Phobic anxiety, depression, and risk of ventricular arrhythmias in patients with coronary heart disease.
OBJECTIVE
Findings of an association between phobic anxiety and elevated risks of sudden cardiac death suggest that phobic anxiety may be related to increased risk of ventricular arrhythmias. The purpose of this study was to examine whether phobic anxiety is associated with ventricular arrhythmias in patients with documented coronary artery disease (CAD).


METHODS
Phobic anxiety level was measured using the Crown-Crisp phobic anxiety scale in 940 patients (660 men, 280 women) hospitalized for diagnostic cardiac catheterization between April 1999 and June 2002. Depressive symptomatology was assessed using the Beck Depression Inventory. Patients were followed for a median follow-up period of 3 years, and the occurrence of ventricular arrhythmias was determined through review of medical records.


RESULTS
Ventricular arrhythmias occurred in 97 patients and were significantly related to higher phobic anxiety after statistical adjustment for established medical and demographic determinants of arrhythmias (odds ratio = 1.40; p = .012). Depressive symptomatology was significantly correlated with phobic anxiety (r = 0.44, p < .001) and was also related to ventricular arrhythmias (odds ratio = 1.40; p = .006). The composite of depression and phobic anxiety predicted ventricular arrhythmias with a larger effect size than either depression or phobic anxiety score alone (odds ratio = 1.6, 95% confidence interval, 1.2-2.1, p = .002).


CONCLUSIONS
Both phobic anxiety and depressive symptomatology predict ventricular arrhythmias in patients with CAD and may share a common factor predictive of ventricular arrhythmias.
Watkins
Lana L
LL
Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27710, USA. watki017@mc.duke.edu
Blumenthal
James A
JA
Davidson
Jonathan R T
JR
Babyak
Michael A
MA
McCants
Charles B
CB
Sketch
Michael H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000523:psychology; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000523:psychology; D010698:Phobic Disorders / Q000453:epidemiology*; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000523:psychology; D014693:Ventricular Fibrillation / Q000453:epidemiology* / Q000523:psychology