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Negative Emotions: Depression, Exhaustion, and Anxiety

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Handbook of Cardiovascular Behavioral Medicine

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Abstract

This chapter reviews the role of depression and anxiety as risk factors for coronary heart disease. The epidemiology and methods of assessment for these disorders are discussed as well as the role of sub-threshold levels and related conditions including chronic psychological distress and exhaustion. The degree of risk of coronary heart disease associated with depression is as high as that associated with traditional cardiovascular risk factors (e.g., cholesterol, smoking, hypertension). Anxiety is also a significant risk indicator for coronary heart disease, but most studies show that the strength of the association is less than for depression. Anti-depressive interventions in patients with coronary heart disease show modest effects in reducing depression and improving quality of life but have minimal effects on adverse cardiac prognosis. Post-hoc analyses indicate, however, that anti-depressive interventions do reduce adverse cardiac events in the subgroup of patients where treatment results in marked improvements in depression. Little is known about behavioral or pharmacological interventions for anxiety in patients at risk of adverse cardiac events.

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References

  1. Abbott RA, Whear R, Rodgers LR, Bethel A, Thompson Coon J, Kuyken W, Stein K, Dickens C (2014) Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: a systematic review and meta-analysis of randomised controlled trials. J Psychosom Res 76(5):341–351

    Article  PubMed  Google Scholar 

  2. Albert CM, Chae CU, Rexrode KM, Manson JE, Kawachi I (2005) Phobic anxiety and risk of coronary heart disease and sudden cardiac death among women. Circulation 111(4):480–487

    Article  PubMed  Google Scholar 

  3. Appels A, Mulder P (1989) Fatigue and heart disease. The association between ‘vital exhaustion’ and past, present and future coronary heart disease. J Psychosom Res 33(6):727–738

    Article  PubMed  Google Scholar 

  4. Appels A, Falger PR, Schouten EG (1993) Vital exhaustion as risk indicator for myocardial infarction in women. J Psychosom Res 37(8):881–890

    Article  PubMed  Google Scholar 

  5. Appels A, Bar F, van der Pol G, Erdman R, Assman M, Trijsburg W, van Diest R, van Dixhoorn J, Mendes de Leon C (2005) Effects of treating exhaustion in angioplasty patients on new coronary events: results of the randomized Exhaustion Intervention Trial (EXIT). Psychosom Med 67(2):217–223

    Article  PubMed  Google Scholar 

  6. Barth J, Schumacher M, Herrmann-Lingen C (2004) Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med 66(6):802–813

    Article  PubMed  Google Scholar 

  7. Bellingrath S, Weigl T, Kudielka BM (2008) Cortisol dysregulation in school teachers in relation to burnout, vital exhaustion, and effort-reward-imbalance. Biol Psychol 78(1):104–113

    Article  PubMed  Google Scholar 

  8. Carney RM, Jaffe AS (2002) Treatment of depression following acute myocardial infarction. JAMA 288(6):750–751

    Article  PubMed  Google Scholar 

  9. Carney R, Freedland K, Miller G, Jaffe A (2002) Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res 53:897–902

    Article  PubMed  Google Scholar 

  10. Carney RM, Freedland KE, Steinmeyer B, Blumenthal JA, de Jonge P, Davidson KW, Czajkowski SM, Jaffe AS (2009) History of depression and survival after acute myocardial infarction. Psychosom Med 71(3):253–259

    Article  PubMed  PubMed Central  Google Scholar 

  11. Connerney I, Shapiro P, McLaughlin J, Bagiella E, Sloan R (2001) Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 358:1766–1771

    Article  PubMed  Google Scholar 

  12. Denollet J, Freedland KE, Carney RM, de Jonge P, Roest AM (2013) Cognitive-affective symptoms of depression after myocardial infarction: different prognostic importance across age groups. Psychosom Med 75(7):701–708

    Article  PubMed  Google Scholar 

  13. Eaker ED, Sullivan LM, Kelly-Hayes M, D’Agostino RB Sr, Benjamin EJ (2005) Tension and anxiety and the prediction of the 10-year incidence of coronary heart disease, atrial fibrillation, and total mortality: the Framingham Offspring Study. Psychosom Med 67(5):692–696

    Article  PubMed  Google Scholar 

  14. ENRICHD (2003) Effects of treating depresion and low perceived social support on clinical events after myocardial infarction. JAMA 289:3106–3116

    Article  Google Scholar 

  15. Frasure-Smith N, Lesperance F, Talajic M (1995) Depression and 18-month prognosis after myocardial infarction. Circulation 91:999–1005

