Functional status in coronary artery disease: a one-year prospective study of the role of anxiety and depression.
OBJECTIVE
Although coronary disease is the second most common cause of work and functional disability, little is known about the relative contributions of biomedical and psychosocial factors to this disability. This study was conducted to determine the associations of depression and anxiety with self-reported physical function and activity interference in patients with coronary artery disease.


METHODS
This was a 1-year prospective cohort study of 198 HMO members who had elective cardiac catheterization for coronary artery disease in 1992. Measures included: severity of coronary artery stenosis from cardiac catheterization reports; anxiety and depression severity using interviewer-administered Hamilton Anxiety and Depression Rating Scales; and self-reported physical function and activity interference.


RESULTS
At the time of catheterization, patients' self-reported physical function differed significantly by number of main coronary vessels stenosed >70% (P <0.03), by anxiety quartiles (P = 0.001), and by depression quartiles (P = 0.001). At 1 year, physical function was no longer associated with the number of main coronary vessels stenosed at baseline, but still was significantly associated with baseline anxiety (P <0.001) and depression quartiles (P = 0.01). Moreover, change in physical function scores from baseline to 12 months was associated with baseline anxiety (P <0.001) or depression (P <0.001) quartiles, but not with baseline number of occluded coronaries. Results for activity interference were similar to those for physical function. These associations were largely unchanged when corrected for age, sex, education, social class, medical versus surgical management of CAD, and degree of medical comorbidity.


CONCLUSIONS
Anxiety and depression have a significant and persistent effect on physical function in patients with coronary artery disease. Although current treatment methods appear to neutralize the influence of coronary stenosis on physical function during the year following catheterization, this is not true for anxiety and depression.
Sullivan
M D
MD
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA.
LaCroix
A Z
AZ
Baum
C
C
Grothaus
L C
LC
Katon
W J
WJ
D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000150:complications* / Q000208:ethnology; D006328:Cardiac Catheterization; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000208:ethnology / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000150:complications* / Q000208:ethnology; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012737:Sex Factors; D012923:Social Class