Mood disorders affect one in ten ICD patients
04 Jul 2023
byKanas Chan
Depression, anxiety, and post-traumatic stress disorder (PTSD) are highly prevalent in patients with an implantable cardioverter defibrillator (ICD), a meta-analysis has revealed.
“Poor mood outcomes in ICD patients are gaining increasing attention as they are associated with lower quality of life and well-being, along with increased mortality,” said lead author Professor Hannah Keage of the University of South Australia, Adelaide, Australia.
To determine rates of depression, anxiety, and PTSD (ie, presence of a diagnosis or clinically relevant symptomology) in ICD patients, the researchers conducted a random-effects meta-analysis of 109 studies (n=39,954; mean age, 64 years; male, 91 percent). Differences in rates of these psychiatric conditions between sex, shock status, and ICD indication (primary vs secondary) were also investigated in subgroup analyses. [Europace 2023;doi:10.1093/europace/euad130]
“Poor mood outcomes in ICD patients are gaining increasing attention as they are associated with lower quality of life and well-being, along with increased mortality,” said lead author Professor Hannah Keage of the University of South Australia, Adelaide, Australia.
To determine rates of depression, anxiety, and PTSD (ie, presence of a diagnosis or clinically relevant symptomology) in ICD patients, the researchers conducted a random-effects meta-analysis of 109 studies (n=39,954; mean age, 64 years; male, 91 percent). Differences in rates of these psychiatric conditions between sex, shock status, and ICD indication (primary vs secondary) were also investigated in subgroup analyses. [Europace 2023;doi:10.1093/europace/euad130]
Rates of anxiety and depression were notably high (32 percent and 23 percent, respectively) in the first 5 months after ICD implantation. “This is higher than the general population, where the estimated point prevalence of anxiety and depression was 7 percent and 13 percent, respectively,” pointed out the researchers. [Psychol Med 2013;43:897-910; Sci Rep 2018;8:2861]
Depression symptoms significantly decreased in the first 5 months after ICD implantation (Hedges’ g, 0.13; 95 percent confidence interval [CI], 0.03–0.23), while anxiety symptoms significantly decreased after 6 months (Hedges’ g, 0.07; 95 percent CI, 0.00–0.14).
After 12 months, rates of anxiety and depression dropped to 22.39 percent and 13.6 percent, respectively. “The decline in mood disorders over time could be due to several factors, including patients getting psychological help or adapting to their new life,” Keage explained. “Anxiety appears to be consistently more prevalent than depression [in] ICD patients and is likely the primary psychological issue revolving around fear of recurrence of arrhythmia and shock.”
Results of subgroups analyses showed no significant differences in rates of depression and anxiety between primary and secondary ICD indications. “However, ICD patients who experienced a shock were four times more likely to have anxiety [odds ratio (OR), 3.92; 95 percent CI, 1.67–9.15; k=5] and nearly twice as likely to have depression [OR, 1.87; 95 percent CI, 1.34–2.59; k=4],” reported the researchers.
Furthermore, anxiety symptom burden was higher in females (Hedges’ g=0.39; 95 percent CI, 0.15–0.62) vs males. “The sex differences were expected as rates of anxiety are generally higher in women compared with men,” they explained.
The most striking finding relates to PTSD, which was apparent in 12 percent of ICD patients >12 months after implantation – a rate far higher than the point prevalence in the general population (1–2 percent) and equal to that in US military veterans (12 percent).
“The findings make a lot of sense, as cardiac health and mood disorders go hand in hand. Poor mental health can also lead to cardiac problems through chronic stress and unhealthy lifestyles,” Keage commented.
“Psychologists have had little involvement in the care of cardiac patients, but this needs to change,” said Keage. “I would encourage patients and their partners to seek help if their mood is low or if they are overly worried, as there are evidence-based therapies for anxiety, depression and PTSD.”