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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 36  |  Issue : 3  |  Page : 139-143

Psychiatric morbidity and quality of life in cardiac patients


Department of Psychiatry, Faculty of Medicine, Misr University for Sciences and Technology, Giza, Egypt

Date of Submission03-Aug-2015
Date of Acceptance13-Sep-2015
Date of Web Publication30-Sep-2015

Correspondence Address:
Samah H Rabei
5 Omroo Al Kaysst, 7th District, Nasr City, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1105.166353

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  Abstract 

Background
Cardiac patients have increased rates of psychiatric morbidity and unsatisfactory quality of life (QoL).
Aim of the study
The study aims to detect psychiatric morbidity and QoL in cardiac patients.
Study design
This is an observational, analytical, cross-sectional field study.
Patients and methods
Thirty patients were recruited from the cardiac clinics, wards, and critical care units of three hospitals (10 from Ain Shams University Hospital, 10 from Kasr Al Ainy University Hospital, and 10 from Misr University Hospital). Patients were assessed using the ICD-10 criteria, the Egyptian version of the Suicide Probability Scale, and the Arabic version of the World Health Organization Quality of Life Questionnaire.
Results
Cardiac patients have increased rates of psychiatric morbidity and unsatisfactory QoL and increased suicidal probability. Positive associations were found between the following: (a) job, residence, type of cardiac disease, hospital accommodation, and QoL; (b) presence of comorbidity and ICD-10 diagnoses; and (c) marital state, type of cardiac disease, presence of comorbidity, and increased suicidal probability.

Keywords: Adjustment, anxiety, depression


How to cite this article:
Bastawy MA, Rabei SH. Psychiatric morbidity and quality of life in cardiac patients. Egypt J Psychiatr 2015;36:139-43

How to cite this URL:
Bastawy MA, Rabei SH. Psychiatric morbidity and quality of life in cardiac patients. Egypt J Psychiatr [serial online] 2015 [cited 2021 May 5];36:139-43. Available from: http://new.ejpsy.eg.net/text.asp?2015/36/3/139/166353


  Review of literature Top


Depression and anxiety are associated with adverse cardiovascular outcomes in patients with recent acute cardiac events [1] . Links between the heart and emotion have been postulated for centuries. However, data supporting this connection have only become available recently. A growing body of evidence now suggests that negative affective states, including anxiety, lead to an increased risk for cardiovascular disease [2],[3],[4],[5],[6] and that the presence of negative affective states is associated with poor long-term prognosis [7],[8],[9],[10] . Serious cardiac events are traumatic and life threatening. Some patients develop intrusive thoughts, memories, or nightmares about their cardiac event; they avoid situations that remind them of the event, and have disturbed sleep (e.g. irritability, insomnia) [11] . Certain patients with cardiac disease may be at particularly high risk for the development of post traumatic stress disorder (PTSD). For example, a recent study [12] found the prevalence of PTSD in cardiac arrest survivors to be 27% after more than 2 years following the incident, a significantly higher rate than would be expected given that the lifetime prevalence of PTSD is 7.8% [13] . In another study involving pediatric patients aged 5-12 years who underwent cardiac surgery [14] 12% met the criteria for PTSD and 23% had increases in PTSD symptomatology 4-8 weeks after surgery.

The third category of individuals that appears to be at risk for the development of PTSD or panic disorder comprises patients with automatic implantable cardioverter defibrillators, in whom unexpected firing of the defibrillator has been reported to lead to the full spectrum of PTSD symptoms [15],[16] or panic disorder [17] .

In addition to panic disorder associated with automatic implantable cardioverter defibrillators, some patients develop repeated, unexpected panic attacks after experiencing a myocardial infarction [18] . These panic attacks are frequently triggered by palpitations or other physical symptoms that the patient experienced during the original heart attack. As with idiopathic panic disorder, patients frequently develop agoraphobia and avoidance of activities that they associate with cardiac symptoms (e.g. exercise). As exercise is a fundamental part of cardiac rehabilitation, the development of panic disorder can impede progress toward recovery, in addition to reducing the quality of life (QoL). Treatment of postmyocardial infarction panic should include psychoeducation, cognitive behavioral therapy (CBT), and, in some cases, treatment with an selective serotonine reuptake inhibitors (SSRI).


  Aim of the study Top


The study aims to detect psychiatric morbidity and QoL in cardiac patients.


  Background Top


Cardiac patients have increased rates of psychiatric morbidity and unsatisfactory QoL.


  Study design Top


This is an observational, analytical, cross-sectional field study.


  Participants and methods Top


Thirty patients were recruited from the cardiac clinics, wards, and critical care units of three hospitals (10 from Ain Shams University Hospital, 10 from Kasr Al Ainy University Hospital, and 10 from Misr University Hospital). Patients were assessed using the ICD-10 criteria, the Egyptian version of the Suicide Probability Scale, and the Arabic version of the World Health Organization Quality of Life Questionnaire.


