Clinical Review

Psychological Distress and Cardiovascular Disease

Journal of Clinical Outcomes Management. 2015 September;22(9)

Author(s):

References

1. Dembroski TM, MacDougall JM, Shields JL, et al. Components of the type A coronary-prone behavior pattern and cardiovascular responses to psychomotor performance challenge. J Behav Med 1978;1:159–76.

2. Rumsfeld JS, Ho PM. Depression and cardiovascular disease: a call for recognition. Circulation 2005;111:250–3.

3. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014;129:e28–e292.

4. Mathers C, Stevens G, Mascarenhas M. Global health risks: Mortality and burden of diesease attributable to select major risks. Geneva, Switzerland: World Health Organization, 2009.

5. Randall G, Molloy GJ, Steptoe A. The impact of an acute cardiac event on the partners of patients: A systematic review. Health Psychol Rev 2009;3:1–84.

6. Kronish IM, Rieckmann N, Halm EA, et al. Persistent depression affects adherence to secondary prevention behaviors after acute coronary syndromes. J Gen Intern Med 2006;21:1178–83.

7. Stafford L, Berk M, Reddy P, Jackson HJ. Comorbid depression and health-related quality of life in patients with coronary artery disease. J Psychosom Res 2007;62:401–10.

8. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med 2004;66:802–13.

9. van Melle JP, de Jonge P, Spijkerman TA, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004;66:814–22.

10. Doyle F, McGee HM, Conroy RM, Delaney M. What predicts depression in cardiac patients: sociodemographic factors, disease severity or theoretical vulnerabilities? Psychol Health 2011;26:619–34.

11. Figueredo VM. The time has come for physicians to take notice: the impact of psychosocial stressors on the heart. Am J Med 2009;122:704–12.

12. Matthews KA. Matters of the heart: advancing psychological perspectives on cardiovascular diseases. Persp Psychol Sci 2013;8:676–8.

13. Whooley MA, Wong JM. Depression and cardiovascular disorders. Annu Rev Clin Psychol 2013;9:327–54.

14. Mittleman MA, Mostofsky E. Physical, psychological and chemical triggers of acute cardiovascular events: preventive strategies. Circulation 2011;124:346–54.

15. Hamer M, Molloy GJ, Stamatakis E. Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms. J Am Coll Cardiol 2008;52:2156–62.

16. Richardson S, Shaffer JA, Falzon L, et al. Meta-analysis of perceived stress and its association with incident coronary heart disease. Am J Cardiol 2012;110:1711–6.

17. Steptoe A, Kivimaki M. Stress and cardiovascular disease. Nat Rev Cardiol 2012;9:360–70.

18. Brumby S, Chandrasekara A, McCoombe S, et al. Cardiovascular risk factors and psychological distress in Australian farming communities. Aust J Rural Health 2012;20:131–7.

19. Arnold SV, Smolderen KG, Buchanan DM, et al. Perceived stress in myocardial infarction long-term mortality and health status outcomes. J Am Coll Cardiol 2012;60:1756–63.

20. Cohen BE, Edmondson D, Kronish IM. State of the art review: depression, stress, anxiety, and cardiovascular disease. Am J Hypertens 2015.

21. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

22. Davidson KW, Kupfer DJ, Bigger JT, et al. Assessment and treatment of depression in patients with cardiovascular disease: National Heart, Lung, and Blood Institute Working Group Report. Psychosom Med 2006;68:645–50.

23. Niranjan A, Corujo A, Ziegelstein RC, Nwulia E. Depression and heart disease in US adults. Gen Hosp Psychiatry 2012;34:254–61.

24. Seldenrijk A, Vogelzangs N, Batelaan NM, et al. Depression, anxiety and 6-year risk of cardiovascular disease. J Psychosom Res 2015;78:123–9.

25. Ayerbe L, Ayis S, Crichton S, et al. The natural history of depression up to 15 years after stroke: The South London Stroke Register. Stroke 2013.

