title: Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease.
abstract: BACKGROUND
  Depression has been related to mortality in coronary heart disease (CHD) patients, but few studies have evaluated the role of anxiety or the role of the co-occurrence of depression and anxiety. We examined whether anxiety is associated with increased risk of mortality after accounting for depression in individuals with established CHD.
  
  
  RESULTS
  The cohort was composed of 934 men and women with confirmed CHD (mean age, 62±11 years) who completed the Hospital Anxiety and Depression scale (HADS) during hospitalization for coronary angiography. Over the 3-year follow-up period, there were 133 deaths. Elevated scores on the HADS anxiety subscale (HADS-A≥8) were associated with increased risk of mortality after accounting for established risk factors including age, congestive heart failure, left ventricular ejection fraction, 3-vessel disease, and renal disease (hazard ratio [HR], 2.27; 95% CI, 1.55 to 3.33; P<0.001). Elevated scores on the HADS depression subscale (HADS-D≥8) were also associated with increased risk of mortality (HR, 2.18; 95% CI, 1.47 to 3.22; P<0.001). When both psychosocial factors were included in the model, each maintained an association with mortality (anxiety, HR, 1.83; 95% CI, 1.18 to 2.83; P=0.006; depression, HR, 1.66; 95% CI, 1.06 to 2.58; P=0.025). Estimation of the HR for patients with both anxiety and depression versus those with neither revealed a larger HR than for patients with either factor alone (HR, 3.10; 95% CI, 1.95 to 4.94; P<0.001).
  
  
  CONCLUSIONS
  Anxiety is associated with increased risk of mortality in CHD patients, particularly when comorbid with depression. Future studies should focus on the co-occurrence of these psychosocial factors as markers of increased mortality risk.
authors.affiliation: Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. watki017@mc.duke.edu
authors.forename: Lana L
authors.initials: LL
authors.lastname: Watkins
authors.forename: Gary G
authors.initials: GG
authors.lastname: Koch
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherwood
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Jonathan R T
authors.initials: JR
authors.lastname: Davidson
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Connor
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sketch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology*; D001008:Anxiety Disorders / Q000453:epidemiology*; D002423:Cause of Death; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000453:epidemiology*; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
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