title: Characteristics associated with anxiety, depressive symptoms, and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients.
abstract: OBJECTIVE
  Although most patients with implantable cardioverter defibrillators (ICDs) adjust well, some have considerable psychological distress. Factors associated with psychological adjustment in ICD-recipients are still not well understood. Our purpose was to describe quality-of-life (QoL) and prevalence of self-reported symptoms of anxiety and depression in a large national cohort of ICD-recipients, and to determine socio-demographic, clinical, and ICD-related factors associated with these variables.
  
  
  METHODS
  A cross-sectional, correlational design was used. All eligible adult ICD-recipients in the Swedish ICD- and Pacemaker Registry were invited to participate. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and QoL with the EuroQol-5D.
  
  
  RESULTS
  A total of 3067 ICD-recipients (66±11years, 80% male) were included. The mean HADS score was 3.84±3.70 for anxiety symptoms and 2.99±3.01 for symptoms of depression. The mean EQ-5D index score was 0.82±0.21. The probability of symptoms of anxiety and depression was associated with younger age, living alone, and a previous history of myocardial infarction or heart failure. Additionally, female ICD-recipients had a higher probability of symptoms of anxiety. A higher level of ICD-related concerns was most prominently related to symptoms of anxiety, depressive symptoms and poorer QoL, while number of shocks, ICD-indication and time since implantation were not independently related.
  
  
  CONCLUSIONS
  In this large cohort of ICD-recipients, the association of ICD-related concerns with symptoms of anxiety, depressive symptoms, and poor QoL suggests that ICD specific factors should be addressed in order to improve outcomes.
authors: Department of Cardiology and Department of Medicine and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping, Sweden. Electronic address: ingela.thylen@lio.se.
authors: Ingela
authors: I
authors: Thylén
authors: College of Nursing, University of Kentucky, Lexington, United States. Electronic address: rebecca.dekker@uky.edu.
authors: Rebecca L
authors: RL
authors: Dekker
authors: Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden. Electronic address: tiny.jaarsma@liu.se.
authors: Tiny
authors: T
authors: Jaarsma
authors: Department of Cardiology and Department of Medicine and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping, Sweden. Electronic address: anna.stromberg@liu.se.
authors: Anna
authors: A
authors: Strömberg
authors: College of Nursing, University of Kentucky, Lexington, United States. Electronic address: dmoser@email.uky.edu.
authors: Debra K
authors: DK
authors: Moser
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D001008:Anxiety Disorders / Q000209:etiology* / Q000523:psychology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000209:etiology* / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries
keywords: Anxiety; Depression; Implantable cardioverter defibrillator; Patient outcomes; Psychological distress; Quality-of-life