title: Anxiety enhances the detrimental effect of depressive symptoms on health status following percutaneous coronary intervention.
abstract: OBJECTIVE
  We examined whether anxiety has incremental value to depressive symptoms in predicting health status in patients undergoing percutaneous coronary intervention (PCI) treated in the drug-eluting stent era.
  
  
  METHODS
  A series of consecutive patients (n=692) undergoing PCI as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital registry completed the Hospital Anxiety and Depression Scale at 6 months and the Short-Form Health Survey (SF-36) at 6 and 12 months post-PCI.
  
  
  RESULTS
  Of 692 patients, 471 (68.1%) had no symptoms of anxiety nor depression, 62 (9.0%) had anxiety only, 59 (8.5%) had depressive symptoms only, and 100 (14.5%) had co-occurring symptoms. There was an overall significant improvement in health status between 6 and 12 months post-PCI (P<.001); the interaction effect for time by psychological symptoms was also significant (P=.003). Generally, patients with co-occurring symptoms reported significantly poorer health status compared with the other three groups (Ps <.001). Patients with co-occurring symptomatology were also at greater risk of impaired health status on six of the eight subdomains of the SF-36 compared with the other three symptom groups, adjusting for baseline characteristics and health status at 6 months.
  
  
  CONCLUSIONS
  Patients with co-occurring symptoms of anxiety and depression reported poorer health status compared with anxious or depressed-only patients and no-symptom patients, showing that anxiety has incremental value to depressive symptoms in identifying PCI patients at risk for impaired health status treated in the drug-eluting stent era.
authors.affiliation: Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, The Netherlands. s.s.pedersen@uvt.nl
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.forename: Helle
authors.initials: H
authors.lastname: Spindler
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Ruud A M
authors.initials: RA
authors.lastname: Erdman
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000523:psychology*; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003327:Coronary Disease / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D003866:Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D018450:Disease Progression; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015607:Stents; D013997:Time Factors