Loyola University Maryland, Baltimore, MD, USA.
J Psychosom Res. 2011 Oct;71(4):223-31. doi: 10.1016/j.jpsychores.2011.02.014. Epub 2011 Apr 20.
The implantable cardioverter defibrillator (ICD) is used to treat life-threatening ventricular arrhythmias and in the prevention of sudden cardiac death. A significant proportion of ICD patients experience psychological symptoms including anxiety, depression or both, which in turn can impact adjustment to the device. The objective of this systematic review was to assess the prevalence of anxiety and depression or symptoms of anxiety and depression among adults with ICDs.
Search of MEDLINE®, CINAHL®, PsycINFO®, EMBASE® and Cochrane® for English-language articles published through 2009 that used validated diagnostic interviews to diagnose anxiety or depression or self-report questionnaires to assess symptoms of anxiety or depression in adults with an ICD.
Forty-five studies that assessed over 5000 patients were included. Between 11% and 28% of patients had a depressive disorder and 11-26% had an anxiety disorder in 3 small studies (Ns=35-90) that used validated diagnostic interviews. Rates of elevated symptoms of anxiety (8-63%) and depression (5-41%) based on self-report questionnaires ranged widely across studies and times of assessment. Evidence was inconsistent on rates pre- versus post-implantation, rates over time, rates for primary versus secondary prevention, and for shocked versus non-shocked patients.
Larger studies utilizing structured interviews are needed to determine the prevalence of anxiety and depression among ICD patients and factors that may influence rates of anxiety and depressive disorders. Based on existing data, it may be appropriate to assume a 20% prevalence rate for both depressive and anxiety disorders post-ICD implant, a rate similar to that in other cardiac populations.
植入式心脏复律除颤器（ICD）用于治疗危及生命的室性心律失常和预防心脏性猝死。相当比例的 ICD 患者经历心理症状，包括焦虑、抑郁或两者兼有，这反过来又会影响他们对设备的适应。本系统评价的目的是评估患有 ICD 的成年人中焦虑和抑郁或焦虑和抑郁症状的发生率。
通过 MEDLINE、CINAHL、PsycINFO、EMBASE 和 Cochrane 搜索英文文献，检索截止到 2009 年，使用有效的诊断访谈来诊断焦虑或抑郁，或使用自我报告问卷来评估患有 ICD 的成年人的焦虑或抑郁症状。
纳入了 45 项评估了 5000 多名患者的研究。3 项小型研究（样本量为 35-90）使用有效的诊断访谈，结果显示 11%至 28%的患者患有抑郁障碍，11-26%的患者患有焦虑障碍。基于自我报告问卷的焦虑症状（8-63%）和抑郁症状（5-41%）的发生率在研究和评估时间上差异很大。关于植入前后、随时间的变化、一级预防与二级预防、电击与非电击患者的发生率，证据并不一致。
需要更大规模的研究采用结构化访谈来确定 ICD 患者中焦虑和抑郁的发生率，以及可能影响焦虑和抑郁障碍发生率的因素。基于现有数据，假设 ICD 植入后抑郁和焦虑障碍的发生率分别为 20%左右可能是合适的，这一比率与其他心脏人群相似。
