Concerns about implantable cardioverter-defibrillator shocks mediate the relationship between actual shocks and psychological distress.
OBJECTIVE
Although most implantable cardioverter-defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not yet been investigated. Our objective was to examine whether the relationship between receipt of defibrillating shocks and psychological distress was mediated by patients' concerns related to their ICD.


RESULTS
All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3067 completing the survey (55% response rate). Their mean age was 66 ± 11 years, and 80% were male. One-third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression [odds ratio (OR) 1.58 and OR 3.04, respectively]. The association between receipt of shocks and psychologically distress was mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety, and 54% of the relationship between shocks and symptoms of depression.


CONCLUSIONS
Implantable cardioverter-defibrillator-related concerns have a bigger impact on psychological distress than receipt of an actual shock. Assessing ICD-related concerns in clinical practice can identify patients at risk for psychological distress. Further research on assessment of, and interventions targeting, ICD-related concerns is warranted.
Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden.
Ingela
I
Thylén
College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA University of Ulster, Newtownabbey, UK dmoser@uky.edu.
Debra K
DK
Moser
Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden.
Anna
A
Strömberg
College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA.
Rebecca A
RA
Dekker
College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA.
Misook L
ML
Chung
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D002318:Cardiovascular Diseases / Q000628:therapy*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression; D004554:Electric Countershock / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D057566:Self Report; D013315:Stress, Psychological; D013548:Sweden; D055815:Young Adult
ICD shocks; ICD-related concerns; Implantable cardioverter-defibrillator; Mediators; Psychological distress