| Background: With the acceleration of population aging and the intensification of social competition,the prevalence of coronary heart disease(CHD),depression and anxiety keep rising up year after year.Previous studies have revealed that the prevalence of depression and anxiety in patients with CHD increases;depression and anxiety disorders can lead to the incidence of CHD;and the CHD patients with depression and anxiety will share a worse prognosis.Despite this,the pattern of the impact of CHD on emotional symptoms is still not clear,and the distribution of depression and anxiety among different subtypes of CHD remains unknown.Besides,the relationship of self-perceived stress with depression,anxiety,and clinical features of patients has rarely been reported.Objective: To investigate the distribution of depression,anxiety and self-perceived stress levels in patients with admitting diagnosis of CHD,to determine the main determinants of depression and anxiety in CHD patients,to understand the influence of emotional symptoms and perceived stress on the prognosis,and to explore the effect patterns of disease severity on mood.Methods: The 9-item Patient Health Questionnaire(PHQ-9),the Generalized Anxiety Disorder-7(GAD-7),and the Perceived Stress Scale-10(PSS-10)were applied in this cross-sectional study.From October 2017 to January 2018,705 patients with admitting diagnosis of CHD were consecutively included and systematically classified based on the results of coronary angiography and discharge diagnosis.The prevalence of depression and anxiety as well as clinical characteristics between groups were compared.Results: The prevalence of depression and anxiety in those hospitalized patients with admitting diagnosis of CHD reached 40.0% and 30.4%,among which patients with non-obstructive coronary were with the highest rate(mild above: 60.0%,48.0%;moderate to severe: 24.0%,24.0%),and the ones with obstructive coronary were with the lowest.For patients with angina pectoris,high chest discomfort frequency before admission,low endogenous creatinine clearance,diabetes,and low education level were the core influencing factors of depressive symptoms,and female,younger age,high chest discomfort frequency,low education level,mild coronary artery stenosis were the core influencing factors of anxiety symptoms.By contrast,the effect of gender and course of cardiogenic discomfort were most relevant to the mood symptoms in patients with acute myocardial infarction.Discrepancy of disease severity existed between the depressed and nondepressed.However,only when the CHD reached a certain severity,patients' depressive symptoms began to escalate as the disease got worse(NYHA III/IV VS NYHA I AP: binary model: OR 3.32 [1.28-8.61],p=0.013;ordinal model: OR 3.94 [2.11,7.36],p<0.001).The anxiety symptoms of CHD patients with stable condition remained at a low level,but once the homeostasis was broken,the anxiety level of patients might increase significantly.The level of education was only related to depression and anxiety in patients with unstable angina.(SAP: binary model: p=0.64 ordinal model: p=0.41;UAP: binary model: p=0.026 ordinal model: p<0.001).Besides,it related more closely to somatic depression symptoms(SAP: somatic: p=0.29 cognitive: p=0.28;UAP: somatic: p=0.009 cognitvie: p=0.049).Patients with angina pectoris had a closer correlation between self-perceived stress levels and anxiety symptoms.For male patients with angina,high perceived stress was associated with endogenous hypercoagulability(AP: p<0.0001;SAP: p=0.018;UAP: p<0.001)Conclusion: The emotional symptoms of patients with CHD are largely derived from disease itself,and are affected by factors such as the severity and stability of illness,the level of education and so on.Physical and emotional symptoms are mutually restricted.High self-perceived stress may promote endogenous coagulation. |
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