    Article  PubMed  Google Scholar 

  16. Freedland K, Rich M, Skala J, Carney R, Davila-Roman V, Jaffe A (2003) Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom Med 65:119–128

    Article  PubMed  Google Scholar 

  17. Frestad D, Prescott E (2017) Vital exhaustion and coronary heart disease risk: a systematic review and meta-analysis. Psychosom Med 79(3):260–272

    Article  PubMed  Google Scholar 

  18. Gehi AK, Lampert R, Veledar E, Lee F, Goldberg J, Jones L, Murrah N, Ashraf A, Vaccarino V (2009) A twin study of metabolic syndrome and autonomic tone. J Cardiovasc Electrophysiol 20(4):422–428

    Article  PubMed  Google Scholar 

  19. Glassman A, O’Connor C, Califf R, Swedeberg K, Schwartz P, Bigger JJ, Krishnan K, van Zyl L, Swenson J, Finkel M, Landau C, Shapiro P, Pepine C, Mardekian J, Harrison W, Barton D, McIvor M (2002) Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 288:701–709

    Article  PubMed  Google Scholar 

  20. Glassman AH, Bigger JT Jr, Gaffney M (2009) Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: seven-year follow-up of SADHART participants. Arch Gen Psychiatry 66(9):1022–1029

    Article  PubMed  Google Scholar 

  21. Herrmann-Lingen C, Beutel ME, Bosbach A, Deter HC, Fritzsche K, Hellmich M, Jordan J, Junger J, Ladwig KH, Michal M, Petrowski K, Pieske B, Ronel J, Sollner W, Stohr A, Weber C, de Zwaan M, Albus C, Group S-CS (2016) A stepwise psychotherapy intervention for reducing risk in coronary artery disease (SPIRR-CAD): results of an observer-blinded, multicenter, randomized trial in depressed patients with coronary artery disease. Psychosom Med 78(6):704–715

    Article  PubMed  Google Scholar 

  22. Hwang B, Moser DK, Pelter MM, Nesbitt TS, Dracup K (2015) Changes in depressive symptoms and mortality in patients with heart failure: effects of cognitive-affective and somatic symptoms. Psychosom Med 77(7):798–807

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kop WJ (1999) Chronic and acute psychological risk factors for clinical manifestations of coronary artery disease. Psychosom Med 61:476–486

    Article  PubMed  Google Scholar 

  24. Kop WJ (2012) Somatic depressive symptoms, vital exhaustion, and fatigue: divergent validity of overlapping constructs. Psychosom Med 74(5):442–445

    Article  PubMed  Google Scholar 

  25. Lesperance F, Frasure-Smith N, Talajic M (2002) Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 105:1049–1053

    Article  PubMed  Google Scholar 

  26. Lesperance F, Frasure-Smith N, Koszycki D, Laliberte MA, van Zyl LT, Baker B, Swenson JR, Ghatavi K, Abramson BL, Dorian P, Guertin MC (2007) Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA 297(4):367–379

    Article  PubMed  Google Scholar 

  27. Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, Freedland KE, Jaffe AS, Leifheit-Limson EC, Sheps DS, Vaccarino V, Wulsin L, American Heart Association Statistics Committee of the Council on E, Prevention, the Council on C, Stroke N (2014) Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation 129(12):1350–1369

    Article  PubMed  Google Scholar 

  28. Linden W, Stossel C, Maurice J (1996) Psychosocial interventions for patients with coronary artery disease. Arch Intern Med 156:745–752

    Article  PubMed  Google Scholar 

  29. Low CA, Thurston RC, Matthews KA (2010) Psychosocial factors in the development of heart disease in women: current research and future directions. Psychosom Med 72(9):842–854

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nicolson NA, van Diest R (2000) Salivary cortisol patterns in vital exhaustion. J Psychosom Res 49(5):335–342

    Article  PubMed  Google Scholar 

  31. Prescott E, Holst C, Gronbaek M, Schnohr P, Jensen G, Barefoot J (2003) Vital exhaustion as a risk factor for ischaemic heart disease and all-cause mortality in a community sample. A prospective study of 4084 men and 5479 women in the Copenhagen City Heart Study. Int J Epidemiol 32(6):990–997

    Article  PubMed  Google Scholar 

  32. Roest AM, Martens EJ, Denollet J, de Jonge P (2010) Prognostic association of anxiety post myocardial infarction with mortality and new cardiac events: a meta-analysis. Psychosom Med 72(6):563–569

    Article  PubMed  Google Scholar 

  33. Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S (2004) Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 364(9438):953–962

