title: Psychological distress and mortality in systolic heart failure.
abstract: BACKGROUND
  Depression, anxiety, and type D ("distressed") personality (tendency to experience negative emotions paired with social inhibition) have been associated with poor prognosis in coronary heart disease, but little is known about their role in chronic heart failure. Therefore, we investigated whether these indicators of psychological distress are associated with mortality in chronic heart failure.
  
  
  RESULTS
  Consecutive outpatients with chronic heart failure (n=641; 74.3% men; mean age, 66.6+/-10.0 years) filled out a 4-item questionnaire to assess mixed symptoms of anxiety and depression and the 14-item type D scale. End points were defined as all-cause and cardiac mortality. After a mean follow-up of 37.6+/-15.6 months, 123 deaths (76 due to cardiac cause) were recorded. Cumulative hazard functions for elevated anxiety/depression symptoms differed marginally for all-cause (P=0.06), but not cardiac, mortality (P=0.43); type D personality was associated with neither all-cause mortality (P=0.63) nor cardiac mortality (P=0.87). In multivariable analyses, neither elevated anxiety/depression symptoms nor type D personality was associated with all-cause mortality (hazard ratio [HR]=1.18; 95% CI, 0.76 to 1.84; P=0.45 and HR=1.09; 95% CI, 0.67 to 1.77; P=0.73, respectively) or cardiac mortality (HR=1.13; 95% CI, 0.63 to 2.04; P=0.65 and HR=1.16; 95% CI, 0.62 to 2.18; P=0.67). In secondary analyses, a 1-point increase in anxiety/depression (range, 0 to 16) was associated with an 8% increase in risk for all-cause mortality (HR=1.08; 95% CI, 1.01 to 1.15; P=0.02).
  
  
  CONCLUSIONS
  Neither elevated anxiety/depression symptoms nor type D personality was associated with an increased risk for all-cause or cardiac mortality. Future studies with adequate power and a longer follow-up duration are needed to further elucidate the role of psychological distress in chronic heart failure.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
authors.forename: Aline J
authors.initials: AJ
authors.lastname: Pelle
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Angélique A
authors.initials: AA
authors.lastname: Schiffer
authors.forename: Balázs
authors.initials: B
authors.lastname: Szabó
authors.forename: Jos W
authors.initials: JW
authors.lastname: Widdershoven
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D002423:Cause of Death; D016009:Chi-Square Distribution; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D054143:Heart Failure, Systolic / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010551:Personality; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires