Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing.

OBJECTIVE: Beyond acute myocardial infarction, little is known about the effect of depression, and especially anxiety, on prognosis in cardiology patients. The present study aims to examine the effect of anxiety and depression on 5-year mortality in patients referred for exercise testing. METHODS: A total of 5,057 patients referred for routine exercise testing completed the Hospital Anxiety and Depression Scale (HADS) before undergoing the exercise test. Survival data were obtained from 5,017 (99.2%) of those patients after 5.7 +/- 0.8 years. HADS scores and cardiological baseline data were used to predict mortality. RESULTS: In univariate analyses, HADS depression was not a significant predictor; high anxiety was associated with improved survival. Logistic regression revealed nine independent objective predictors from which we computed a composite somatic risk index. When controlling for this physical risk index, anxiety and depression had independent, opposite effects; that is, anxiety was associated with a lower mortality and depression with a higher mortality. CONCLUSION: Anxiety and depression scores have different predictive effects on mortality in patients referred for exercise testing. These effects are independent of a highly effective physical risk index, suggesting that psychological screening of cardiology patients might improve risk stratification.

Diagnostic groups and depressed mood as predictors of 22-month mortality in medical inpatients.

OBJECTIVE: While depression has been found to predict mortality in acute myocardial infarction, results from many other groups of medical patients are inconclusive. It is, therefore, unclear whether depression also predicts mortality in the typical mixed patient populations treated on medical hospital wards and whether an increased risk can be identified by means of patients' self ratings of depression. METHOD: The Hospital Anxiety and Depression scale was used as a routine screening tool in consecutive admissions to the general medical wards of a university hospital. The official survival data were obtained 22 months later. For all 454 patients who completed the screening questionnaire, complete survival data were available. RESULTS: High depression scores significantly predicted mortality in univariate comparisons (odds ratio 3.2; 95% CI 1.9-5.5) and in multivariate Cox regression analyses controlling for demographic and medical baseline variables (multivariate odds ratio 1.9; 95% CI 1.2-3.1; p < .01). Other significant predictors in the multivariate model were having a principal diagnosis of hematological disease or cancer, and older age. Disability, as assessed by nurses' ratings, and gender were not related to mortality. Subgroup analyses showed that the effect of depression scores was greatest in cardiopulmonary patients, but there was also a uniform trend toward higher mortality in depressed patients with other diagnoses. CONCLUSION: Depressed mood is an independent risk factor for all-cause mortality in medical inpatients. Identifying patients at risk does not require formal psychiatric diagnoses, but can be achieved by means of a short, routinely administered self-rating questionnaire.