Psychiatry Unit, Department of Medicine and Surgery, Università di Parma.
Department of Mental Health, Azienda Unità Sanitaria Locale di Parma.
Health Psychol. 2018 Dec;37(12):1115-1122. doi: 10.1037/hea0000658. Epub 2018 Oct 11.
Depression is an established risk factor for acute coronary syndrome (ACS), with an impact on cardiac prognosis; nonetheless, the literature disagrees on the role played by anxiety. No study has evaluated this relationship in a cardiac population with no history of depression and after their first diagnosis of ACS. The aim of this study is to explore these associations without the confounding role of long-lasting heart disease or psychiatric illnesses.
Two hundred sixty-six patients with no history of depression completed the Hospital Anxiety and Depression Scale and the Primary Care Evaluation of Mental Disorder at baseline and at 1, 2, 4, 6, 9, 12, and 24 months follow-up after their first diagnosis of ACS. During the follow-up period, we collected information regarding the major adverse cardiac events.
Developing a first-ever depressive episode, in a proportional hazard model, was associated with almost 3 times the risk of a recurrent cardiac event (odds ratio = 2.590, 95% confidence interval [CI] [1.321, 5.078], p = .006). Furthermore, a moderation analysis revealed that increasing levels of baseline anxiety had opposing effects on cardiac outcomes, being protective only in those who did not develop incident depression (B = -0.0824, 95% CI [-0.164, -0.005], p = .048). No dose-response effect between depressive or anxious symptoms and cardiac outcomes emerged.
Our results confirm the detrimental effect of depression on cardiac prognosis in a selected population and suggest that anxiety after the first diagnosis of ACS might have different roles depending on the illness' course. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
抑郁是急性冠状动脉综合征（ACS）的既定风险因素，对心脏预后有影响；然而，文献对焦虑的作用存在分歧。尚无研究在没有抑郁病史且首次诊断为 ACS 的心脏患者人群中评估这种关系。本研究旨在在没有长期心脏病或精神疾病的混杂作用下探讨这种相关性。
266 例无抑郁病史的患者在基线时以及首次诊断为 ACS 后 1、2、4、6、9、12 和 24 个月时完成了医院焦虑抑郁量表和初级保健精神障碍评估。在随访期间，我们收集了主要不良心脏事件的信息。
在比例风险模型中，首次出现抑郁发作与再次发生心脏事件的风险几乎增加了 3 倍（优势比=2.590，95%置信区间[CI] [1.321, 5.078]，p=0.006）。此外，一项调节分析显示，基线焦虑水平的升高对心脏结局有相反的影响，仅在未发生新发抑郁的患者中具有保护作用（B=-0.0824，95%CI[-0.164，-0.005]，p=0.048）。抑郁或焦虑症状与心脏结局之间没有剂量反应关系。
我们的结果证实了抑郁对特定人群心脏预后的不利影响，并表明 ACS 首次诊断后焦虑可能根据疾病的病程发挥不同的作用。（PsycINFO 数据库记录（c）2018 APA，保留所有权利）。
