Impact of Rumination on Severity and Persistence of Anxiety and Depression in Cardiac Patients

Background: Anxiety and depression are common after an acute cardiac event. While many studies have investigated the predictors of anxiety and depression, few have focused on the role of rumination. The aim of this study was to identify the ruminative styles that predict anxiety and depression in the 2 years' postcardiac event. Methods: A total of 426 cardiac patients, 210 admitted for acute coronary syndrome (ACS), and 216 to undergo coronary artery bypass graft surgery were recruited from three metropolitan hospitals in Melbourne, Australia. Participants completed self-report questionnaires at the time of their event and at 12- and 24-months postevent. Anxiety and depression were assessed at all three time points, whereas ruminative styles were assessed at 24 months. Clinical information was retrieved from the participants' medical records. Bivariate and multivariate analyses were undertaken to identify the factors associated with and predictive of anxiety and depression at 24-months postevent. Results: A diagnosis of ACS, history of depression, smoking, and brooding and intrusive rumination were associated with both anxiety and depression, while female gender was associated with anxiety only. Brooding and intrusive rumination were the unique predictors of anxiety and depression, after controlling for other factors. Limitations: Generalizability of the findings is limited by the preponderance of men in the sample and by participant attrition over the study period. Conclusion: The findings indicate the importance of screening for rumination styles after a cardiac event to enhance targeting of psychological treatments for cardiac patients at risk of persistent anxiety or depression.