Psychosocial assessment and psychological interventions following a cardiac event

Abstract

If, for example, depression is not addressed, it may have negative consequences for the patient and healthcare system, including poorer patient health outcomes, quality of life and well-being, incomplete or failed return to work and attenuation of healthcare costs.3–5 Depression and anxiety are common among people with CVD: 30% of women and 20% of men report clinically relevant symptoms of depression; 39% of women and 22% of men report clinically relevant symptoms of anxiety.6 The prevalence of depression and anxiety is higher in CVD populations than in the general population.4 In some CVD populations, for example, with an implantable cardioverter defibrillator (ICD), over 50% meet the criteria for anxiety.7 Depression and anxiety are associated with being female, having a lower level of educational attainment, a sedentary or inactive lifestyle, more severe symptoms, poorer quality of life, increased risk of disease and death and increased healthcare costs.6 8 Moreover, as CVD and depression are the most common causes of disability in high income countries and predicted to remain among the top 10 of diseases worldwide until at least 2030,9 the challenges they pose in CVD prevention and the consequences to the quality of care for patients are considerable. Lower socioeconomic status, loneliness, social isolation and a lack of social support are often inter-related and linked to depression and increased CVD risk,17–19 and compounded by factors such as unemployment, occupational stress and strain, financial insecurity, loss of independence and low self-esteem.11 15 Older people and those living alone are particularly vulnerable.20 21 Thus, efforts to strengthen social connections and social support, including existing family relationships and networks, are likely to help combat loneliness and social isolation and also offer protection from depression.22 While social technology may potentially combat loneliness and isolation (by facilitating social connection), it may not be an effective substitute for face-to-face social interaction. [...]a recent study in patients with an ICD indicates that several patients develop new onset anxiety and depression during 24 months of follow-up, which suggests that screening several times may be warranted.31 In addition, given the paucity of studies like the Comparison of Depression Interventions after Acute Coronary Syndrome: Quality of Life randomised clinical trial, it may be premature to conclude that screening combined with treatment does not work.26Box 2 Reasons for screening for psychosocial risk factors in patients with CVD 27–30 Highly prevalent in patients with CVD—20% suffer from anxiety and/or depression that warrant treatment. [...]when screening patients, for example, for depression (figure 2) as recommended,36 in our example using the Patient Health Questionnaire 9-item depression scale,35 we should consider focusing on the ‘negative’ (ie, on anxiety, depression, distress) and use measures that are more positive and tap into, for example, optimism, happiness, positive affect and gratitude, as also recommended,2 as positive factors are associated with better patient-reported and clinical outcomes and negative factors associated with worse outcomes (box 4).Box 4 Assessment: measures of positive psychological health2 Positive psychological health Happiness.

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