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Time-dependent depression and anxiety symptoms as risk factors for recurrent cardiac events: findings from the UPBEAT-UK study

Published online by Cambridge University Press:  10 February 2021

Joanna Norton Open the ORCID record for Joanna Norton [Opens in a new window] ,
Manuela Pastore ,
Matthew Hotopf ,
Andre Tylee ,
Anthony Mann ,
Marie-Laure Ancelin  and
Jorge Palacios
Joanna Norton*
Affiliation:
Univ Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
Manuela Pastore
Affiliation:
Univ Montpellier, CNRS, Inserm, Biocampus UAR3426, Montpellier, France
Matthew Hotopf
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK South London and Maudsley NHS Foundation Trust, London, UK
Andre Tylee
Affiliation:
Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Anthony Mann
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Marie-Laure Ancelin
Affiliation:
Univ Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
Jorge Palacios
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
Author for correspondence: Joanna Norton, E-mail: [email protected]
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Abstract

Background

Depression is a well-known risk factor for recurrent cardiac events (RCEs) but findings are less consistent for anxiety, not previously reported on using a time-dependent approach. We aimed to study the prognostic effect of anxiety and depression symptom levels on RCEs.

Methods

Data (N = 595) were drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Hospital Anxiety and Depression Scale symptoms were grouped into: agitation (three items), anxiety (four items), and depression (seven items) subscales. We performed two types of multivariate analyses using Cox proportional hazard models with delayed entry: with baseline variables (long-term analysis), and with variables measured 12-to-18 months prior to the event (short-term time-dependent analysis), as RCE risk factors.

Results

In the baseline analysis, both anxiety and depression, but not agitation, were separate RCE risk factors, with a moderating effect when considered jointly. In the short-term time-dependent analysis, elevated scores on the anxiety subscale were associated with increased RCE risk even when adjusted for depression [hazard ratio (95% confidence interval) 1.22 (1.05–1.41), p = 0.009]. Depression was no longer a significant predictor when adjusted for anxiety [1.05 (0.87–1.27), p = 0.61]. For anxiety, individual items associated with RCEs differed between the two approaches: item 5 ‘worrying thoughts’ was the most significant long-term risk factor [1.52 (1.21–1.91), p = 0.0004] whereas item 13 ‘feelings of panic’ was the most significant time-dependent short-term risk factor [1.52 (1.18–1.95), p = 0.001].

Conclusions

Anxiety is an important short-term preventable and potentially causal risk factor for RCEs, to be targeted in secondary cardiac disease prevention programmes.

Keywords

Anxietycardiac diseasedepressionrecurrent cardiac eventtime-dependent analysis
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 15 , November 2022 , pp. 3442 - 3450
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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