title: Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients.
abstract: The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.
authors.affiliation: Cardiac and Thoracic Surgical Unit, Department of Medicine, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia. Phil.Tully@health.sa.gov.au
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Helen R
authors.initials: HR
authors.lastname: Winefield
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Turnbull
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000503:physiopathology; D003327:Coronary Disease / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D016584:Panic Disorder / Q000453:epidemiology; D010361:Patients / Q000523:psychology*; D010551:Personality / Q000145:classification; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery