the Cardiac Distress Inventory

Article

Full-text available

Jun 2020

Introduction Distress is experienced by the majority of cardiac patients, yet no cardiac-specific measure of distress exists. The aim of this project is to develop and validate the Cardiac Distress Inventory (CDI). Using the CDI, health professionals will be able to identify key clusters of psychological, emotional and social concern to address with patients, postcardiac event. Methods and analysis An item pool will be generated through: identification of items by a multidisciplinary group of clinician researchers; review of generic and condition-specific distress measures; focus group testing with cardiac rehabilitation professionals; feedback from patients. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) criteria will be used to inform the development of the methodology for determining the CDI’s psychometric properties. The item pool will be tested with 400 cardiac patients and responses subjected to exploratory factor analysis, Rasch analysis, construct validity testing and latent class analysis. Receiver operating characteristic analysis will be used to identify the optimal CDI cut-off score for distinguishing whether a person experiences clinically significant distress. Ethics and dissemination Approved by the Monash Health Human Research Ethics Committee (approval number—RES-19-0000631L-559790). The CDI will be made available to clinicians and researchers without charge. The CDI will be translated for use internationally. Study findings will be shared with cardiac patient support groups; academic and medical communities via publications and presentations; in the training of cardiac secondary prevention professionals; and in reports to funders. Authorship for publications will follow the uniform requirements for manuscripts submitted to biomedical journals.

Prevalence of Depression in Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis

Article

Full-text available

Mar 2020

Coronary artery bypass graft surgery (CABG) might adversely affect the health status of the patients, producing cognitive deterioration, with depression being the most common symptom. The aim of this study is to analyse the prevalence of depression in patients before and after coronary artery bypass surgery. A systematic review and meta-analysis was carried out, involving a study of the past 10 years of the following databases: CINAHL, LILACS, MEDLINE, PsycINFO, SciELO, Scopus, and Web of Science. The total sample comprised n = 16,501 patients. The total number of items was n = 65, with n = 29 included in the meta-analysis. Based on the different measurement tools used, the prevalence of depression pre-CABG ranges from 19-37%, and post-CABG from 15-33%. There is a considerable presence of depression in this type of patient, but this varies according to the measurement tool used and the quality of the study. Systematically detecting depression prior to cardiac surgery could identify patients at potential risk.

Confirming a beneficial effect of the six-minute walk test on exercise confidence in patients with heart failure

Article

Oct 2019

Background Low confidence to exercise is a barrier to engaging in exercise in heart failure patients. Participating in low to moderate intensity exercise, such as the six-minute walk test, may increase exercise confidence. Aim To compare the effects of a six-minute walk test with an educational control condition on exercise confidence in heart failure patients. Methods This was a prospective, quasi-experimental design whereby consecutive adult patients attending an out-patient heart failure clinic completed the Exercise Confidence Scale prior to and following involvement in the six-minute walk test or an educational control condition. Results Using a matched pairs, mixed model design ( n=60; 87% male; M age =58.87±13.16), we identified a significantly greater improvement in Total exercise confidence ( F(1,54)=4.63, p=0.036, partial η 2= 0.079) and Running confidence ( F(1,57)=4.21, p=0. 045, partial η 2= 0.069) following the six-minute walk test compared to the educational control condition. These benefits were also observed after adjustment for age, gender, functional class and depression. Conclusion Heart failure patients who completed a six-minute walk test reported greater improvement in exercise confidence than those who read an educational booklet for 10 min. The findings suggest that the six-minute walk test may be used as a clinical tool to improve exercise confidence. Future research should test these results under randomized conditions and examine whether improvements in exercise confidence translate to greater engagement in exercise behavior.

A Systematic Review of the Diagnostic Accuracy of Depression Questionnaires for Cardiac Populations: IMPLICATIONS FOR CARDIAC REHABILITATION

Article

Mar 2019

Purpose: Depression is overrepresented in patients with cardiovascular disease and increases risk for future cardiac events. Despite this, depression is not routinely assessed within cardiac rehabilitation. This systematic review sought to examine available depression questionnaires to use within the cardiac population. We assessed each instrument in terms of its capability to accurately identify depressed patients and its sensitivity to detect changes in depression after receiving cardiac rehabilitation. Methods: Citation searching of previous reviews, MEDLINE, PsycInfo, and PubMed was conducted. Results: The Beck Depression Inventory-II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS-D) are among the most widely used questionnaires. Screening questionnaires appear to perform better at accurately identifying depression when using cut scores with high sensitivity and specificity for the cardiac population. The BDI-II and the HADS-D showed the best sensitivity and negative predictive values for detecting depression. The BDI-II, the HADS-D, the Center for Epidemiological Studies-Depression Scale, and the 15-item Geriatric Depression Scale best captured depression changes after cardiac rehabilitation delivery. Conclusions: The BDI-II is one of the most validated depression questionnaires within cardiac populations. Health practitioners should consider the BDI-II for depression screening and tracking purposes. In the event of time/cost constraints, a briefer 2-step procedure (the 2-item Patient Health Questionnaire, followed by the BDI-II, if positive) should be adopted. Given the emphasis on cut scores for depression diagnosis and limited available research across cardiac diagnoses, careful interpretation of these results should be done. Thoughtful use of questionnaires can help identify patients in need of referral or further treatment.

The Construction of Well-Being

Conference Paper

Dec 2018

Mary Mitchell

My thesis develops an alternative to orthodox theories of well-being. I argue that well-being is not a property of people or the world that exists separately from attempts to define and measure it. Instead, assessments of well-being are largely shaped by the purposes and interests of the people making the measurement. In part I, I argue that philosophy of well-being should take at face value the variety of ways that well-being is understood and measured. This points towards a pluralist account of well-being. I go on to argue that a theory of well-being is incomplete unless it says something about how to determine the extent to which life is going well for someone. I argue that the identification of well-being in individuals amounts to a form of measurement. Theories of well-being must therefore be theories of the measurement of well-being. In part II, I look closely at three approaches to defining and measuring well-being—in terms of objective goods, preferences, and subjective experience. I argue that, in each case, appraisals of whether someone is doing well or not, and how well they are doing, depend on the context of measurement, the tools used to measure well-being, and the goals and purposes of the people making the assessment. In part III, I propose that well-being should not be treated as a property of people or of the world, but rather something which is largely constructed in the process of measurement. I draw on contemporary model theories of measurement to argue that well-being is best understood as representing a relation between the person whose well-being is being measured, a measuring instrument, and the environment. This relation is modelled by the people who are making the measurement in order to produce information about well-being and ascriptions of well-being are therefore unavoidably attitude dependent.