26. Lichtman JH, Bigger JT Jr, Blumenthal JA, et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation 2008;118:1768–75.

27. Lichtman JH, Froelicher ES, Blumenthal JA, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation 2014;129:1350–69.

28. Hasnain M, Vieweg WV, Lesnefsky EJ, Pandurangi AK. Depression screening in patients with coronary heart disease: a critical evaluation of the AHA guidelines. J Psychosom Res 2011;71:6–12.

29. Ziegelstein RC, Thombs BD, Coyne JC, de Jonge P. Routine screening for depression in patients with coronary heart disease never mind. J Am Coll Cardiol 2009;54:886–90.

30. Ziegelstein RC, Kim SY, Kao D, et al. Can doctors and nurses recognize depression in patients hospitalized with an acute myocardial infarction in the absence of formal screening? Psychosom Med 2005;67:393–7.

31. Whooley MA. To screen or not to screen? Depression in patients with cardiovascular disease. J Am Coll Cardiol 2009;54:891–3.

32. Davidson KW, Rieckmann N, Clemow L, et al. Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. Arch Intern Med 2010;170:600–8.

33. Berkman LF, Blumenthal J, Burg M, et al. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003;289:3106–16.

34. Whooley M, Unutzer J. Interdisciplinary stepped care for depression after acute coronary syndrome. Arch Intern Med 2010;170:585–6.

35. McGuire AW, Eastwood JA, Macabasco-O’Connell A, et al. Depression screening: utility of the patient health questionnaire in patients with acute coronary syndrome. Am J Crit Care 2013;22:12–9.

36. Sowden G, Mastromauro CA, Januzzi JL, et al. Detection of depression in cardiac inpatients: feasibility and results of systematic screening. Am Heart J 2010;159:780–7.

37. Bigger JT, Glassman AH. The American Heart Association science advisory on depression and coronary heart disease: an exploration of the issues raised. Cleve Clin J Med 2010;77 Suppl 3:S12–9.

38. Page KN, Davidson P, Edward KL, et al. Recovering from an acute cardiac event--the relationship between depression and life satisfaction. J Clin Nurs 2010;19:736–43.

39. Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012;10:CD006525.

40. Blumenthal JA, O’Connor C. No laughing matter. J Am Coll Cardiol 2010;55:836.

41. Davidson KW, Korin MR. Depression and cardiovascular disease: selected findings, controversies, and clinical implications from 2009. Cleve Clin J Med 2010;77 Suppl 3:S20–6.

42. Doering LV, McGuire A, Eastwood JA, et al. Cognitive behavioral therapy for depression improves pain and perceived control in cardiac surgery patients. Eur J Cardiovasc Nurs 2015.

43. Freedland KE, Skala JA, Carney RM, et al. Treatment of depression after coronary artery bypass surgery: a randomized controlled trial. Arch Gen Psychiatry 2009;66:387–96.

44. Huffman JC, Mastromauro CA, Sowden GL, et al. collaborative care depression management program for cardiac inpatients: depression characteristics and in-hospital outcomes. Psychosomatics 2011;52:26–33.

45. Hwang B, Eastwood JA, McGuire A, et al. Cognitive behavioral therapy in depressed cardiac surgery patients: role of ejection fraction. J Cardiovasc Nurs 2015;30:319–24.

46. Mavrides N, Nemeroff C. Treatment of depression in cardiovascular disease. Depression Anxiety 2013;30:328–41.

47. Zuidersma M, Ormel J, Conradi HJ, de Jonge P. An increase in depressive symptoms after myocardial infarction predicts new cardiac events irrespective of depressive symptoms before myocardial infarction. Psychol Med 2012;42:683–93.

48. Banankhah SK, Friedmann E, Thomas S. Effective treatment of depression improves post-myocardial infarction survival. World J Cardiol 2015;7:215–23.

49. Ayerbe L, Ayis S, Crichton S, et al. The long-term outcomes of depression up to 10 years after stroke; the South London Stroke Register. J Neurol Neurosurg Psychiatry 2014;85:514–21.

