Galli Federica, Borghi Lidia, Carugo Stefano, Cavicchioli Marco, Faioni Elena Maria, Negroni Maria Silvia, Vegni Elena
Department of Health Sciences, University of Milan, Milan, Italy.
Cardiology Unit and UTIC, UOC Cardiology, ASST Santi Paolo e Carlo, Milan, Italy.
PeerJ. 2017 Aug 11;5:e3537. doi: 10.7717/peerj.3537. eCollection 2017.
Psychological factors have been suggested to have an influence in Atrial Fibrillation (AF) onset, progression, severity and outcomes, but their role is unclear and mainly focused on anxiety and depression.
A systematic electronic search had been conducted to identify studies exploring different psychological factors in AF. The search retrieved 832 articles that were reviewed according to inclusion criteria: observational study with a control/comparison group; use of standardized and validated instruments for psychological assessment. Results were summarized qualitatively and quantitatively by effect size measure (Cohen's d and its 95% confidence interval). Cochrane Collaboration guidelines and the PRISMA Statement were adopted.
Eight studies were included in the systematic review. Depression was the most studied construct/ but only one study showed a clear link with AF. The remaining studies showed small and non-significant (95% CI [-0.25-1.00]) differences between AF and controls, no differences in frequency of depression history (95% CI [-0.14-0.22]) or in case frequency (95% CI [-0.50-0.04]). Miscellaneous results were found as far as anxiety: AF patients showed higher levels when compared to healthy subjects (95% CI [2.05-2.95]), but findings were inconsistent when compared to other heart diseases. Considering personality and life-events preceding AF, we respectively found a large (95% CI [1.87-2.49]) and a moderate to large effect (95% CI [0.48-0.98]).
The small number of studies does not allow to draw clear-cut conclusions on the involvement of psychological factors in AF. Promising lines of research are related to personality and adverse life-events, and to the increase of longitudinal design studies. Some methodological problems could be overcome by including clinical psychologists in the implementation of research protocols.
有研究表明心理因素会影响心房颤动（AF）的发作、进展、严重程度及预后，但心理因素的作用尚不清楚，且主要集中在焦虑和抑郁方面。
通过系统的电子检索来识别探索心房颤动中不同心理因素的研究。检索得到832篇文章，根据纳入标准进行审查：有对照组的观察性研究；使用标准化和经过验证的心理评估工具。结果通过效应量测量（科恩d值及其95%置信区间）进行定性和定量总结。采用了Cochrane协作组指南和PRISMA声明。
系统评价纳入了8项研究。抑郁是研究最多的因素，但只有一项研究表明其与心房颤动有明确联系。其余研究显示心房颤动患者与对照组之间存在微小且无统计学意义（95%置信区间[-0.25 - 1.00]）的差异，抑郁病史频率（95%置信区间[-0.14 - 0.22]）或病例频率（95%置信区间[-0.50 - 0.04]）无差异。关于焦虑的结果不一：与健康受试者相比，心房颤动患者的焦虑水平更高（95%置信区间[2.05 - 2.95]），但与其他心脏病患者相比时结果不一致。考虑到心房颤动之前的人格和生活事件，我们分别发现了较大效应（95%置信区间[1.87 - 2.49]）和中等至较大效应（95%置信区间[0.48 - 0.98]）。
研究数量较少，无法就心理因素在心房颤动中的作用得出明确结论。有前景的研究方向与人格和不良生活事件以及纵向设计研究的增加有关。通过让临床心理学家参与研究方案的实施，可以克服一些方法学问题。
