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PLoS One. 2019 Mar 7;14(3):e0213334. doi: 10.1371/journal.pone.0213334. eCollection 2019.

Multi-state models of transitions in depression and anxiety symptom severity and cardiovascular events in patients with coronary heart disease.

Author information

1
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
2
Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
3
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
4
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
5
Klinik Schwabenland, Isny-Neutrauchburg, Germany.
6
Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany.
7
Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
8
German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.
9
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.

Abstract

OBJECTIVE:

Patients with coronary heart disease (CHD) commonly suffer from depression and anxiety, yet transitions of symptom severity and cardiovascular events (CVE) over time are not well characterized.

METHODS:

We included 997 patients with stable CHD from a prospective cohort study. We estimated 5- and 10-year transition probabilities of depression and anxiety symptom severity levels and fatal- and non-fatal adverse CVE. Depression and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale 5 times over 13 years and categorized as no, mild, or moderate/severe symptoms. Using multi-state modeling, we calculated 5- and 10-year transition probabilities for depression and anxiety symptom severity and CVE and calculated transition intensity ratios for factors associated with symptom severity progression and regression.

RESULTS:

At 5 years, only approximately half of participants with moderate or severe symptom severity at baseline transitioned to no symptom severity. Patients with low physical activity (<1x/week or never) had a higher probability of worse symptom severity after 5 and 10 years and a higher probability of a CVE after 5 and 10 years regardless of their depression status at baseline compared to higher physical activity groups. Higher body mass index, <10 years of education, and lower physical activity were associated with depression symptom progression; female and lower physical activity were associated with anxiety symptom progression.

CONCLUSIONS:

Patients with CHD had a consistent burden of depression and anxiety symptoms. Secondary prevention strategies should target depression and anxiety and include a physical activity component.

PMID:
30845176
DOI:
10.1371/journal.pone.0213334
Free PMC Article

Conflict of interest statement

The authors have declared that no competing interests exist.

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