CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
Int J Cardiol. 2013 May 10;165(2):327-32. doi: 10.1016/j.ijcard.2011.08.071. Epub 2011 Oct 2.
Little is known about the relationship between emotional distress and mortality in patients with an implantable cardioverter defibrillator (ICD). Our aim was to examine the predictive value of general negative and positive affect, and depressive symptoms (including its components somatic symptoms and cognitive-affective symptoms) for mortality.
ICD patients (N=591, 81% male, mean age=62.7 ± 10.1 years) completed the Global Mood Scale to measure the independent dimensions negative and positive mood, and the Beck Depression Inventory to measure depressive symptoms. Covariates consisted of demographic and clinical variables.
During the median follow-up of 3.2 years, 96 (16.2%) patients died. After controlling for covariates, negative affect was significantly related to all-cause mortality (HR=1.034, p=0.002), whereas positive affect was not (HR=1.007, p=0.61). Depressive symptoms were also independently associated with an increased mortality risk (HR=1.031, p=0.030) and somatic symptoms of depression in particular (HR=1.130, p=0.003), but cognitive-affective symptoms were not associated with mortality (HR=0.968, p=0.29). When entering both significant psychological predictors in a covariate-adjusted model, negative mood remained significant (HR=1.039, p=0.009), but somatic symptoms of depression did not (HR=0.988, p=0.78). Similar results were found for cardiac-related death. Of covariates, increased age, CRT, appropriate shocks were positively related to death.
Negative affect in general was related to mortality, but reduced positive affect was not. Depression, particularly its somatic symptoms, was also related to mortality, while cognitive-affective symptoms were not. Future research may further focus on the differential predictive value of emotional distress factors, as well as on mechanisms that relate emotional distress factors to mortality.
对于植入式心脏复律除颤器（ICD）患者的情绪困扰与死亡率之间的关系，人们知之甚少。我们的目的是研究一般负性和正性情绪以及抑郁症状（包括躯体症状和认知情感症状）对死亡率的预测价值。
ICD 患者（N=591，81%为男性，平均年龄为 62.7±10.1 岁）完成了全球情绪量表来测量独立的负性和正性情绪维度，以及贝克抑郁量表来测量抑郁症状。协变量包括人口统计学和临床变量。
在中位数为 3.2 年的随访期间，96 名（16.2%）患者死亡。在控制了协变量后，负性情绪与全因死亡率显著相关（HR=1.034，p=0.002），而正性情绪则没有（HR=1.007，p=0.61）。抑郁症状也与死亡率增加的风险独立相关（HR=1.031，p=0.030），特别是抑郁的躯体症状（HR=1.130，p=0.003），但认知情感症状与死亡率无关（HR=0.968，p=0.29）。当将两个有统计学意义的心理预测因子都纳入到校正了协变量的模型中时，负性情绪仍然具有统计学意义（HR=1.039，p=0.009），但抑郁的躯体症状则没有（HR=0.988，p=0.78）。对于与心脏相关的死亡，也得到了类似的结果。在协变量中，年龄增加、CRT 和适当的电击与死亡呈正相关。
一般来说，负性情绪与死亡率相关，但正性情绪降低则不相关。抑郁，特别是其躯体症状，也与死亡率相关，而认知情感症状则不相关。未来的研究可能会进一步关注情绪困扰因素的预测价值差异，以及情绪困扰因素与死亡率相关的机制。
