Hegel M T, Griegel L E, Black C, Goulden L, Ozahowski T
Dartmouth Medical School, USA.
Int J Psychiatry Med. 1997;27(1):57-69. doi: 10.2190/1G9V-EQMD-MTLQ-E0BW.
The implantable cardioverter-defibrillator (ICD) has dramatically improved survival rates following sudden cardiac death episodes. However, researchers have devoted little attention to the psychosocial consequences of living with the device. The current study used a longitudinal design to evaluate the impact of adaptation to the ICD on incidence and severity of anxiety and depression.
ICD recipients were administered standardized anxiety and depression questionnaires as well as questions evaluating quality of life related to the ICD in two consecutive yearly assessments. A preliminary evaluation of potentially important theoretical variables, such as the perceived predictability and controllability of shock onset was also conducted.
One-third of the study population (N = 38) had clinically significant levels of anxiety, depressed mood, and fear of symptoms of autonomic arousal. These negative affective states persisted over time, with 40 to 63 percent of subjects continuing to have ongoing difficulties over a one-year time period. Anxiety about the ICD firing was closely associated with the occurrence of depression, while avoidance of activities was associated with anxiety. "Worry" about the ICD and a belief that ICD firing can be predicted were associated with anxiety sensitivity.
Depressive and anxiety states in ICD recipients may be frequent, clinically significant, and resistant to spontaneous resolution. Early signs of anxiety and depression in ICD recipients should be evaluated. Implications for future research are discussed.
植入式心脏复律除颤器（ICD）显著提高了心脏性猝死发作后的生存率。然而，研究人员很少关注携带该设备所带来的心理社会后果。本研究采用纵向设计来评估适应ICD对焦虑和抑郁的发生率及严重程度的影响。
在连续两年的评估中，对ICD植入者进行标准化的焦虑和抑郁问卷调查，以及评估与ICD相关的生活质量的问题。还对潜在重要的理论变量进行了初步评估，如电击发作的可感知可预测性和可控性。
三分之一的研究人群（N = 38）有临床上显著的焦虑、抑郁情绪以及对自主神经兴奋症状的恐惧。这些负面情绪状态随时间持续存在，40%至63%的受试者在一年时间内持续存在困扰。对ICD放电的焦虑与抑郁的发生密切相关，而回避活动与焦虑相关。对ICD的“担忧”以及认为ICD放电可预测的信念与焦虑敏感性相关。
ICD植入者的抑郁和焦虑状态可能很常见，具有临床显著性，且难以自行缓解。应评估ICD植入者焦虑和抑郁的早期迹象。讨论了对未来研究的启示。
