Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden.
College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA University of Ulster, Newtownabbey, UK
Europace. 2016 Jun;18(6):828-35. doi: 10.1093/europace/euv220. Epub 2015 Aug 31.
Although most implantable cardioverter-defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not yet been investigated. Our objective was to examine whether the relationship between receipt of defibrillating shocks and psychological distress was mediated by patients' concerns related to their ICD.
All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3067 completing the survey (55% response rate). Their mean age was 66 ± 11 years, and 80% were male. One-third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression [odds ratio (OR) 1.58 and OR 3.04, respectively]. The association between receipt of shocks and psychologically distress was mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety, and 54% of the relationship between shocks and symptoms of depression.
Implantable cardioverter-defibrillator-related concerns have a bigger impact on psychological distress than receipt of an actual shock. Assessing ICD-related concerns in clinical practice can identify patients at risk for psychological distress. Further research on assessment of, and interventions targeting, ICD-related concerns is warranted.
尽管大多数植入式心脏复律除颤器（ICD）患者适应良好，但对接受 ICD 电击的恐惧已被确定为心理困扰的主要决定因素。ICD 相关问题、接受除颤电击和焦虑、抑郁症状之间的关系尚未得到研究。我们的目的是检验接受除颤电击与心理困扰之间的关系是否通过患者对 ICD 的担忧而产生中介作用。
邀请所有瑞典 ICD 接受者参加这项横断面相关性研究；3067 人完成了调查（55%的回复率）。他们的平均年龄为 66±11 岁，80%为男性。三分之一（35%）接受过除颤电击，26%有高度的 ICD 相关担忧。回归分析表明，至少接受过一次电击显著预测焦虑和抑郁症状[比值比（OR）分别为 1.58 和 3.04]。电击与心理困扰之间的关联通过高度的 ICD 相关担忧产生中介作用，该担忧解释了电击与焦虑症状之间关系的 68%，以及电击与抑郁症状之间关系的 54%。
与 ICD 相关的担忧对心理困扰的影响大于实际电击的影响。在临床实践中评估 ICD 相关问题可以识别有心理困扰风险的患者。进一步研究评估和针对 ICD 相关问题的干预措施是必要的。
