Depression and Anxiety after an Acute Coronary Syndrome in a Primary Care Setting

BACKGROUND: Depression and anxiety inhibit recovery, decrease medication compliance, and have a negative impact on social functioning in patients after an acute coronary syndrome (ACS). Few studies have examined patterns of change in anxiety and depression, and the effectiveness of cognitive behavioral therapy (CBT) on these mood disorders, in patients with an ACS.

OBJECTIVES: The primary objective of this study was to examine patterns of change in the joint distribution of depression and anxiety in ACS patients. Our secondary study objectives were to examine the effect of CBT on depression and anxiety, and to determine if both mood disorders change at the same rate with the administration of CBT.

METHODS: A total of 100 patients with an ACS and scores on the Hospital and Anxiety Depression Scale (HADS) indicating mild to severe depression and/or anxiety at 1 month post-hospital discharge were enrolled in this trial. Patients completed the HADS at baseline and at 2, 3, and 6 months post-baseline.

RESULTS: The average age of study patients was 60 years and 30% were women. Patients in the intervention group had 20% of improvement in the HADS scores for depression and anxiety at the end of the study. The correlations between anxiety and depression scores followed a similar trajectory in the intervention group and controls, but the correlation coefficients were higher in the treatment group at the different follow-up points. CBT appeared to have similar effects on both mood disorders.

CONCLUSIONS: The results of this study indicate that depression and anxiety are highly correlated in ACS patients both at baseline and over a 6 month follow-up period. The intervention does not appear to uncouple the correlation between anxiety and depression, suggesting that the intervention has comparable effects on both mood disorders.