Stella Rosson1, Francesco Monaco, Alessandro Miola, Giammarco Cascino, Brendon Stubbs, Christoph U Correll, Joseph Firth, Cagatay Ermis, Andrea Perrotti, Francesca Marciello, Andrè F Carvalho, Andre R Brunoni, Paolo Fusar-Poli, Michele Fornaro, Giovanni Gentile, Umberto Granziol, Giorgio Pigato, Angela Favaro, Marco Solmi. 1. From the Neurosciences Department (Rosson, Miola, Gentile, Favaro, Solmi), University of Padua, Padua; Department of Mental Health (Monaco), Residential Eating Disorder Unit "Mariconda," ASL Salerno; Department of Medicine (Cascino, Marciello), Surgery and Dentistry "Scuola Medica Salernitana," Section of Neurosciences, University of Salerno, Salerno, Italy; Physiotherapy Department (Stubbs), South London and Maudsley National Health Services Foundation Trust; Department of Psychological Medicine (Stubbs), Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry (Correll), The Zucker Hillside Hospital, Northwell Health, Glen Oaks; Department of Psychiatry and Molecular Medicine (Correll), Zucker School of Medicine at Hofstra/Northwell, Hempstead; The Feinstein Institute for Medical Research (Correll), Center for Psychiatric Neuroscience, Manhasset, New York; Department of Child and Adolescent Psychiatry (Correll), Charité Universitätsmedizin Berlin, Berlin, Germany; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health (Firth), University of Manchester, Manchester, United Kingdom; NICM Health Research Institute, School of Science and Health (Firth), University of Western Sydney, Sydney; Centre for Youth Mental Health, University of Melbourne (Firth), Melbourne, Australia; Department of Child and Adolescent Psychiatry (Ermis), Dokuz Eylul University, İzmir, Turkey; Cardio-Thoracic Surgery Department (Perrotti), University Hospital Jean Minjoz; EA 3920, University of Franche-Comté (Perrotti), Besançon, France; Centre for Addiction and Mental Health (CAMH) (Carvalho); Department of Psychiatry (Carvalho), University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry and Psychotherapy (Brunoni), University Hospital, LMU Munich, Munich, Germany; Service of Interdisciplinary Neuromodulation, Department of Psychiatry, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry (Brunoni), University of Sao Paulo; Hospital Universitario, Departamento de Clínica Médica (Brunoni), Faculdade de Medicina da USP, São Paulo, Brazil; Early Psychosis: Interventions and Clinical-detection (EPIC) Laboratory, Department of Psychosis Studies (Fusar-Poli, Solmi), Institute of Psychiatry, Psychology and Neuroscience, King's College London; OASIS Service, South London and Maudsley NHS Foundation Trust (Fusar-Poli), London, United Kingdom; Department of Brain and Behavioral Sciences (Fusar-Poli), University of Pavia, Pavia, Italy; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust (Fusar-Poli), London, United Kingdom; Neuroscience, Reproductive Science and Odontostolmatology, Section of Psychiatry (Fornaro), University School of Medicine Federico II, Naples; Neuroscience Centre (Favaro, Solmi) and Department of General Psychology (Granziol), University of Padua; and Psychiatry Unit (Pigato), Padua University Hospital, Padua, Italy.
Abstract
OBJECTIVE: This study aimed to analyze the longitudinal course of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in patients with cardiac disease after heart surgery (HS). METHODS: We conducted a systematic review and random-effects meta-analysis of cohort studies in patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days thereafter. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken. RESULTS: We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter-defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g = 0.32; 95% confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure and persisted for 1 year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension, and dyslipidemia and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was nonsignificant. CONCLUSIONS: Depressive and anxiety symptoms improve for 1 year after HS, whereas PTSD symptoms might worsen. Older patients and those with metabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.
OBJECTIVE: This study aimed to analyze the longitudinal course of depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms in patients with cardiac disease after heart surgery (HS). METHODS: We conducted a systematic review and random-effects meta-analysis of cohort studies in patients undergoing HS, measuring anxiety, depressive, and PTSD symptoms before and at least 30 days thereafter. Subgroup and meta-regression analyses, investigation of publication bias, and quality assessment were undertaken. RESULTS: We included 94 studies relating to 15,561 patients. HS included coronary artery bypass graft surgery, valve replacement, implantable cardioverter-defibrillator placement, left ventricular assist device placement, heart transplantation, and other types of HS. Across studies, symptoms of depression (g = 0.32; 95% confidence interval [CI] = 0.25 to 0.39; p < .001) and anxiety improved after HS (g = 0.52; 95% CI = 0.43 to 0.62; p < .001), whereas PTSD symptoms worsened (g = -0.42; 95% CI = -0.80 to -0.04; p = .032). The reduction of depression and anxiety levels was more pronounced for patients with underlying coronary artery disease and heart failure and persisted for 1 year after HS, whereas the increase in PTSD symptoms returned to baseline after 6 months. Depression improvement was inversely associated with older age, diabetes, hypertension, and dyslipidemia and positively with baseline heart failure. No additional clinical or demographic variables were associated with the course of anxiety symptoms. Quality of included studies was low overall. Publication bias was nonsignificant. CONCLUSIONS:Depressive and anxiety symptoms improve for 1 year after HS, whereas PTSD symptoms might worsen. Older patients and those with metabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.