The relationship between phobic anxiety and 2-year readmission after Acute Coronary Syndrome: What is the role of heart rate variability?

Article

Dec 2018
J AFFECT DISORDERS

Objective Phobic anxiety is a risk factor for poor prognosis following Acute Coronary Syndrome (ACS). A psychophysiological marker of vagal function, autonomic dysfunction may play a critical role in this relationship. The aim of the study was two-fold: to assess whether phobic anxiety was characterised by autonomic dysfunction (heart rate variability) in the short (1-month) and longer term (12-months) following ACS, and (ii) to quantify the extent to which HRV parameters modified the effect of phobic anxiety on all-cause hospital readmission over 2 years. Methods The ADVENT study followed 416 ACS patients. At 1-month following discharge (T0), phobic anxiety and autonomic functioning were assessed using the Crown Crisp Index (CCI) and 11 indices of heart rate variability (HRV), respectively. HRV was measured again at 12-months (T1) (n = 359). Hospital readmission (all cause) was derived from an audit of hospital records by two medically trained research fellows. Generalised linear modelling (GLM) was used to first determine the association between CCI score at T0 and HRV parameters at T0 and T1. Binary logistic regression was used to measure the relationship between CCI scores and readmission (yes/no) and the extent to which HRV parameters modified this effect. Results CCI scores were associated with 7 of the 11 indices of HRV: Average RR (ms), SDRR (ms), RMSSD (ms), SDSD (ms), pRR50 (%), LF Powers (ms2) and HF Powers (ms2) at T0 but not T1. CCI scores at T0 significantly predicted likelihood of readmission to hospital in the subsequent 2 year period. No parameter of HRV at T0 modified this effect. Limitations We were unable to provide adjudicated major adverse coronary events outcome data, or account for changes in medication adherence, diet or physical activity. Conclusions While phobic anxiety is associated with both reduced vagal function in the short term after an ACS event and 2 year all cause readmission, HRV does not appear to be the pathway by which phobic anxiety drives this outcome.

Effect of cardiac rehabilitation on 24-month all-cause hospital readmissions: A prospective cohort study

Article

Full-text available

Dec 2018

Background:: Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. Aim:: The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. Methods:: Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013-June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. Results:: Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31-0.91 p-value:0.022) and length of stay (coefficient -1.21 days, 95% confidence interval: -2.46-0.26; marginally significant p-value: 0.055) in adjusted models. Conclusion:: This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.

The Effects of the 6-Minute Walk Test on Exercise Confidence in Chronic Heart Failure Patients

Article

Jan 2018

The association of depressive symptoms in patients with acute myocardial infarction in a regional hospital in Durban, South Africa

Article

Full-text available

Jul 2018

What is cardiac distress and how should we measure it?

Article

Jun 2018

After cardiac events, rates of depression and anxiety of 20–30% have been reported, along with elevated rates of post-traumatic stress disorder and higher rates of suicide. As unresolved negative affect is associated with greater morbidity and mortality, attempts have been made to understand the complexity of emotional and psychological responses to cardiac events. Although many studies purport to measure ‘cardiac distress’, they are often limited by adopting a definition of distress as depression plus anxiety. Following the lead of the oncology and diabetes fields in the development of condition-specific distress measures, this article argues for a multidimensional approach to cardiac distress and its measurement; it builds on the concept of the ‘cardiac blues’, to show the importance of understanding and measuring how this transient phenomenon of adjustment can become a persistent negative state which challenges the ability to cope with living after a cardiac event.

The Association of Depressive Symptoms in patients with Acute Myocardial Infarction in a Regional Hospital in Durban, South Africa

Article

Full-text available

May 2018

Naresh Ranjith

Objective: To examine the association of depressive symptoms and contributing psychosocial factors during hospitalisation and 1-month post discharge in patients with acute myocardial infarction (MI). Methods and results: The study population comprised consecutive patients from a multi-ethnic background, admitted June 2015 - November 2015 to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, with a diagnosis of MI. Demographic and clinical data stored in a specialised electronic cardiac database were extracted for all patients. Patients were screened for depressive symptoms using the Cardiac Depression Scale (CDS). Levels of perceived stress were evaluated using the 4-item Perceived Stress Scale (4-PSS). The study cohort consisted of 117 patients with a mean age of 58.16 ± 11.12 years, the majority of whom were males (70%, mean age 56.54 ± 1.23 years) and 30% females (mean age 61.97 ± 1.75 years). Forty-nine percent of the participants were diagnosed with depressive symptoms with a significantly greater number of females experiencing depressive symptoms compared to males (p <0.01). Patients with depressive symptoms were more likely to have a previous history of depression (p=0.02), positive family history of depression (p=0.04), greater non-adherence to their medication (p <0.01) and lower levels of physical activity (p <0.01). Depressed patients also reported higher levels of stress on voluntary (p <0.01) and subjective rating (p <0.01), experienced greater financial stress (p <0.01), major life events (p <0.01) and had higher 4–PSS scores (p <0.01). Thirteen percent of patients experienced major adverse cardiac events (MACE) with a significantly greater number of events found in those with depressive symptoms (p <0.01)

