Association of Baseline Anxiety With Depression Persistence at 6 Months in Patients With Acute Cardiac Illness

Objective To assess the association of baseline anxiety with depression persistence and change in depressive symptoms 6 months after cardiac hospitalization. Methods Data were analyzed from 137 depressed patients hospitalized on inpatient cardiac units for acute coronary syndrome, decompensated heart failure, or arrhythmia and who were enrolled in a randomized trial of collaborative care depression management. Subjects’ demographic, medical, and psychiatric information at baseline was compiled. Measures of health-related quality of life, cardiac symptoms, and psychiatric symptoms, including the Hospital Anxiety and Depression Scale—anxiety subscale (HADS-A) for anxiety, were obtained at baseline and serially during a 6-month follow-up period. The association between baseline HADS-A score and depression persistence (<50% reduction in depressive symptoms on the Patient Health Questionnaire-9) at 6 months was assessed by multivariate logistic regression accounting for the effects of multiple relevant medical and psychological covariates. The association between baseline HADS-A score and improvement in depressive symptoms (Patient Health Questionnaire-9) from baseline at 6 months was assessed by linear regression accounting for the same covariates. Results Baseline HADS-A score was independently associated with depression persistence at 6 months (odds ratio = 1.11, 95% confidence interval = 1.01–1.22, p = .03). Likewise, higher baseline HADS-A score was associated with less improvement in depressive symptoms at 6 months (β = −0.34, p = .01). Conclusions Among a cohort of depressed cardiac patients, higher baseline anxiety score was linked with lesser improvement in depressive symptoms and increased likelihood of depression persistence at 6 months, independent of multiple relevant covariates. Trial Registration: clinicaltrials.gov Identifier: NCT00847132. Abbreviations CPFQ = Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire; HADS-A = Hospital Anxiety and Depression Scale—anxiety subscale; HF = heart failure; HRQoL = health-related quality of life; MI = myocardial infarction; PHQ-9 = Patient Health Questionnaire-9; SF-12 MCS = Medical Outcomes Study 12-item Short-Form—mental component score; SF-12 PCS = Medical Outcomes Study 12-item Short-Form—physical component score