title: Coexisting anxiety and depressive symptoms in patients with heart failure.
abstract: BACKGROUND
  Among patients with heart failure (HF), anxiety symptoms may co-exist with depressive symptoms. However, the extent of overlap and risk factors for anxiety symptoms have not been thoroughly described.
  
  
  OBJECTIVE
  The aim of this study was to describe the coexistence of anxiety and depressive symptoms, and to determine the predictors of anxiety symptoms in patients with HF.
  
  
  METHODS
  The sample consisted of 556 outpatients with HF (34% female, 62±12 years, 54% New York Heart Association (NYHA) class III/IV) enrolled in a multicenter HF quality of life registry. Anxiety symptoms were assessed with the Brief Symptom Inventory-anxiety subscale. Depressive symptoms were measured with the Beck Depression Inventory-II (BDI). We used a cut-point of 0.35 to categorize patients as having anxiety symptoms or no anxiety symptoms. Logistic regression was used to determine whether age, gender, minority status, educational level, functional status, comorbidities, depressive symptoms, and antidepressant use were predictors of anxiety symptoms.
  
  
  RESULTS
  One-third of patients had both depressive and anxiety symptoms. There was a dose-response relationship between depressive symptoms and anxiety symptoms; higher levels of depressive symptoms were associated with a higher level of anxiety symptoms. Younger age (odds ratio (OR)= 0.97, p=0.004, 95% confidence interval (CI) 0.95-0.99) and depressive symptoms (OR =1.25, p<0.001, 95% CI 1.19-1.31) were independent predictors of anxiety symptoms.
  
  
  CONCLUSIONS
  Patients with HF and depressive symptoms are at high risk for experiencing anxiety symptoms. Clinicians should assess these patients for comorbid anxiety symptoms. Research is needed to test interventions for both depressive and anxiety symptoms.
authors.affiliation: 1College of Nursing, University of Kentucky, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Dekker
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
authors.forename: Lynn V
authors.initials: LV
authors.lastname: Doering
authors.forename: Misook L
authors.initials: ML
authors.lastname: Chung
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Wu
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D064646:Cardiovascular Nursing / Q000379:methods*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000451:nursing / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D011581:Psychological Tests; D011788:Quality of Life / Q000523:psychology; D012042:Registries; D012307:Risk Factors
keywords: Cardiovascular; anxiety disorder; depressive disorder; heart failure