Hospital Anxiety and Depression Essay

Hospital Anxiety and Depression scale (HADS) were used in 2 studies to measure symptoms of anxiety and depression in their patients population [15, 20]. The Thyln et al study showed that out of n=3067 post ICD patients, n=485 had symptoms of anxiety with an anxiety mean score of 3.84  3.70 and n= 263 had symptoms of depression with a depression mean score of 2.99  3.01 [20].

The state version of the StateTrait Anxiety Inventory (STAI) was used in many studies to assess general symptoms of anxieties such as worries, concerns, and tension [18, 14, 13]. Anxiety scores were obtained using numerical items scale, in which anxiety symptoms are rated based on a numerical value called Likert Scale. A high anxiety level would be associated with a high score [18]. In a study that determined the prevalence of PTSD symptoms in ICD patients 18 months post ICD 16 out of 30 patients with PTSD were Type D personality and 83% (n=25) experienced anxiety at baseline. Both Type D personality (odds ratio= 3.5) and baseline anxiety (odds ratio= 4.3) were significant predictors of PTSD at eighteen months post implantation [14]. Another study was able to determine that in the first year postICD placement patients (n=1012). The mean anxiety score was 38.9, ranging between 20 and 80. Nineteen % (n=192) of patients experienced ventricular arrhythmias (VA). Four % (n=45) of patients died within the first year. It was concluded that patients with anxiety have 1.9 increased risks for ventricular arrhythmias and 2.9 increased risk for mortality. Anxiety was significantly associated with VA [18]. Other studies used validated diagnostic interviews or selfreport questionnaires to diagnose anxiety or depression or to assess anxiety or depression symptoms [19, 15].

In post cardiac infarction patients implanted with cardioverterdefibrillators for secondary prevention (n=100), individual patient scores revealed high incidences of anxiety (2434%) and depression (1422%). ICD shocks and shock storms increased anxiety significantly [15].

In order to determine the prevalence and persistence of depression, Tsuyoshi et al, used the Zung selfrating depression scale. A twoyear longitudinal study showed that among n= 90 patients, depression was present in 32% of patients at baseline and still present in 28% of them two years later. Patients who were depressed experienced more shocks than nondepressed patients after two years [5].

Most Studies reported that anxiety and depression were in fact present in post ICD implant patients. However, very few assessed anxiety or depression at base line and at the end of the study [5, 15]. None of the studies reported data confirming the prevalence of anxiety versus depression, PTSD.

There were small sample sizes found with relatively short followup periods using a mean score analyses. The power to detect a differential effect of appropriate and inappropriate shocks was limited. Information on left ventricular ejection fraction and complications was incomplete and could not be included in the analysis. Baseline questionnaires were not completed between 0 and 3 weeks postimplantation. No data is available on patients that immediately refused study participation.