title: Emotional distress, positive affect, and mortality in patients with an implantable cardioverter defibrillator.
abstract: BACKGROUND
  Little is known about the relationship between emotional distress and mortality in patients with an implantable cardioverter defibrillator (ICD). Our aim was to examine the predictive value of general negative and positive affect, and depressive symptoms (including its components somatic symptoms and cognitive-affective symptoms) for mortality.
  
  
  METHODS
  ICD patients (N=591, 81% male, mean age=62.7 ± 10.1 years) completed the Global Mood Scale to measure the independent dimensions negative and positive mood, and the Beck Depression Inventory to measure depressive symptoms. Covariates consisted of demographic and clinical variables.
  
  
  RESULTS
  During the median follow-up of 3.2 years, 96 (16.2%) patients died. After controlling for covariates, negative affect was significantly related to all-cause mortality (HR=1.034, p=0.002), whereas positive affect was not (HR=1.007, p=0.61). Depressive symptoms were also independently associated with an increased mortality risk (HR=1.031, p=0.030) and somatic symptoms of depression in particular (HR=1.130, p=0.003), but cognitive-affective symptoms were not associated with mortality (HR=0.968, p=0.29). When entering both significant psychological predictors in a covariate-adjusted model, negative mood remained significant (HR=1.039, p=0.009), but somatic symptoms of depression did not (HR=0.988, p=0.78). Similar results were found for cardiac-related death. Of covariates, increased age, CRT, appropriate shocks were positively related to death.
  
  
  CONCLUSIONS
  Negative affect in general was related to mortality, but reduced positive affect was not. Depression, particularly its somatic symptoms, was also related to mortality, while cognitive-affective symptoms were not. Future research may further focus on the differential predictive value of emotional distress factors, as well as on mechanisms that relate emotional distress factors to mortality.
authors.affiliation: CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. CvdBroek@uvt.nl
authors.forename: Krista C
authors.initials: KC
authors.lastname: van den Broek
authors.forename: Fetene B
authors.initials: FB
authors.lastname: Tekle
authors.forename: Mirela
authors.initials: M
authors.lastname: Habibović
authors.forename: Marco
authors.initials: M
authors.lastname: Alings
authors.forename: Pepijn H
authors.initials: PH
authors.lastname: van der Voort
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000339:Affect / Q000502:physiology; D000368:Aged; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000401:mortality / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013315:Stress, Psychological / Q000401:mortality* / Q000523:psychology*