Murphy Barbara, Ludeman Deborah, Elliott Peter, Judd Fiona, Humphreys John, Edington John, Jackson Anthony, Worcester Marian
Heart Research Centre, Melbourne, VIC, Australia University of Melbourne, VIC, Australia.
Heart Research Centre, Melbourne, VIC, Australia
Eur J Prev Cardiol. 2014 Sep;21(9):1079-89. doi: 10.1177/2047487313493058. Epub 2013 Jun 3.
While early symptoms of anxiety and depression resolve for many patients soon after an acute cardiac event, the persistence or worsening of symptoms indicates increased mortality risk. It is therefore important to identify the predictors, or red flags, of persistent or worsening anxiety and depression symptoms. Most previous research has focussed on metropolitan patients, hence the need for studies of regional and rural dwellers.
In this study, 160 cardiac patients consecutively admitted to two hospitals in regional Victoria, Australia, were interviewed in hospital and 2 and 6 months after discharge. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Growth mixture modelling was used to identify the trajectories of anxiety and depression over the 6 months after the acute event, and post-hoc tests identified predictors of persistent or worsening symptoms.
For both anxiety and depression, three common symptom trajectories were identified. Inhospital anxiety symptoms tended to persist over time, whereas inhospital depression symptoms resolved for some patients and worsened for others. A mental health history, younger age, smoking, financial stress, poor self-rated health, and social isolation were red flags for persistent anxiety and worsening depression. Additionally, diabetes, and other comorbidities were red flags for persistent anxiety.
The results highlight several potential red flags for increased risk of persistent anxiety or worsening depressive symptoms after a cardiac event, including demographic, psychosocial, and behavioural indicators. These red flags could assist with identification of at-risk patients on admission to or discharge from hospital, thereby enabling targeting of interventions.
虽然许多患者在急性心脏事件后不久焦虑和抑郁的早期症状就会缓解，但症状持续或恶化表明死亡风险增加。因此，识别持续性或恶化性焦虑和抑郁症状的预测因素或警示信号很重要。以往大多数研究都集中在大城市的患者身上，因此需要对地区和农村居民进行研究。
在本研究中，对连续入住澳大利亚维多利亚州地区两家医院的160名心脏病患者在住院期间以及出院后2个月和6个月进行了访谈。使用医院焦虑和抑郁量表评估焦虑和抑郁情况。采用生长混合模型来识别急性事件后6个月内焦虑和抑郁的轨迹，事后检验确定了持续性或恶化性症状的预测因素。
对于焦虑和抑郁，均识别出三种常见的症状轨迹。住院期间的焦虑症状往往会随着时间持续存在，而住院期间的抑郁症状在一些患者中得到缓解，在另一些患者中则恶化。心理健康史、年轻、吸烟、经济压力、自我健康评分差和社会孤立是持续性焦虑和抑郁恶化的警示信号。此外，糖尿病和其他合并症是持续性焦虑的警示信号。
研究结果突出了心脏事件后持续性焦虑风险增加或抑郁症状恶化的几个潜在警示信号，包括人口统计学、心理社会和行为指标。这些警示信号有助于在患者入院或出院时识别高危患者，从而有针对性地进行干预。