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation

Article

Full-text available

Apr 2024

Background: Depression and anxiety occur frequently (with reported prevalence rates of around 40%) in individuals with coronary heart disease (CHD), heart failure (HF) or atrial fibrillation (AF) and are associated with a poor prognosis, such as decreased health-related quality of life (HRQoL), and increased morbidity and mortality. Psychological interventions are developed and delivered by psychologists or specifically trained healthcare workers and commonly include cognitive behavioural therapies and mindfulness-based stress reduction. They have been shown to reduce depression and anxiety in the general population, though the exact mechanism of action is not well understood. Further, their effects on psychological and clinical outcomes in patients with CHD, HF or AF are unclear. Objectives: To assess the effects of psychological interventions (alone, or with cardiac rehabilitation or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF, compared to no psychological intervention, on psychological and clinical outcomes. Search methods: We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2009 to July 2022. We also searched three clinical trials registers in September 2020, and checked the reference lists of included studies. No language restrictions were applied. Selection criteria: We included randomised controlled trials (RCTs) comparing psychological interventions with no psychological intervention for a minimum of six months follow-up in adults aged over 18 years with a clinical diagnosis of CHD, HF or AF, with or without depression or anxiety. Studies had to report on either depression or anxiety or both. Data collection and analysis: We used standard Cochrane methods. Our primary outcomes were depression and anxiety, and our secondary outcomes of interest were HRQoL mental and physical components, all-cause mortality and major adverse cardiovascular events (MACE). We used GRADE to assess the certainty of evidence for each outcome. Main results: Twenty-one studies (2591 participants) met our inclusion criteria. Sixteen studies included people with CHD, five with HF and none with AF. Study sample sizes ranged from 29 to 430. Twenty and 17 studies reported the primary outcomes of depression and anxiety, respectively. Despite the high heterogeneity and variation, we decided to pool the studies using a random-effects model, recognising that the model does not eliminate heterogeneity and findings should be interpreted cautiously. We found that psychological interventions probably have a moderate effect on reducing depression (standardised mean difference (SMD) -0.36, 95% confidence interval (CI) -0.65 to -0.06; 20 studies, 2531 participants; moderate-certainty evidence) and anxiety (SMD -0.57, 95% CI -0.96 to -0.18; 17 studies, 2235 participants; moderate-certainty evidence), compared to no psychological intervention. Psychological interventions may have little to no effect on HRQoL physical component summary scores (PCS) (SMD 0.48, 95% CI -0.02 to 0.98; 12 studies, 1454 participants; low-certainty evidence), but may have a moderate effect on improving HRQoL mental component summary scores (MCS) (SMD 0.63, 95% CI 0.01 to 1.26; 12 studies, 1454 participants; low-certainty evidence), compared to no psychological intervention. Psychological interventions probably have little to no effect on all-cause mortality (risk ratio (RR) 0.81, 95% CI 0.39 to 1.69; 3 studies, 615 participants; moderate-certainty evidence) and may have little to no effect on MACE (RR 1.22, 95% CI 0.77 to 1.92; 4 studies, 450 participants; low-certainty evidence), compared to no psychological intervention. Authors' conclusions: Current evidence suggests that psychological interventions for depression and anxiety probably result in a moderate reduction in depression and anxiety and may result in a moderate improvement in HRQoL MCS, compared to no intervention. However, they may have little to no effect on HRQoL PCS and MACE, and probably do not reduce mortality (all-cause) in adults who have a diagnosis of CHD or HF, compared with no psychological intervention. There was moderate to substantial heterogeneity identified across studies. Thus, evidence of treatment effects on these outcomes warrants careful interpretation. As there were no studies of psychological interventions for patients with AF included in our review, this is a gap that needs to be addressed in future studies, particularly in view of the rapid growth of research on management of AF. Studies investigating cost-effectiveness, return to work and cardiovascular morbidity (revascularisation) are also needed to better understand the benefits of psychological interventions in populations with heart disease.

Consultation-Liaison Psychiatry and Psychosomatics: From Subspecialty to Forma Mentis

Chapter

Jan 2024

A comprehensive handbook covering current, controversial, and debated topics in psychiatric practice, aligned to the EPA Scientific Sections. All chapters been written by international experts active within their respective fields and they follow a structured template, covering updates relevant to clinical practice and research, current challenges, and future perspectives. This essential book features a wide range of topics in psychiatric research from child and adolescent psychiatry, epidemiology and social psychiatry to forensic psychiatry and neurodevelopmental disorders. It provides a unique global overview on different themes, from the recent dissemination in ordinary clinical practice of the ICD-11 to the innovations in addiction and consultation-liaison psychiatry. In addition, the book offers a multidisciplinary perspective on emerging hot topics including emergency psychiatry, ADHD in adulthood, and innovation in telemental health. An invaluable source of evidence-based information for trainees in psychiatry, psychiatrists, and mental health professionals.

The pathophysiology and management of depression in cardiac surgery patients

Article

Full-text available

Oct 2023

Background Depression is common in the cardiac surgery population. This contemporary narrative review aims to explore the main pathophysiological disturbances underpinning depression specifically within the cardiac surgery population. The common non-pharmacological and pharmacological management strategies used to manage depression within the cardiac surgery patient population are also explored. Methods A total of 1291 articles were identified through Ovid Medline and Embase. The findings from 39 studies were included for qualitative analysis in this narrative review. Results Depression is associated with several pathophysiological and behavioral factors which increase the likelihood of developing coronary heart disease which may ultimately require surgical intervention. The main pathophysiological factors contributing to depression are well characterized and include autonomic nervous system dysregulation, excessive inflammation and disruption of the hypothalamic–pituitary–adrenal axis. There are also several behavioral factors in depressed patients associated with the development of coronary heart disease including poor diet, insufficient exercise, poor compliance with medications and reduced adherence to cardiac rehabilitation. The common preventative and management modalities used for depression following cardiac surgery include preoperative and peri-operative education, cardiac rehabilitation, cognitive behavioral therapy, religion/prayer/spirituality, biobehavioral feedback, anti-depressant medications, and statins. Conclusion This contemporary review explores the pathophysiological mechanisms leading to depression following cardiac surgery and the current management modalities. Further studies on the preventative and management strategies for postoperative depression in the cardiac surgery patient population are warranted.

Placing patient-reported outcomes at the centre of cardiovascular clinical practice: implications for quality of care and management

Article

Full-text available

Aug 2023
EUR HEART J

Patient-reported outcomes (PROs) provide important insights into patients' own perspectives about their health and medical condition, and there is evidence that their use can lead to improvements in the quality of care and to better-informed clinical decisions. Their application in cardiovascular populations has grown over the past decades. This statement describes what PROs are, and it provides an inventory of disease-specific and domain-specific PROs that have been developed for cardiovascular populations. International standards and quality indices have been published, which can guide the selection of PROs for clinical practice and in clinical trials and research; patients as well as experts in psychometrics should be involved in choosing which are most appropriate. Collaborations are needed to define criteria for using PROs to guide regulatory decisions, and the utility of PROs for comparing and monitoring the quality of care and for allocating resources should be evaluated. New sources for recording PROs include wearable digital health devices, medical registries, and electronic health record. Advice is given for the optimal use of PROs in shared clinical decision-making in cardiovascular medicine, and concerning future directions for their wider application.

Association of Depression and Cardiovascular Disease

Article

May 2023
AM J MED

Background: Cardiovascular disease remains the leading worldwide cause of mortality. There has been increased awareness of the impact of psychological health on cardiovascular disease. In particular, major depression has been linked to increased all-cause mortality, development of cardiovascular disease, and worse outcomes in those with existing cardiovascular disease. Methods: We conducted a meta-analysis assessing the incidence of cardiovascular disease and cardiovascular disease outcomes among those with major depressive disorder. Results: Among 26 studies of 1,957,621 individuals, depression was associated with increased risk of incident stroke (hazard ratio [HR] 1.13; 95% confidence interval [CI], 1.00-1.28), myocardial infarction (HR 1.28; 95% CI, 1.14-1.45), congestive heart failure (HR 1.04; 95% CI, 1.00-1.09), or any cardiovascular disease (HR 1.16; 95% CI, 1.04-1.30). Depression was associated with increased risk of all-cause mortality (HR 1.43; 95% CI, 1.27-1.60), cardiovascular disease mortality (HR 1.44; 95% CI, 1.27-1.63), and congestive heart failure mortality (HR 3.20; 95% CI, 1.29-7.94). Conclusion: Depression has a significant negative impact on development of cardiovascular disease and on cardiovascular disease outcomes. Further efforts to understand and mitigate these impacts are prudent.

