title: The importance of depression and alcohol use in coronary artery bypass graft surgery patients: risk factors for delirium and poorer quality of life.
abstract: OBJECTIVE
  To investigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after coronary artery bypass (CABG) surgery.
  
  
  METHODS
  A total of 180 CABG patients (mean age of 63.5 ± 10.1 years, 82.2% males) completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.
  
  
  RESULTS
  Delirium developed in 63 persons (35% of sample). After adjustment for covariates, delirium was significantly associated with depression [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03-1.13, P = 0.003], anxiety (OR: 1.07; 95% CI: 1.02-1.13, P = 0.01) and stress (OR: 1.05; 95% CI: 1.00-1.09, P = 0.03). Preoperative depression scores were associated with poorer QOL including bodily pain (β = -0.39, P = 0.013), vitality (β = -0.32, P = 0.020), social functioning (β = -0.51, P ≤ 0.001), emotional role function (β = -0.44, P = 0.003) and general health (β = -0.33, P = 0.038). Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.
  
  
  CONCLUSIONS
  Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.
authors.affiliation: School of Psychology, Faculty of Health Sciences, University of Adelaide, Australia.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Humphreys
authors.affiliation: School of Psychology, Faculty of Health Sciences, University of Adelaide, Australia.
authors.forename: Linley A
authors.initials: LA
authors.lastname: Denson
authors.affiliation: Cardiac Surgery Research, Department of Surgery, School of Medicine, Flinders University of South Australia, Australia.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baker
authors.affiliation: University of Bordeaux, Department of Neuroepidemiology, Bordeaux, France; INSERM, Department of Neuroepidemiology, Bordeaux, France; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, University of Adelaide, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
keywords: Coronary artery bypass grafts; Coronary heart disease; Delirium; Depression; Quality of life