title: Depression, anxiety and major adverse cardiovascular and cerebrovascular events in patients following coronary artery bypass graft surgery: a five year longitudinal cohort study.
abstract: BACKGROUND
  Although depression and anxiety have been implicated in risk for major adverse cardiovascular and cerebrovascular events (MACCE), a theoretical approach to identifying such putative links is lacking. The objective of this study was to examine the association between theoretical conceptualisations of depression and anxiety with MACCE at the diagnostic and symptom dimension level.
  
  
  METHODS
  Before coronary artery bypass graft (CABG) surgery, patients (N = 158; 20.9 % female) underwent a structured clinical interview to determine caseness for depression and anxiety disorders. Depression and anxiety disorders were arranged into the distress cluster (major depression, dysthymia, generalized anxiety disorder, post-traumatic stress disorder) and fear cluster (panic disorder, agoraphobia, social phobia). Patients also completed the self-report Mood and Anxiety Symptom Questionnaire, measuring anhedonia, anxious arousal and general distress/negative affect symptom dimensions. Incident MACCE was defined as fatal or non-fatal; myocardial infarction, unstable angina pectoris, repeat revascularization, heart failure, sustained arrhythmia, stroke or cerebrovascular accident, left ventricular failure and mortality due to cardiac causes. Time-to-MACCE was determined by hazard modelling after adjustment for EuroSCORE, smoking, body mass index, hypertension, heart failure and peripheral vascular disease.
  
  
  RESULTS
  In the total sample, there were 698 cumulative person years of survival for analysis with a median follow-up of 4.6 years (interquartile range 4.2 to 5.2 years) and 37 MACCE (23.4 % of total). After covariate adjustment, generalized anxiety disorder was associated with MACCE (hazard ratio [HR] = 2.79, 95 % confidence interval [CI] 1.00-7.80, p = 0.049). The distress disorders were not significantly associated with MACCE risk (HR = 2.14; 95 % CI .92-4.95, p = 0.077) and neither were the fear-disorders (HR = 0.24, 95 % CI .05-1.20, p = 0.083). None of the symptom dimensions were significantly associated with MACCE.
  
  
  CONCLUSIONS
  Generalized anxiety disorder was significantly associated with MACCE at follow-up after CABG surgery. The findings encourage further research pertaining to generalized anxiety disorder, and theoretical conceptualizations of depression, general distress and anxiety in persons undergoing CABG surgery.
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergstr. 41, D-79085 Freiburg, Germany ; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia ; Department of Medicine, Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Adelaide, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: School of Psychology, The University of Adelaide, Adelaide, Australia.
authors.forename: Helen R
authors.initials: HR
authors.lastname: Winefield
authors.affiliation: Department of Medicine, Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Adelaide, Australia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.affiliation: CoRPS, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
authors.affiliation: Department of Psychology, University of Southern Denmark, Odense, Denmark ; Department of Cardiology, Odense University Hospital, Odense, Denmark ; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.affiliation: Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wittert
authors.affiliation: Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia ; School of Psychology, The University of Adelaide, Adelaide, Australia.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Turnbull
keywords: Cardiovascular disease; Coronary artery bypass grafts; Coronary heart disease; Depression; Generalized anxiety disorder; Prognosis; Survival analysis