50. Hama S, Yamashita H, Yamawaki S, Kurisu K. Post-stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response. Psychogeriatrics 2011;11:68–76.

51. Caeiro L, Ferro JM, Costa J. Apathy secondary to stroke: a systematic review and meta-analysis. Cerebrovasc Dis 2013;35:23–39.

52. Ahmed A, Simmons Z. Pseudobulbar affect: prevalence and management. Ther Clin Risk Manag 2013;9:483–9.

53.Karamchandani R, Vahidy F, Bajgur S, et al. Early Depression Screening is Feasible in Hospitalized Stroke Patients. Neurology 2014;82(10 Supplement):S62.005.

54. El Husseini N, Goldstein LB, Peterson ED, et al. Depression and antidepressant use after stroke and transient ischemic attack. Stroke 2012;43:1609–16.

55. D’Aniello GE, Scarpina F, Mauro A, Mori I, et al. Characteristics of anxiety and psychological well-being in chronic post-stroke patients. J Neurol Sci 2014;338:191–6.

56. Huffman JC, Smith FA, Blais MA, et al. Anxiety, independent of depressive symptoms, is associated with in-hospital cardiac complications after acute myocardial infarction. J Psychosom Res 2008;65:557–63.

57. Shen B-J, Avivi YE, Todaro JF, et al. Anxiety characteristics independently and prospectively predict myocardial infarction in men: the unique contribution of anxiety among psychologic factors. J Am Coll Cardiol 2008;51:113–9.

58. Butnoriene J, Bunevicius A, Saudargiene A, et al. Metabolic syndrome, major depression, generalized anxiety disorder, and ten-year all-cause and cardiovascular mortality in middle aged and elderly patients. Int J Cardiol 2015;190:360–6.

59. Roest AM, Zuidersma M, de Jonge P. Myocardial infarction and generalised anxiety disorder: 10-year follow-up. Br J Psychiatry 2012;200:324–9.

60. Doering LV, Moser DK, Riegel B, et al. Persistent comorbid symptoms of depression and anxiety predict mortality in heart disease. Int J Cardiol 2010;145:188–92.

61. Edmondson D, Kronish IM, Shaffer JA, et al. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Am Heart J 2013;166:806–14.

62. Ahmadi N, Hajsadeghi F, Mirshkarlo HB, et al. Post-traumatic stress disorder, coronary atherosclerosis, and mortality. Am J Cardiol 2011;108:29–33.

63. Zen AL, Whooley MA, Zhao S, Cohen BE. Post-traumatic stress disorder is associated with poor health behaviors: findings from the heart and soul study. Health Psychol 2012;31:194–201.

64. Chung MC, Dennis I, Berger Z, et al. Posttraumatic stress disorder following myocardial infarction: personality, coping, and trauma exposure characteristics. Int J Psychiatry Med 2011;42:393–419.

65. Bluvstein I, Moravchick L, Sheps D, et al. Posttraumatic growth, posttraumatic stress symptoms and mental health among coronary heart disease survivors. J Clin Psychol Med Settings 2013;20:164–72.

66. Huffman JC, Smith FA, Blais MA, et al. Recognition and treatment of depression and anxiety in patients with acute myocardial infarction. Am J Cardiol 2006;98:319–24.

67. Crosson JC, Heisler M, Subramanian U, et al. Physicians’ perceptions of barriers to cardiovascular disease risk factor control among patients with diabetes: results from the translating research into action for diabetes (TRIAD) study. J Am Board Fam Med 2010;23:171–8.

68. Amin AA, Jones AM, Nugent K, et al. The prevalence of unrecognized depression in patients with acute coronary syndrome. Am Heart J 2006;152:928–34.

69. Chung MC, Berger Z, Jones R, Rudd H. Posttraumatic stress and co-morbidity following myocardial infarction among older patients: the role of coping. Aging Ment Health 2008;12:124–33.