  Results Top


Descriptive

[Figure 1] shows the distribution of ICD-10 diagnosis among the cardiac patients: 37% (n = 11) of the patients were suffering from a depression disorder and 27% (n = 8) were suffering from generalized anxiety disorder or adjustment disorder.
Figure 1: Cardiac patients have increased rates of psychiatric morbidity

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[Figure 2] shows the distribution of the overall domain results of the QoL 100 questionnaire among cardiac patients: 77% (n = 23) of the cardiac patients described their overall QoL to be poor.
Figure 2: Cardiac patients have increased rates of unsatisfactory QoL

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[Figure 3] shows the results of suicidal probability among cardiac patients: 30% (n = 9) of the cardiac patients expressed mild suicidal probability and none of the patients who participated in the study showed high suicidal probability.
Figure 3: Cardiac patients have increased suicide probability

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Comparative analysis

A comparison of patient sociodemographic data with the results of the questionnaires used revealed the following:

There was a significant relationship (P < 0.05) between marital status and suicidal probability: 100% (n = 2) of cardiac patients who were single at the time of the study showed mild suicidal probability, whereas only 33.3% (n = 7) of the cardiac patients who were married showed mild suicidal probability [Table 1].
Table 1 Associating Qol and occupation


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There was a significant relationship between the occupation of cardiac patients and the results of the psychological domain of the QoL 100 questionnaire: all cardiac patients who were unemployed, who were working as skilled workers (n = 4), and those in professional jobs (n = 3) had poor scores on the psychological domain, whereas 60% (n = 6) of the employed cardiac patients and 36% (n = 4) of the cardiac patients working in unskilled jobs had poor scores on the psychological domain [Table 2].
Table 2 Associating marital state and suicidality


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There was a significant relationship between the residence of cardiac patients and the results of the psychological domain of the QoL 100 questionnaire: 72% (n = 18) of the cardiac patients who were living in urban areas showed poor results in the psychological domain, compared with only 20% (n = 1) of the cardiac patients living in rural areas [Table 3].
Table 3 Associating psychological QoL and residence


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There was a significant relationship between the residence of the cardiac patient and the results of the overall QoL of the QoL 100 questionnaire: 84% (n = 21) of the cardiac patients living in urban areas showed poor results as regards the overall QoL domain, compared with 40% (n = 5) of the cardiac patients living in urban areas [Table 4].
Table 4 Associating overall QoL and residence


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As regards the effect of the medical condition of the cardiac patient on the parameters of the study we found the following.

All cardiac patients suffering from infective endocarditis (n = 3) and the only patient suffering from heart failure showed mild suicidal probability, whereas 33.3% (n = 3) of the cardiac patients suffering from ischemic heart disease (IHD) had mild suicidal probability. The least suicidal probability in the sample was among patients with rheumatic heart diseases (11.1%, n = 1) [Table 5].
Table 5 Associating type of cardiac disease and suicidality


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There was a significant relationship between comorbidity and the results of suicidal probability: 47% (n = 8) of the cardiac patients suffering from comorbid medical conditions showed mild probability for suicide, in contrast to only 7.6% (n = 1) of cardiac patients not suffering from comorbid conditions [Table 6].
Table 6 Associating comorbidity and suicidality


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Comorbidity was also significantly associated with the ICD-10 diagnosis.

There was significant relationship between the presence of comorbid medical conditions and presence of ICD-10 diagnosis among cardiac patient who shared in the study, where 52.9% (n = 9) of the cardiac patients with a positive history of comorbid medical conditions were suffering from depression, 29% (n = 5) were suffering from adjustment disorder, and 17.6% (n = 3) were suffering from generalized anxiety disorder (GAD). None of them were ICD-10 diagnosis free [Table 7].
Table 7 Associating comorbidity and ICD-10 diagnoses


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There was a significant relationship between the type of cardiac disease and the physical QoL 100 questionnaire result: all cardiac patients suffering from rheumatic heart disease, infective endocarditis, and heart failure (n = 9, 3, and 1, respectively) showed poor physical QoL in the QoL 100 questionnaire, whereas only 33.3% (n = 15) of cardiac patients suffering from ischemic heart disease showed poor physical QoL [Table 8].
Table 8 Associating type of cardiac disease and physical QoL


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There was a significant relationship between patient accommodation in the hospital (according to illness severity) and the results of the environmental domain in the QoL 100 questionnaire: 70% (n = 7) of cardiac patients who were attending the outpatient clinic had a poor environmental QoL, compared with 40% (n = 4) of cardiac patients in the ward and 30% (n = 3) of cardiac patient being treated in the ICU [Table 9].
Table 9 Associating hospital accommodations and environmental QoL


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  Discussion Top


Major diseases such as cardiovascular diseases, especially myocardial infarction, cause many disabilities in patients, reducing their QoL [19],[20] . There exists many ways to promote QoL in patients. Interventions in life and habits may create constant changes in QoL. Another study [21] showed that there exists a significant relationship between QoL and participation in rehabilitation programs. Meyer and Laederach-Hofmann [22] suggested that in patients with stable chronic heart failure significant improvements in both generic and disease-specific QoL related to improved exercise tolerance can be achieved within 12 weeks of comprehensive rehabilitation.

