title: Symptom dimensions of anxiety following myocardial infarction: associations with depressive symptoms and prognosis.
abstract: OBJECTIVE
  Differential associations of symptom dimensions with prognosis in myocardial infarction (MI) patients have been shown for depression, but no studies have focused on anxiety dimensions. The aim of this study was to assess the association between somatic and psychological symptoms of anxiety following acute MI with adverse prognosis and to assess the overlap between anxiety and depression dimensions.
  
  
  METHODS
  Patients (n = 418) were assessed on demographic and clinical variables. The Hamilton Anxiety and Depression Rating Scales were used to measure anxiety and depression 2 months post-MI. Mean follow-up period was 3.8 years and the endpoint consisted of all-cause mortality and recurrent MI.
  
  
  RESULTS
  After adjustment for demographic and clinical variables, somatic anxiety was significantly associated with recurrent MI and mortality (HR: 1.32; 95% CI [1.03, 1.69]; p = .03), and a trend was shown for an association between psychological anxiety and outcome (HR: 1.29; 95% CI [0.99, 1.67]; p = .06). The total anxiety score of the HARS was the strongest predictor of recurrent MI and mortality (HR: 1.38; 95% CI [1.07, 1.78]; p = .02). The HARS and the HDRS were highly correlated (r = .86; p < .01). Dimensions consisting of psychological distress (HR: 1.29; 95% CI [1.02, 1.63]; p = .03) and cardiopulmonary/autonomic symptoms (HR: 1.36; 95% CI [1.06, 1.75]; p = .02) also predicted outcome in adjusted analyses.
  
  
  CONCLUSIONS
  Anxiety was associated with adverse prognosis in MI patients with significant associations for somatic anxiety and total anxiety. When combining anxiety and depression items, psychological distress and cardiopulmonary/autonomic symptoms predicted recurrent MI and mortality. Future research might better focus on dimensions of anxiety and depression simultaneously in MI patients.
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology, Tilburg University.
authors.forename: Annelieke M
authors.initials: AM
authors.lastname: Roest
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology, Tilburg University.
authors.forename: Anne
authors.initials: A
authors.lastname: Heideveld
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology, Tilburg University.
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Martens
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology, Tilburg University.
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical Psychology, Tilburg University.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000368:Aged; D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000473:pathology / Q000523:psychology*; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012008:Recurrence