title: Differential predictive value of depressive versus anxiety symptoms in the prediction of 8-year mortality after acute coronary syndrome.
abstract: OBJECTIVE
  Both depression and anxiety have been associated with poor prognosis in patients with acute coronary syndrome (ACS). However, certain symptoms and how they are measured may be more important than others. We investigated three different scales to determine their predictive validity.
  
  
  METHODS
  Patients with ACS (N = 598) completed either the Hospital Anxiety and Depression Scales (HADS-A, HADS-D; n = 316) or the Beck Depression Inventory-Fast Screen (n = 282). Their all-cause mortality status was assessed at 8 years.
  
  
  RESULTS
  During follow-up, 20% (121/598) of participants died. Cox proportional hazards modeling showed that the HADS-D was predictive of mortality (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 1.04-1.19), and this association remained significant after adjustment for major clinical/demographic factors, whereas the HADS-A (HR = 0.96, 95% CI = 0.85-1.09) and the Beck Depression Inventory-Fast Screen (HR = 0.99, 95% CI = 0.91-1.08) were not. The following depression items from the HADS-D predicted mortality: "I still enjoy the things I used to enjoy" (HR = 1.38, 95% CI = 1.05-1.82), "I can laugh and see the funny side of things" (HR = 1.48, 95% CI = 1.11-1.96), "I feel as if I am slowed down" (HR = 1.66, 95% CI = 1.24-2.22), and "I look forward with enjoyment to things" (HR = 1.36, 95% CI = 1.08-1.72).
  
  
  CONCLUSIONS
  Depressive symptoms related to lack of enjoyment or pleasure and physical or cognitive slowing, as measured by the HADS-D, predicted all-cause mortality at 8 years ACS patients, whereas other depressive and anxiety symptoms did not. Whether symptoms of distress predict prognosis in ACS seems to be dependent on the measures and items used.
authors.affiliation: Department of Psychology, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. fdoyle4@rcsi.ie
authors.forename: Frank
authors.initials: F
authors.lastname: Doyle
authors.forename: Ronan
authors.initials: R
authors.lastname: Conroy
authors.forename: Hannah
authors.initials: H
authors.lastname: McGee
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000523:psychology; D000368:Aged; D059445:Anhedonia; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results