Depression: Current Perspectives in Research and Treatment

Book

May 2023

Gary Christopher

Psychosocial assessment and psychological interventions following a cardiac event

Article

Jan 2023

Patient-centered care in Coronary Heart Disease: what do you want to measure? A systematic review of reviews on patient-reported outcome measures

Article

Full-text available

Nov 2022
QUAL LIFE RES

Background The number of published articles on Patient-Reported Outcomes Measures (PROMs) in Coronary Heart Disease (CHD), a leading cause of disability-adjusted life years lost worldwide, has been growing in the last decades. The aim of this study was to identify all the disease-specific PROMs developed for or used in CHD and summarize their characteristics (regardless of the construct), to facilitate the selection of the most adequate one for each purpose. Methods A systematic review of reviews was conducted in MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews. PROQOLID and BiblioPRO libraries were also checked. PROMs were classified by construct and information was extracted from different sources regarding their main characteristics such as aim, number of items, specific dimensions, original language, and metric properties that have been assessed. Results After title and abstract screening of 1224 articles, 114 publications were included for full text review. Finally, we identified 56 PROMs: 12 symptoms scales, 3 measuring functional status, 21 measuring Health-Related Quality of Life (HRQL), and 20 focused on other constructs. Three of the symptoms scales were specifically designed for a study (no metric properties evaluated), and only five have been included in a published study in the last decade. Regarding functional status, reliability and validity have been assessed for Duke Activity Index and Seattle Angina Questionnaire, which present multiple language versions. For HRQL, most of the PROMs included physical, emotional, and social domains. Responsiveness has only been evaluated for 10 out the 21 HRQL PROMs identified. Other constructs included psychological aspects, self-efficacy, attitudes, perceptions, threats and expectations about the treatment, knowledge, adjustment, or limitation for work, social support, or self-care. Conclusions There is a wide variety of instruments to assess the patients’ perspective in CHD, covering several constructs. This is the first systematic review of specific PROMs for CHD including all constructs. It has practical significance, as it summarizes relevant information that may help clinicians, researchers, and other healthcare stakeholders to choose the most adequate instrument for promoting shared decision making in a trend towards value-based healthcare.

The cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event

Article

Full-text available

Nov 2022
BMC Cardiovasc Disord

Background Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted.

Evaluating anxiety in elective coronary angiography study: rationale, design, and study methodology

Article

Oct 2022

Aims: Prevalence of anxiety disorder in coronary artery disease reaches up to 15% and about half of patients with coronary artery disease have anxiety or depression comorbidity. Prevalence of anxiety in patients undergoing percutaneous coronary intervention ranges 24-72%. Depression can often overlap with anxiety symptoms and the evaluation of anxiety in elective coronary angiography study (ANGST) aims to determine the prevalence of anxiety by excluding patients with comorbid depressive symptoms. ANGST also aims to determine how anxiety correlates with psychological parameters (personality traits, coping strategies) and with outcome of elective coronary angiography (ECA). Methods: We will conduct a prospective single-center cross-section study in patients undergoing ECA. Anxiety will be evaluated at four time points using self-rating questionnaires: 14 days prior to ECA; 2-4 h before ECA; 24 h after ECA, but prior to discharge; and 4-6 weeks after discharge. The primary outcome of ANGST is the burden of anxiety experienced by patients without depressive symptoms and a correlation of anxiety with ECA outcome. Conclusion: Our study aims to provide evidence on which personality traits and coping strategies affect the levels of anxiety. We will also determine psychometric properties of the two questionnaires used in our study. The results will have implications for improvement of interventions designed to recognize anxiety and will offer future research of psychological and/or pharmacological interventions to reduce the burden of anxiety.

Iron Deficiency in Heart Failure Patients and Benefits of Iron Replacement on Clinical Outcomes Including Comorbid Depression

Article

Nov 2021
Heart Lung Circ

Background: Iron deficiency and depression are prevalent comorbidities in the setting of heart failure. Both conditions are associated with poorer patient outcomes including mortality, hospitalisation and quality of life. Iron replacement has come to the fore as a means to improve patient outcomes. This review aims to assess the current literature regarding the benefits of iron supplementation for iron deficient heart failure patients including potential improvements in depression. Methods and results: The databases of Medline, EMBASE, the Cochrane library of systematic reviews, Central Register of Controlled Trials, PubMed, Web of Science and ClinicalTrials.gov were searched for studies with relevant patient outcomes. A total of 18 studies were identified and included in the review. In essence, intravenous iron was found to be beneficial for New York Heart Association (NYHA) classification, quality of life measures, heart failure (HF) hospitalisation and aerobic capacity. Oral iron however was not beneficial. Research surrounding intravenous iron improving cardiovascular mortality, time to first hospitalisation and changes in depression status is lacking. Conclusions: Further research is required to elucidate the advantages of intravenous iron for iron deficient heart failure patients on their depression, mortality and first admission to hospital. Consensus is required regarding which form of iron and the treatment regime that should be adopted for future clinical guidelines.

The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman

Article

Full-text available

Sep 2021

Consideration of sex, hormonal status, and pregnancy history must all be included in the CV risk assessment, and diagnosis and treatment of women with CVD. Menstruation onset and characteristics, hypertensive or diabetic pregnancy complications, and menopausal timing and treatments are all contributory to CV health and/or disease. An awareness of increased CV risk in women with hypertensive and/or diabetic pregnancy complications, or premature menopause enables inclusion in routine CV risk assessments, with appropriate interventions, and intensified assessments and management of traditional risk factors, in order to improve long term CV outcomes in affected women. Hormonal influences on metabolic and vascular effects may be cardioprotective or disease promoting, depending upon temporal factors, concentration and proportionality, and whether endogenous or exogenous exposure. The effects of exogenous estrogens (and progesterone) are complex and controversial, influenced by both pharmacological and individual patient characteristics. There is currently no evidence to support the use of exogenous MHT for the specific purpose of primary or secondary CV risk prevention in postmenopausal women, except primary CV risk prevention in those with natural or surgical premature or early menopause.

