title: General anxiety, depression, and physical health in relation to symptoms of heart-focused anxiety- a cross sectional study among patients living with the risk of serious arrhythmias and sudden cardiac death.
abstract: OBJECTIVE
  To investigate the role of three distinct symptoms of heart-focused anxiety (cardio-protective avoidance, heart-focused attention, and fear about heart sensations) in relation to general anxiety, depression and physical health in patients referred to specialized cardio-genetics outpatient clinics in Norway for genetic investigation and counseling.
  
  
  METHODS
  Participants were 126 patients (mean age 45 years, 53.5% women). All patients were at higher risk than the average person for serious arrhythmias and sudden cardiac death (SCD) because of a personal or a family history of an inherited cardiac disorder (familial long QT syndrome or hypertrophic cardiomyopathy). Patients filled in, Hospital Anxiety and Depression Scale, Short-Form 36 Health Survey, and Cardiac Anxiety Questionnaire, two weeks before the scheduled counseling session.
  
  
  RESULTS
  The patients experienced higher levels of general anxiety than expected in the general population (mean difference 1.1 (p < 0.01)). Hierarchical regression analyses showed that avoidance and fear was independently related to general anxiety, depression, and physical health beyond relevant demographic covariates (age, gender, having children) and clinical variables (clinical diagnosis, and a recent SCD in the family). In addition to heart-focused anxiety, having a clinical diagnosis was of importance for physical health, whereas a recent SCD in the family was independently related to general anxiety and depression, regardless of disease status.
  
  
  CONCLUSIONS
  Avoidance and fear may be potentially modifiable symptoms. Because these distinct symptoms may have important roles in determining general anxiety, depression and physical health in at-risk individuals of inherited cardiac disorders, the present findings may have implications for the further development of genetic counseling for this patient group.
authors.affiliation: Genetic Epidemiology Research Group, Department of Public Health and Primary Health Care, University of Bergen, Norway. Anniken.Hamang@isf.uib.no
authors.forename: Anniken
authors.initials: A
authors.lastname: Hamang
authors.forename: Geir E
authors.initials: GE
authors.lastname: Eide
authors.forename: Berit
authors.initials: B
authors.lastname: Rokne
authors.forename: Karin
authors.initials: K
authors.lastname: Nordin
authors.forename: Nina
authors.initials: N
authors.lastname: Øyen
mesh_terms: D001008:Anxiety Disorders / Q000523:psychology*; D001288:Attention; D001362:Avoidance Learning; D002312:Cardiomyopathy, Hypertrophic / Q000235:genetics / Q000523:psychology*; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac; D003866:Depressive Disorder / Q000523:psychology*; D005239:Fear; D005260:Female; D006304:Health Status; D006801:Humans; D008133:Long QT Syndrome / Q000235:genetics / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009664:Norway; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
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