Anxiety, Depression May Triple Heart Patients' Death Risk
Researcher recommends stress-reducing measures
The investigators found that 90 patients had anxiety, 65 had depression and 99 suffered from both.
Of the 133 patients who died over the three years of follow-up, 55 suffered from anxiety, depression or both, the researchers reported. Most of these deaths (93) were related to heart disease, they noted.
Patients who are highly anxious during a stressful life experience, such as a cardiac hospitalization, are at an increased risk of dying, and this risk is independent of the severity of their heart disease and also of depression, Watkins said.
According to the researchers, anxiety can increase inflammation and blood pressure. Fatigue or feelings of worthlessness associated with depression may cause people to ignore their treatment for heart disease.
Simon Rego, director of psychology training at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said these findings show how mental health issues can complicate medical problems.
"These findings lend further support to the serious impact that psychological disorders can have on medical outcomes, and suggest that patients presenting with medical conditions and/or for medical procedures should be routinely assessed for both anxiety and depression," Rego said.
Patients with anxiety and/or depression should, at a minimum, have their symptoms closely monitored on a regular basis, and ideally get referred to a psychologist with expertise in treatments for anxiety and depression, such as cognitive behavioral therapy, Rego said. Cognitive behavioral therapy is a treatment that helps patients try to change their thoughts, feelings and behaviors.
Whether treating anxiety and depression in these patients will reduce the risk of dying isn't clear, however, Fonarow said.
"Further studies are needed to determine if effective treatment of anxiety and depression can reduce cardiovascular risk," he said.
The authors acknowledge that one limitation of the study is that it did not account for substance use and abuse, which tends to be high in people with depression and anxiety disorders.
While the study found an association between an increased risk of death from all causes and having heart disease accompanied by anxiety and depression, it did not prove a cause-and-effect relationship.