Exploring anxiety, depression and their correlates among Implantable Cardioverter Defibrillator (ICD) recipients and people with chronic heart failure

Davidson, Claire (2021) Exploring anxiety, depression and their correlates among Implantable Cardioverter Defibrillator (ICD) recipients and people with chronic heart failure. D Clin Psy thesis, University of Glasgow.

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Aims and Objectives:To systematically review factors influencing anxiety and depression in implantable cardioverter defibrillator (ICD) recipients.

Background: An ICD is a device used to prevent life-threatening ventricular arrhythmias. While the ICD is accepted by most recipients: a considerable number of patients experience distress following implant. The socio-demographic, clinical, ICD- specific and psychosocial factors associated with distress in ICD-recipients has received increasing attention.

Methods:Six electronic databases (Applied Social Science Index and Abstract, CINAHL, EMBASE, Medline, Psychology and Behavioral Sciences Collection and PsycINFO) were searched on the 24/07/2020. Additional papers were identified by hand searching relevant journals, forward citation searching and reviewing the reference lists of included studies. This review was limited to studies on adult patients who received a transvenous or automatic ICD or ICD with cardiac resynchronisation therapy for primary or secondary prevention purposes. Other inclusion criteria were peer reviewed quantitative papers published in English from January 2014 to July 2020, which examined factors influencing anxiety and depression. The quality of the papers was rated using the Crowe Critical Appraisal Tool.

Results: Anxiety and depression were linked to socio-demographic factors (female sex, younger age, living alone), clinical factors (heart failure, coronary heart-disease or history of emotional distress/psychotropic medication use), ICD-specific factors (elevated ICD-related concerns, low ICD knowledge, negative treatment expectations), and psychosocial factors (avoidance, perceived control, Type D personality and optimism).

Conclusions: All papers suffered from methodological limitations and the findings should be interpreted with caution. Future research employing prospective longitudinal designs with controls for confounding factors is required to understand the relationship between socio-demographic, clinical, ICD-specific and psychosocial factors and distress in ICD-recipients over time.

Relevance to clinical practice: Results demonstrated a relationship between elevated ICD-related concerns and increased distress in ICD-recipients. Routine screening for ICD-related concerns may identify patients at risk of anxiety and depression post ICD- implant.

Aims and Objectives: To describe the trajectory of anxiety and depression in Chronic Heart Failure (CHF) patients during 12-month follow-up and to identify characteristics independently associated with anxiety and depression.

Background: CHF patients with depression and anxiety are at increased risk of poorer outcomes including hospital readmission. There is limited research describing the trajectories of anxiety and depression in CHF patients over time.

Design: The study was a secondary analysis of data collected in a longitudinal study investigating the palliative care needs of 272 CHF patients in Glasgow.

Methods: Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline and every four-months.

Results: From baseline to 12-months, there was a significant reduction in the proportion of CHF patients reporting symptoms of anxiety (43.5% vs 25%) and depression (40% vs 27.4%). Looking at change in HADS scores over 12-months, 54.3% of patients were free of significant anxiety at all assessments, 21.7% showed an improvement in initially distressing anxiety, and 2.2% developed anxiety as the study progressed. Based on change in HADS depression scores across 12-months, 53.7% did not report significant depression, 18.9% experienced resolution of depression symptoms, and 6.3% went on to develop depression as the study progressed. One in five patients experienced persistent anxiety and depression throughout. In regression analysis, baseline anxiety, health- related quality of life, history of depression and female sex emerged as predictors of anxiety, while baseline depression, history of depression, antidepressant medication use, and female sex predicted depression.

Conclusions: Results suggest a significant reduction in the proportion of CHF patients reporting clinically significant anxiety and depression from baseline to 12-month follow- up. Although there was a subset of participants that experienced persistent symptoms of anxiety and depression.

Relevance to Clinical Practice: Routine screening for anxiety and depression in CHF patients is recommended.

Item Type: Thesis (D Clin Psy)
Qualification Level: Doctoral
Keywords: anxiety, depression, implantable cardioverter defibrillator anxiety, depression, heart failure.
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Life Sciences
Supervisor's Name: McLeod, Professor Hamish and Robb, Dr Katie
Date of Award: 2021
Depositing User: Miss Claire Davidson
Unique ID: glathesis:2021-82186
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 14 May 2021 10:15
Last Modified: 21 Nov 2022 09:37
Thesis DOI: 10.5525/gla.thesis.82186
URI: http://theses.gla.ac.uk/id/eprint/82186

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