70. Neylon A, Canniffe C, Anand S, et al. A global perspective on psychosocial risk factors for cardiovascular disease. Prog Cardiovasc Dis 2013;55:574–81.

71. Carney RM, Freedland KE. Are somatic symptoms of depression better predictors of cardiac events than cognitive symptoms in coronary heart disease? Psychosom Med 2012;74:33–8.

72. McGuire AW, Eastwood JA, Hays RD, Macabasco-O’Connell A, et al. Depressed or not depressed: untangling symptoms of depression in patients hospitalized with coronary heart disease. Am J Crit Care 2014;23:106–16.

73. Williams LS, Brizendine EJ, Plue L, et al. Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke 2005;36:635–8.

74. Junehag L, Asplund K, Svedlund M. A qualitative study: perceptions of the psychosocial consequences and access to support after an acute myocardial infarction. Intensive Crit Care Nurs 2014;30:22–30.

75. Lea P. Factors affecting nurses’ intent to assess for depression in heart failure patients. Dimens Crit Care Nurs 2014;33:320–6.

From the California State University, Long Beach, School of Nursing, Long Beach, CA (Dr. McGuire, Ms. Ahearn), and the University of California, Los Angeles, School of Nursing, Los Angeles, CA (Dr. Doering).

Abstract

Objective: To review the current literature regarding psychological distress in patients with cardiovascular disease (CVD).
Methods: Relevant and current (2005–2015) studies were retrieved by a series of searches conducted in the PubMed and PsychINFO databases using Boolean terms/phrases along with manual extraction from the reference lists of pertinent studies. Narrative and tabular summaries of the findings are reported.
Results: There is a vast literature on psychological distress and CVD. Depression is the most common disorder studied followed by anxiety and post-traumatic stress disorder. Physiologic mechanisms linking psychological distress to CVD are well theorized. Screening for psychological distress in CVD is recommended. Referral and treatment issues need further exploration. Pharmacologic treatment of psychological distress in CVD remains equivocal; however, promising data exists for other therapies such as cognitive behavioral therapy and social support strategies.
Conclusion: Psychological distress has a significant negative impact on patients with CVD and is underrecognized by health care providers. Primary care providers and cardiovascular specialty providers are called upon to improve their recognition of psychological distress in their patients and assure referrals are made to collaborative care teams for proper diagnosis and treatment.

The association between the heart and the mind has been proposed by scientists since the 17th century. However, it was not until the 1970s that the relationship between cardiovascular disease (CVD) and psychological states came into scientific focus. The study of heart-psyche interactions began with investigations of cardiovascular risk and “type A” personality behaviors (aggressiveness, impatience, a sense of time-urgency, intense achievement drive, seeking recognition) [1,2]. Hundreds of studies generated over the last 10 years have yielded an extensive body of literature regarding this complex interaction.

CVD continues to be the leading cause of death globally. Worldwide and in the United States, CVD accounts for 30% of deaths and more than 2000 deaths per day, respectively [3,4]. Psychological distress (specifically depression) has been reported by the World Health Organization (WHO) as the leading cause of disability in the world [4]. Taken together, CVD and depression constitute an immense health burden and result in poor health status, increased care giver burden [5], increased readmission rates to hospitals, increased utilization of primary care services, poor health compliance [6], decreased health related quality of life [7], and a greater than 2 times increase in mortality [8,9].

Despite its devastating consequences, comorbid CVD and psychological distress remains poorly recognized and treated. In this paper, we present a review of the evidence related to key aspects of psychological distress and CVD (for the purposes of this paper, defined as ischemic heart disease and stroke), and provide information to help improve identification among health care providers. Relevant and current (2005-2015) studies for this review were retrieved by a series of searches conducted in the PubMed and PsychINFO databases using Boolean terms/phrases, along with manual extraction from the reference lists of pertinent studies. Due to the breadth and extent of the literature, a comprehensive review of the literature is beyond the scope of this article. However, the reader will be directed to current systematic reviews, meta-analyses, and recent select research studies sourced for this summary and presented in tabular form.