Self-Esteem as a Mediator between Life Satisfaction and Depression among Cardiovascular Disease Patients

Article

Jul 2021
Clin Nurs Res

This study explores the association between life satisfaction and depression among patients with cardiovascular diseases and whether this association is mediated by self-esteem. A cross-sectional study was conducted in a third-grade hospital. We examined 300 patients with cardiovascular diseases with a mean age of 62.00 years (females, 133). Life satisfaction was associated with depression. Adding self-esteem to the model weakened the strength of the association between the two. Moreover, 34.2% of the effect of life satisfaction on depression could be explained by self-esteem. We found that self-esteem could totally explain the effect of life satisfaction on depression among patients with cardiovascular diseases.

Depression and cardiovascular disease

Article

Apr 2021

David L. Hare

Purpose of review: The purpose of this review is to outline the relationship between cardiovascular disease (CVD) and depression, both as a cause of and a result of CVD. Recent findings: The prevalence of depression seems to be increasing in the general population.It is likely that depression will be even more of a problem for CVD patients in the post-COVID-19 pandemic era.New studies confirm the independent association of depression with later incident CVD, although perhaps not as strong as suggested by some previous studies.Depression seems to be becoming even more prevalent in CVD patients, with new data for stroke and peripheral arterial disease patients.Cardiologists rarely screen for depression and most do not believe that they have a responsibility for detecting or treating depression.There are new data suggesting that patients who are more in control of their lives have better outcomes and that change is possible. Summary: Depression is preventable and treatable. It is imperative to detect and manage depression in CVD patients. Additional research is required to see whether or not comprehensive patient screening for depression translates into both better quality of life and improved clinical outcomes.

Resilience and Depressive Symptoms in Adults With Cardiac Disease: A Systematic Review

Article

Dec 2020

Background: Depressive symptoms predict hospitalization and mortality in adults with cardiac disease. Resilience, defined as a dynamic process of positively responding to adversity, could protect against depressive symptoms in cardiac disease. No systematic review has been conducted on the relationship between these variables in this population. Objective: The aim of this review was to explore the association between psychological resilience and depressive symptoms in adults with cardiac disease. Methods: Seven databases (PubMed, EMBASE, CINAHL, PsycInfo, Web of Science, SCOPUS, and Cochrane) were searched from inception to December 2019 using the search terms "cardiac disease," "depressive symptoms," "depression," and "resilience." Inclusion criteria dictated that studies reported original research on the association between resilience and depressive symptoms in adults with a cardiac disease broadly defined. Quality ratings were performed by 2 independent raters. Results: We identified 13 studies for final review. Study sample sizes ranged from 30 to 1022 participants, average age ranged from 52 to 72 years, and all studies had majority male participants (64%-100%). Resilience and depressive symptoms were inversely related in 10 of 13 studies. The 3 studies with poor-quality sampling techniques or significant loss to follow-up found no relationship. Conclusions: Resilience seems to protect against depression in adults with cardiac disease. Gaps in the literature include poor understanding of the direction of causality. Methods of promoting resilience need to be identified and studied.

A cross-sectional study of factors predicting readmission in Thais with coronary artery disease

Article

Sep 2020

Background Coronary artery disease is a major cause of morbidity and mortality with high readmission rates. Hospital readmissions for coronary artery disease contribute to rising healthcare costs and are a marker of quality of care. Despite this, prior studies have found that readmission rates vary widely. Aims This study aims to determine the impact of social support, depression, comorbidities, symptom severity, quality of life and readmission among coronary artery disease patients in Thailand. Methods A total of 321 coronary artery disease patients from tertiary care hospitals across all regions of Thailand were recruited for this study. Data were analysed using multiple regression analysis. Results The coefficient for social support (beta = −0.22) was found to be significant ( p < 0.05), whereas comorbidity, symptom severity, depression and quality of life were not significant. Thus, social support was found to be the most significant predictive factor for readmission. Conclusions Accordingly, when designing effective nursing interventions, nurses should promote social support interventions for coronary artery disease patients to improve the quality of care, decrease readmission rates and improve patients' quality of life.

SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes: a randomized controlled trial

Article

Full-text available

Aug 2020
Coron Artery Dis

Background: There are well-documented treatment gaps in secondary prevention of coronary heart disease with a lack of clearly defined strategies to assist early physical activity after acute coronary syndromes (ACS). Smartphone technology may provide an innovative platform to close these gaps. Objectives: The primary goal of this study was to assess whether a smartphone-based, early cardiac rehabilitation program improved exercise capacity in patients with ACS. Methods: A total of 206 patients with ACS across six tertiary Australian hospitals were included in this randomized controlled trial. Participants were randomized to usual care (UC; including referral to traditional cardiac rehabilitation), with or without an adjunctive smartphone-based cardiac rehabilitation program (S-CRP) upon hospital discharge. The primary endpoint was change in exercise capacity, measured by the change in 6-minute walk test distance at 8 weeks when compared to baseline, between groups. Secondary endpoints included uptake and adherence to cardiac rehabilitation, changes in cardiac risk factors, psychological well-being and quality of life status. Results: Of the 168 patients with complete follow-up (age 56 ± 10 years; 16% females), 83 were in the S-CRP. At 8-week follow-up, the S-CRP group had a clinically significant improvement in 6-minute walk test distance (Δ117 ± 76 vs. Δ91 ± 110 m; P = 0.02). Patients in the S-CRP were more likely to participate (87% vs. 51%, P < 0.001) and adhere (72% vs. 22%, P < 0.001) to a cardiac rehabilitation program. Compared to UC, patients receiving S-CRP had similar smoking cessation rates, LDL-cholesterol levels, blood pressure reduction, depression, anxiety and quality of life measures (all P = NS). Conclusion: In patients with ACS, a S-CRP, as an adjunct to UC improved exercise capacity at 8 weeks in addition to participation and adherence to cardiac rehabilitation (Australian New Zealand Clinical Trials Registry; ACTRN12616000426482).

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation

Article

Jul 2020

Depression and heart failure: the lonely comorbidity

Article

May 2020

Depression is a frequent and debilitating comorbidity that affects heart failure (HF) patients. Up to 30% of HF patients suffer from depression and even more have depressive symptoms. Moreover, depression carries a risk for HF, especially in high‐risk groups, and is significantly associated with worse quality of life and clinical outcomes. The pathophysiology of depression and HF is poorly understood, but both diseases share several mechanisms and risk factors, including dysregulation of platelet reactivity, inflammation, neuroendocrine function, arrhythmias, high‐risk behaviours, and social factors. Current HF guidelines advise to screen HF patients for depression and several screening questionnaires are available. Ultimately, the diagnosis of depression is based on DSM‐5 criteria. Depression treatment consists of non‐pharmacological and pharmacological therapies. Non‐pharmacological therapies, such as exercise training and cognitive‐behavioural therapy, have been shown to have beneficial effects on depressive symptoms. Selective serotonin reuptake inhibitors, the mainstay of antidepressant therapy, appear to be safe in HF but have not shown superiority over placebo in HF in short‐ and long‐term randomized clinical trials. New therapies to treat depression are under investigation and may offer the opportunity to improve depression management in HF, including N‐methyl‐D‐aspartate receptor antagonists, repetitive transcranial magnetic stimulation and omega‐3 supplementation. New technologies may offer several advantages for the screening and diagnosis of depression but they remain to be tested in future research. In this review, we examine the intersection of depression and HF, summarize the epidemiology and pathophysiology, and discuss new opportunities to diagnose and treat HF patients with depression.

Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation

Article

Dec 2019

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the efficacy and costs of psychological interventions (alone, or with CR or pharmacotherapy, or both) in adults who have a diagnosis of CHD, HF or AF compared to no intervention, or treatment as usual, on psychological and clinical outcomes.

Outcomes of a randomised pilot trial of a nurse-led clinic for patients after percutaneous coronary intervention

Article

Oct 2018
Aust Crit Care

Background: Hospitalisation for percutaneous coronary intervention (PCI) in Australia is reducing. Patients who undergo PCI may be discharged home without a post-discharge health management plan, referral for secondary prevention, or understand their chronic condition. Subsequently, negative psychological symptoms such as anxiety and depression may be experienced in the post-discharge period. Objectives: This study assessed the effectiveness of a nurse-led clinic on patients' cardiac self-efficacy and negative psychological symptoms of anxiety and depression 1-week post-PCI discharge. Methods: One-hundred and eighty-eight potential participants were screened, and 33 participants were block-randomised to study groups. The nurse-led clinic used a person-centred approach and delivered tailored education, health assessment, and post-discharge support. In Phase 1, the Cardiac Self-efficacy Scale and State-Trait Anxiety Inventory measured primary outcomes, while the Cardiac Depression Scale was used to measure secondary outcomes. Phase 2 evaluated participants' experiences and healthcare professionals' perceptions of the intervention through semi-structured interviews. Results: In Phase 1, intervention group participants did not show improvements in mental health indicators compared to standard care group participants, except for a moderate reduction in anxiety levels (d = 0.50). Phase 2 qualitative findings; however, highlighted the benefits of the nurse-led clinic. Conclusions: Overall, findings suggest that nurse-led clinics may be valuable to reduce anxiety and act as a supportive measure in the early post-discharge period until commencement of a secondary prevention program. Further research with a more powered sample is needed to determine the significance of the findings.

The Relationship between Sleep Quality with Depression in Patient with Acute Myocardial Infarction

Article

Full-text available

Aug 2018

Background and Objectives: Depression is one of the most psychological outcomes in patients with acute myocardial infraction, which can affect the sleep quality in these patients. Given that adequate sleep has important effect on heart function, the present study was conducted with the aim of determining the correlation between sleep quality with death and cardiac depression in patient with acute myocardial infarction (AMI). Methods: In this descriptive-correlational study, 407 patients with acute myocardial infarction, who were admitted to the CCU wards of the Fatemeh Zahra Educational Center of Sari city, were selected using simple random sampling method. Data were collected by Cardiac Depression Scale (CDS), Death Depression Scale (DDS), and Pittsburgh Sleep Quality Index (PSQI) questionnaires. Data were analyzed using Kolmogorov-Smirnov and Pearson correlation tests. Results: The mean age of the male patients (64.95±17.00; CI95: 62.71-67.19) was more than the mean age of women (62.22±15.48; CI95: 59.96-64.48). The mean score of death depression (68.94±17.24; CI95: 67.26-70.62) and cardiac depression (109.00±16.49; CI95: 107.39-110.60), were below the fifth percentile. Multivariate regression analysis showed that change in cardiac depression score (B=0.036, β=0.153), increasing education levels (B=1.55, β=-0.121), and no history of antidepressant usage (B=4.32, β=0.123), can be significantly independent predictive factors of the variance of sleep quality score in acute myocardial infarction patients. Conclusion: According to the results of this study, although cardiac depression, education level, and non-use of antidepressant drugs are considered as affecting factors in the prediction of sleep quality in acute myocardial infarction patients, sleep quality is affected by more factors. Therefore, further studies are needed in this area.

The Functioning and Well-being of Depressed Patients: Results From the Medical Outcomes Study

Article

Full-text available

Sep 1989

We describe the functioning and well-being of patients with depression, relative to patients with chronic medical conditions or no chronic conditions. Data are from 11,242 outpatients in three health care provision systems in three US sites. Patients with either current depressive disorder or depressive symptoms in the absence of disorder tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions. The poor functioning uniquely associated with depressive symptoms, with or without depressive disorder, was comparable with or worse than that uniquely associated with eight major chronic medical conditions. For example, the unique association of days in bed with depressive symptoms was significantly greater than the comparable association with hypertension, diabetes, and arthritis. Depression and chronic medical conditions had unique and additive effects on patient functioning.

Psychological status during recovery from acute heart attack

Article

Full-text available

Nov 1972
J PSYCHOSOM RES

Two hundred and three male patients with ischaemic heart disease who had received initial treatment in the Coronary Care Unit, Royal Infirmary of Edinburgh, were interviewed in a medical ward during their convalescence and an estimate of their medical, psychiatric and social state was made. Psychological testing included a symptom measure of emotional upset (SSI).Patients presumed to have myocardial ischaemia differed from those with myocardial infarction in that they had poorer work records, were more withdrawn socially and had tolerated psychological symptoms for a shorter time before admission. Though they suffered less severe heart attacks they had at least as much emotional upset during hospitalisation.The presence of emotional upset (a maximal clinical estimate) was recorded in 131 (65 per cent) patients with symptoms of anxiety and depression predominating, and in 110 (54 per cent) cases this was present before admission. On discharge 79 (42 per cent) of the 191 survivors expected to encounter social problems at work, at home or financially. The reaction of the patient to having a heart attack was closely related to the presence or absence of social problems.Psychosocial status was not related to the physical severity of the acute attack. Those who were most upset and had severe social problems were not always those who were most ill.It is suggested that social and psychiatric intervention at an early stage might be appropriate in those patients whose psychosocial problems are at least as debilitating as their physical illness.