    Article  PubMed  Google Scholar 

  34. Rozanski A, Blumenthal J, Kaplan J (1999) Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation 99:2192–2217

    Article  PubMed  Google Scholar 

  35. Rudisch B, Nemeroff C (2003) Epidemiology of comorbid coronary artery disease and depression. Biol Psychiatry 54:227–240

    Article  PubMed  Google Scholar 

  36. Rugulies R (2002) Depression as a predictor of coronary heart disease. Am J Prev Med 23:51–61

    Article  PubMed  Google Scholar 

  37. Rumsfeld JS, Jones PG, Whooley MA, Sullivan MD, Pitt B, Weintraub WS, Spertus JA (2005) Depression predicts mortality and hospitalization in patients with myocardial infarction complicated by heart failure. Am Heart J 150(5):961–967

    Article  PubMed  Google Scholar 

  38. Ruo B, Rumsfeld J, Hlatky M, Browner W, Whooley M (2003) Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA 290:215–221

    Article  PubMed  PubMed Central  Google Scholar 

  39. Sauer W, Berlin J, Kimmel S (2001) Selective serotonin reuptake inhibitors and myocardial infarction. Circulation 104:1894–1898

    Article  PubMed  Google Scholar 

  40. Sauer W, Berlin J, Kimmel S (2003) Effect of antidepressants and their relative affinity for the serotonin transporter on the risk of myocardial infarction. Circulation 108:32–36

    Article  PubMed  Google Scholar 

  41. Smolderen KG, Buchanan DM, Gosch K, Whooley M, Chan PS, Vaccarino V, Parashar S, Shah AJ, Ho PM, Spertus JA (2017) Depression treatment and 1-year mortality after acute myocardial infarction: insights from the TRIUMPH Registry (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status). Circulation 135(18):1681–1689

    Article  PubMed  PubMed Central  Google Scholar 

  42. Sullivan M, Simon G, Spertus J, Russo J (2002) Depression-related costs in heart failure care. Arch Intern Med 162(16):1860–1866

    Article  PubMed  Google Scholar 

  43. Swenson JR (2004) Quality of life in patients with coronary artery disease and the impact of depression. Curr Psychiatry Rep 6(6):438–445

    Article  PubMed  Google Scholar 

  44. Tully PJ, Cosh SM, Baumeister H (2014) The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis, treatment and morbidity risk in coronary heart disease. J Psychosom Res 77(6):439–448

    Article  PubMed  Google Scholar 

  45. van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ, van den Brink RH, van den Berg MP (2004) Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 66(6):814–822. https://doi.org/10.1097/01.psy.0000146294.82810.9c

    Article  PubMed  Google Scholar 

  46. Williams SA, Kasl SV, Heiat A, Abramson JL, Krumholz HM, Vaccarino V (2002) Depression and risk of heart failure among the elderly: a prospective community-based study. Psychosom Med 64(1):6–12

    Article  PubMed  Google Scholar 

  47. Williams JE, Mosley TH Jr, Kop WJ, Couper DJ, Welch VL, Rosamond WD (2010) Vital exhaustion as a risk factor for adverse cardiac events (from the Atherosclerosis Risk In Communities [ARIC] study). Am J Cardiol 105(12):1661–1665

    Article  PubMed  PubMed Central  Google Scholar 

  48. Wulsin LR (2004) Is depression a major risk factor for coronary disease? A systematic review of the epidemiologic evidence. Harv Rev Psychiatry 12:79–93

    Article  PubMed  Google Scholar 

  49. Wulsin L, Singal B (2003) Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med 65:201–210

    Article  PubMed  Google Scholar 

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Acknowledgment

This chapter was adapted, in part, from Wulsin L (2012) Psychological Challenges of Coping with Coronary Artery Disease. In EA Dornelas (Ed.) Stress Proof the Heart: Behavioral Interventions for Cardiac Patients (pp. 9–24) New York: Springer.

Author information

Authors and Affiliations

  1. Departments of Psychiatry and Family Medicine, University of Cincinnati, Cincinnati, OH, USA

    Lawson R. Wulsin

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  1. Lawson R. Wulsin
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Correspondence to Lawson R. Wulsin .

Editor information

Editors and Affiliations

  1. Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA

    Shari R. Waldstein

  2. Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands

    Willem J. Kop

  3. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

    Edward C. Suarez

  4. Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    William R. Lovallo

  5. Division of Gerontology Geriatrics and Palliative Medicine Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Leslie I. Katzel

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Wulsin, L.R. (2022). Negative Emotions: Depression, Exhaustion, and Anxiety. In: Waldstein, S.R., Kop, W.J., Suarez, E.C., Lovallo, W.R., Katzel, L.I. (eds) Handbook of Cardiovascular Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-85960-6_21

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