Moreover, progress in physical and mental dimensions is seen in myocardial infarction patients after rehabilitation [21] .


  Conclusion Top


There is increased psychiatric morbidity and suicidality and decreased quality of life among cardiac patients.

Recommendations

Psychiatric screening and care should be routinely offered to cardiac patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Huffman JC, Mastromauro CA, Beach SR, Celano CM, DuBois CM, Healy BC, et al. (2014). Collaborative care for depression and anxiety disorders in patients with recent cardiac events: the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized clinical trial. JAMA Intern Med 174:927-935.   Back to cited text no. 1
    
2.
Kubzansky LD, Kawachi I (2000). Going to the heart of the matter: do negative emotions cause coronary heart disease? J Psychosom Res 48:323-337.  Back to cited text no. 2
    
3.
Eng PM, Fitzmaurice G, Kubzansky LD, Rimm EB, Kawachi I (2003). Anger expression and risk of stroke and coronary heart disease among male health professionals. Psychosom Med 65:100-110.  Back to cited text no. 3
    
4.
Rozanski A, Blumenthal JA, Kaplan J (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 99:2192-2217.  Back to cited text no. 4
    
5.
Kawachi I, Sparrow D, Vokonas PS, Weiss ST (1994). Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation 90:2225-2229.  Back to cited text no. 5
    
6.
Kawachi I, Colditz GA, Ascherio A, Rimm EB, Giovannucci E, Stampfer MJ, Willett WC Prospective study of phobic anxiety and risk of coronary heart disease in men. Circulation 1994; 89:1992-1997.  Back to cited text no. 6
    
7.
Carney RM, Freedland KE, Jaffe AS, Frasure-Smith N, Lesprance F, Sheps DS, et al. (2004). Depression as a risk factor for post-MI mortality. J Am Coll Cardiol 44:472-472.  Back to cited text no. 7
    
8.
Van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, et al. (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 66:814-822.  Back to cited text no. 8
    
9.
Strik JJ, Denollet J, Lousberg R, Honig A (2003). Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol 42:1801-1807.  Back to cited text no. 9
    
10.
Grace SL, Abbey SE, Irvine J, Shnek ZM, Stewart DE (2004). Prospective examination of anxiety persistence and its relationship to cardiac symptoms and recurrent cardiac events. Psychother Psychosom 73:344-352.  Back to cited text no. 10
    
11.
Mayou R, Williamson B, Foster A (1976). Attitudes and advice after myocardial infarction. Br Med J 1:1577-1579.  Back to cited text no. 11
    
12.
Gamper G, Willeit M, Sterz F, Herkner H, Zoufaly A, Hornik K, et al. (2004). Life after death: posttraumatic stress disorder in survivors of cardiac arrest - prevalence, associated factors, and the influence of sedation and analgesia. Crit Care Med 32:378-383.  Back to cited text no. 12
    
13.
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048-1060.  Back to cited text no. 13
    
14.
Connolly D, McClowry S, Hayman L, Mahony L, Artman M (2004). Posttraumatic stress disorder in children after cardiac surgery. J Pediatr 144:480-484.  Back to cited text no. 14
    
15.
Hamner M, Hunt N, Gee J, Garrell R, Monroe R (1999). PTSD and automatic implantable cardioverter defibrillators. Psychosomatics 40:82-85.  Back to cited text no. 15
    
16.
Neel M (2000). Posttraumatic stress symptomatology in patients with automatic implantable cardioverter defibrillators: nature and intervention. Int J Emerg Ment Health 2:259-263.  Back to cited text no. 16
    
17.
Godemann F, Butter C, Lampe F, Linden M, Schlegl M, Schultheiss HP, Behrens S (2004). Panic disorders and agoraphobia: side effects of treatment with an implantable cardioverter/defibrillator. Clin Cardiol 27:321-326.  Back to cited text no. 17
    
18.
Bovasso G, Eaton W (1999). Types of panic attacks and their association with psychiatric disorder and physical illness. Compr Psychiatry 40:469-477.  Back to cited text no. 18
    
19.
Mazeika PK (2000). Quality of life 4 years after myocardial infarction: short form 36 scores compared with a normal population. Heart 83:104-105.   Back to cited text no. 19
    
20.
Suzuki S, Takaki H, Yasumura Y, Sakuragi S, Takagi S, Tsutsumi Y, et al. (2005). Assessment of quality of life with 5 different scales in patients participating in comprehensive cardiac rehabilitation after acute myocardial infarction. Circ J 69:1527-1534.   Back to cited text no. 20
    
21.
Dugmore LD, Tipson RJ, Phillips MH, Flint EJ, Stentiford NH, Bone MF, Littler WA (1999). Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme. Heart 81:359-366.   Back to cited text no. 21
    
22.
Meyer K (2003), Laederach-Hofmann K. Effects of a comprehensive rehabilitation program on quality of life in patients with chronic heart failure. Prog Cardiovasc Nurs 18:169-176.  Back to cited text no. 22
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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  In this article
Abstract
Review of literature
Aim of the study
Background
Study design
Participants and...
Results
Discussion
Conclusion
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