What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary Artery Disease (CAD) (n=335). Intervention: Percutaneous Coronary Intervention (PCI). Primary outcome: Prevalence of moderate to severe depressive symptoms (PHQ-9 ≥10).

September 16, 2021Open Access

Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention

Key Result

Ten days after percutaneous coronary intervention, 34% of patients with coronary artery disease exhibited moderate to severe depressive symptoms, with female gender, low education, and diabetes as significant predictors.

Study Design

Type

Cross-Sectional (n=335)

Multicenter

Structured PICO

Population

335 adults with stable coronary artery disease (intra-luminal stenosis ≥50% in left main or ≥70% in major epicardial arteries) who underwent elective percutaneous coronary intervention (PCI), mean age 57.5, 75.2% male, based in Jordan. Key exclusions: prior or family history of depression, current antidepressant use, acute coronary syndrome presentation, and post-PCI complications (intubated, shock, ICU transfer).

Intervention

Elective percutaneous coronary intervention (PCI) followed by depression screening at 10 days

Outcome

Prevalence and severity of depressive symptoms measured by the 9-item Patient Health Questionnaire (PHQ-9) at 10 days post-PCIpatient reported

Approximately one-third of stable CAD patients experience moderate to severe depressive symptoms 10 days after elective PCI, highlighting a critical need for early mental health screening and integration in post-PCI care.

Limitations

Cross-sectional design lacks temporality and comparison of depression prevalence before and after CAD diagnosis.
Lacks a comparison or control group to establish a causal relationship.
Relatively small sample size.
PHQ-9 is a screening tool and lacks a structured clinical interview by a psychiatrist to confirm diagnosis.
Potential response bias due to cultural stigma attached to mental health problems.
Patients may not have been completely truthful in their self-reported responses.

Abstract

Background: Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial. Objectives: This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI). Methods: All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed. Results: Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p <0.001); (t(333) = 5.13, p <0.001); and (t(333) = 2.79, p =0.042), respectively. Conclusion: This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

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