Imipramine in Patients with Chest Pain Despite Normal Coronary Angiograms

Article

Full-text available

Oct 1994

David Hare

A Growing Edge of Measurement of Feelings [ Abridged ]: Measurement of Feelings Using Visual Analogue Scales

Article

Oct 1969
Proc Roy Soc Med

R. C. B. Aitken

The functioning and well-being of depressed patients. Results from the Medical Outcomes Study

Article

Aug 1989

K. B. Wells

An Inventory for Measuring Depression

Article

Jun 1961
ARCH GEN PSYCHIAT

A.T. Beck

The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific

Service Utilization and Social Morbidity Associated With Depressive Symptoms in the Community

Article

Mar 1992

Jim Johnson

Objective. —To estimate service utilization and social morbidity in the community associated with depressive symptoms. Estimates were made using an epidemiologic measure, population attributable risk. Population attributable risk is a compound measure reflecting both the morbid risk to an individual with a disorder and the prevalence of the disorder in the community.Design. —Epidemiologic survey.Participants. —Eighteen thousand five hundred seventy-one adults in the Epidemiologic Catchment Area Study interviewed from a complex random sample in five US communities.Outcome Measures. —Suicide attempts, use of psychoactive medications, self-reported physical and emotional health, time lost from work, and general medical services or use of emergency departments for emotional problems.Results. —Major depression-dysthymia (lifetime prevalence, 6.1%) and depressive symptoms (lifetime prevalence, 23.1%) were associated with increased service utilization and social morbidity as measured by the outcome variables. On a population basis, however, as much or more service burden and impairment was associated with depressive symptoms as with the clinical conditions of depression or dysthymia. The equal association results from the greater prevalence of depressive symptoms. Population attributable risk percentages associated with depressive symptoms (not disorder) were as follows: emergency department use (11.8%) or medical consultations for emotional problems (21.5%); use of tranquilizers (14.6%), sleeping pills (21.0%), or antidepressants (22.2%); fair or poor self-reported emotional health (15.3%); days lost from work (17.8%); and suicide attempts (25.0%).Conclusions. —Estimates of population attributable risk indicated that physicians actually provided services to more persons with depressive symptoms than to persons with formally defined conditions of depressive disorders. Subclinical depression, as a consequence of high prevalence, is a clinical and public health problem. Attention to diagnostic and treatment issues is indicated.(JAMA. 1992;267:1478-1483)

The Hospital Anxiety And Depression Scale

Article

Jun 1983
ACTA PSYCHIAT SCAND

ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

Coefficient Alpha and Internal Structure of Tests

Article

Sep 1951

Lee J. Cronbach

A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should be so divided before using the formula. The index [`(r)]ij\bar r_{ij} , derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches. Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial group-factor clusters within a subtest. Scalability is not a requisite.

Depression and Chronic Medical Illness

Article

Jul 1990

Major depression is the most common clinical problem primary care physicians are called upon to diagnose and treat. Depression is associated with high medical care utilization, amplification of somatic symptoms and disability, poor self-care and adherence to medical regimens, and increased morbidity and mortality from medical illness. Despite the high prevalence and the maladaptive effects of major depression on patients' lives, this affective illness is often not accurately diagnosed or effectively treated. Double-blind, placebo-controlled studies have increasingly demonstrated efficacy of the antidepressant agents in primary care patients, patients with chronic pain, and patients with comorbidity--chronic medical illness and major depression.

Responsiveness and validity in health status measurement: A Clarification

Article

Feb 1989
J CLIN EPIDEMIOL

We present data from two studies which clarify the relationship between the responsiveness and validity of instruments designed to measure health status in clinical trials. In a controlled trial of long vs short duration adjuvant chemotherapy for women with Stage II breast cancer, the Breast Cancer Chemotherapy Questionnaire (BCQ) proved valid as a measure of subjective health status and was able to distinguish long vs short arms. Well validated measures of physical and emotional function developed by the Rand Corporation were unable to distinguish between the two groups. The Eastern Co-operative Oncology Group Criteria (ECOG) distinguished the two groups, but failed criteria of clinical sensibility as a measure of subjective health status. In a study of patients with Crohn's disease and ulcerative colitis, the Inflammatory Bowel Disease Questionnaire (IBDQ) showed small intrasubject variability over time. Gobal ratings of change showed moderate to high correlations with changes in IBDQ score, and patients who reported overall improvement or deterioration showed large changes in IBDQ score. Each of these findings support, in different ways, the reproducibility, validity, and responsiveness of the questionnaire. While the same data can at times bear on both validity and responsiveness, when assessing evaluative instruments it is useful to make a conceptual distinction between the two.

Quality of Life After Coronary Artery Surgery

Article

Apr 1987
QJM

Seventy-nine men were assessed using standard interview procedures before and at three and 12 months after coronary artery surgery. At one year, the majority reported relief of angina and reduced difficulty in performing everyday activities, but there was considerable individual variation in changes in quality of life. Overall, there were improvements in mental state, leisure activity, satisfaction and family life, but few benefits for work and sexual relations. For a fifth of patients global quality of life was no better or was worse than before surgery and this poor outcome was not closely related to physical state. Patients who described psychological symptoms or had a 'passive' approach to their illness before operation were less likely to have a good outcome. It is probable that the benefits of surgery could be substantially increased by provision of better facilities including simple individually planned preparation and rehabilitation. The study demonstrates that specific interview based ratings can be used to quantify changes in those aspects of quality of life which are most important to patients and their families.

Development of a quantitative rating scale to assess denial

Article

May 1974
J PSYCHOSOM RES

ALTHOUGH the description of denial as a mechanism of defense started with Anna Freud, the concept was known to physicians as early as 1885. At that time Von Monakow wrote of patients who reacted to blindness by denying it [I]. Josef Babinski introduced the term “anosognosia” in 1914 to describe a condition in which a patient denied the presence of a left hemiplegia [2]. In subsequent years other writers published accounts which supported Babinski’s observations and served to establish the finding of anosognosia in a number of neurological conditions with specific central nervous system damage. Weinstein and Kahn have collected and integrated these neurological and psychological reports and have contributed their own rich experience on anosognosia in a major work on the subject entitled Denial of Illness. In this book they amplified the concept of anosognosia by describing what had been denied and the manner in which denial occurs. For example, they distinguished between explicit verbal denial, as when a patient negates the fact of paralysis by simply saying it is not so, and implicit denial, in which the patient avoids talking about the disability. They point out the way in which various mental maneuvers such as confabulation, displacement, rationalization, hallucination, and delusion can all serve in the interest of denial. Their material complemented the ideas of contemporary psychodynamic theorists, yet the authors adhered so closely to a strict neurological model that neither Anna Freud nor the notion of a defense mechanism was mentioned. Whether the authors deliberately avoided reference to the psychoanalytic school is not known. Their emphasis that denial has its origin in central nervous system damage always takes precedence over its psychology. As an unfortunate result, the book is rarely alluded to in psychiatric discussions of denial. Since their observations and thinking are so germane to the concept of denial as a defense mechanism or coping tactic, it is a shame that more use has not been made of them. Psychoanalytic literature is rife with writings on denial. These have recently been thoroughly reviewed and summarized by Avery Weisman [4]. The major contribution of Anna Freud’s The Ego and the Mechanisms of Defense, Weisman states, “is a theory that defense mechanisms are based upon a primitive response to danger called denial” (p. 58). This use of the term is at once so basic and so general that “denial” can almost be taken as synonymous with the term “defense”. Thus, Weisman opines, A. Freud’s book might as readily have been called “The Ego and the Mechanisms of Denial”. Anna Freud looked upon denial as a unifying concept for different defenses in that their common goal was to reduce a threatening portion of reality in order to allow the individual to function under less psychic stress. It is curious at

