title: A Single, One-Off Measure of Depression and Anxiety Predicts Future Symptoms, Higher Healthcare Costs, and Lower Quality of Life in Coronary Heart Disease Patients: Analysis from a Multi-Wave, Primary Care Cohort Study.
abstract: OBJECTIVE
  To determine whether a one-off, baseline measure of depression and anxiety in a primary care, coronary heart disease (CHD) population predicts ongoing symptoms, costs, and quality of life across a 3-year follow-up.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  16 General Practice surgeries across South-East London.
  
  
  METHODS
  803 adults (70% male, mean age 71 years) contributing up to 7 follow-up points.
  
  
  METHODS
  Ongoing reporting of symptoms, health care costs, and quality of life.
  
  
  RESULTS
  At baseline, 27% of the sample screened positive for symptoms of depression and anxiety, as measured by the Hospital Anxiety and Depression Scale (HADS). The probability of scoring above the cut-off throughout the follow-up was 71.5% (p<0.001) for those screening positive at baseline, and for those screening negative, the probability of scoring below the cut-off throughout the follow-up was 97.6% (p<0.001). Total health care costs were 39% higher during follow-up for those screening positive (p<0.05). Quality of life as measured by the SF-12 was lower on the mental component during follow-up for those screening positive (-0.75, CI -1.53 to 0.03, p = 0.059), and significantly lower on the physical component (-4.99, CI -6.23 to -.376, p<0.001).
  
  
  CONCLUSIONS
  A one-off measure for depression and anxiety symptoms in CHD predicts future symptoms, costs, and quality of life over the subsequent three-years. These findings suggest symptoms of depression and anxiety in CHD persist throughout long periods and are detrimental to a patient's quality of life, whilst incurring higher health care costs for primary and secondary care services. Screening for these symptoms at the primary care level is important to identify and manage patients at risk of the negative effects of this comorbidity. Implementation of screening, and possible collaborative care strategies and interventions that help mitigate this risk should be the ongoing focus of researchers and policy-makers.
authors.affiliation: Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.|Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Palacios
authors.affiliation: NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom.|Department of Applied Health Research, University College London, London, United Kingdom.
authors.forename: Mizanur
authors.initials: M
authors.lastname: Khondoker
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Evanthia
authors.initials: E
authors.lastname: Achilla
authors.affiliation: Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
authors.forename: Andre
authors.initials: A
authors.lastname: Tylee
authors.affiliation: Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.|NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
mesh_terms: D001007:Anxiety / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications* / Q000191:economics / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology; D017048:Health Care Costs; D006801:Humans; D008131:London; D011788:Quality of Life