Measures of Depressive Mood at Monthly Intervals

Article

May 1973

This report arose from a pilot trial to establish the methodology for a double-blind controlled trial of secondary prevention in recurrent depressive disorders. At the out-patient clinic, at monthly intervals, eight patients and two psychiatrists independently scored severity of depression using a Visual Analogue Scale. The Beck Depression Inventory was then completed. Findings (i) The scores on the VAS of the two independent assessors were not significantly different. (ii) The patients' ratings on the VAS were significantly higher than those obtained from the two psychiatrists, while the BDI scores, expressed as a percentage of the maximum possible, were lower for the group as a whole. (iii) The three sets of scores correlated highly and positively when taken overall. For six of the eight subjects the psychiatrists' and the patients' VAS scores correlated significantly. For five of the eight patients, one or other of the VAS scores correlated significantly with the BDI. For some purposes measurement of change in depressive mood during the course of an illness is more important than absolute level; there were no significant differences between the three methods as measures of direction and amount of mood change at monthly intervals. As an overall measure the Beck Depression Inventory, which is relatively time-consuming, had few clear advantages over the Visual Analogue Scale, which only took a moment or so to complete. The quickest single method of optimal sensitivity was the Visual Analogue Scale scored by the psychiatrist; the Scale, whether rated by psychiatrist or the patient or both, offers the clinician a reliable record of mood during the course of a depressive illness, with minimal expenditure of effort and time. Although the Visual Analogue Scale has been used by nurses (Zealley and Aitken, 1969), its value for psychiatrists' ratings of depressive mood has not previously been reported.

Optimal methods for identifying depression following hospitalization for myocardial infarction

Article

Feb 1981
J Chron Dis

Methods for detecting depression were evaluated in 64 men mean age 53 ± 4 yr who underwent treadmill exercise testing 3 and 7 weeks after clinically uncomplicated myocardial infarction. Following an open-ended interview, a therapist rated patients as moderately to severely depressed, of whom (9%) were judged to require treatment for depression. Two self report scales identified only 2 of the 9 patients with moderate to severe depression and only 1 of the 3 patients requiring treatment. Following a standardized interview, a technician rated 4 of the next 31 patients as moderately to severely depressed, all of whom (, 13%) were judged by the therapist to require treatment for depression. Self report identified only 2 of the 4 patients judged by the therapist to require treatment. A trained technician and a therapist detect about the same proportion of patients requiring treatment for depression after myocardial infarction. Both methods of interview are superior to self report scales for the detection of moderately severe depression requiring treatment.

Poor efficacy of the Hospital Anxiety and Depression Scale in the diagnosis of major depressive disorder in both medical and psychiatric patients

Article

Aug 1994
J PSYCHOSOM RES

Peter H. Silverstone

The Hospital Anxiety and Depression scale (HAD) is a brief questionnaire which was designed to indicate the likely presence of a depressive disorder in medically ill patients. However, more recently it has been used in several research studies to determine the presence of depression in both medical and psychiatric patients. The aim of the present study was to validate the usefulness of the HAD when used in this way. The HAD was compared to DSM-III-R diagnoses of major depressive disorder in 153 medical inpatients and 147 psychiatric out-patients. In both groups the sensitivity of the HAD was between 80 and 100% using the cut-off point of 8. However, the positive predictive value (PPV) of the HAD was only 17% in medical patients and 29% in psychiatric patients. Changing the cut-off point for depression or using the total HAD score did not significantly improve the PPV. These findings suggest that the HAD does not accurately determine the presence of DSM-III-R major depressive disorder in medical or psychiatric patients, and should not be used as a research instrument for this purpose. Nonetheless, the HAD should still be used for its original purpose, namely as a clinical indicator as to the possibility of a depressive disorder.

An Inventory For Measuring Depression

Article

Jul 1961
ARCH GEN PSYCHIAT

Measurement @BULLETf fee@BULLETing using visual anal@BULLETgue scales

989-993

A@bullettken Cb

A@BULLETTKEN R CB. Measurement @BULLETf fee@BULLETing using visual anal@BULLETgue scales. Pr@BULLET R S@BULLETc Med @BULLET 969; 62 : 989-993.

Diagn@BULLETsticandStatisti-cal Manual of Mental Disorders

Jan 1980

Americanpsychiatricass@bulletciati@bulletnc@bulletmmittee@bulletnn@bulletmenc@bulletatureandstatisti@bullets

AmericanPsychiatricAss@BULLETciati@BULLETnC@BULLETmmittee@BULLETnN@BULLETmenc@BULLETatureandStatisti@BULLETs.Diagn@BULLETsticandStatisti-cal Manual of Mental Disorders, Third Ed, rev. Washington, DC: American Psychiatric Associa-tion, 1980.

C@BULLETe@BULLET@BULLETcient a@BULLETphaandthe interna@BULLETstructure @BULLETf tests.Psych@BULLETmetrika @BULLET95 @BULLET

297-334

Cronbach Lj

CRONBACH LJ. C@BULLETe@BULLET@BULLETcient a@BULLETphaandthe interna@BULLETstructure @BULLETf tests.Psych@BULLETmetrika @BULLET95 @BULLET ; @BULLET6: 297-334.

Deve@BULLET@BULLETpment @BULLETf a quantitative rating sca@BULLETe t@BULLET assess denia@BULLET

Jan 1974
93-100

Ha Ckett
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HA CKETT TP @BULLET CASSEM NH. Deve@BULLET@BULLETpment @BULLETf a quantitative rating sca@BULLETe t@BULLET assess denia@BULLET. J Psych@BULLETs@BULLETm Res 1974; 18: 93-100.

Cardiac Depression Scale: Validation of a new depression scale for cardiac patients

Abstract

No full-text available

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