Anxiety, depression, and psychological adjustment after an acute cardiac event

Abstract

Psychological adjustment following acute cardiac events such as acute myocardial infarction (AMI) and coronary artery bypass graft surgery (CABGS) has received increasing attention in the last three decades. While physical recovery remains the highest priority, psychological recovery is now considered a primary concern for health professionals working in cardiac rehabilitation and secondary prevention. The prevalence of anxiety and depression in people who have had a cardiac event is up to four times higher than in the general population. Post-event anxiety and depression both confer an increased mortality risk, highlighting the importance of identifying these patients early in order to ensure appropriate treatment. In recent years it has been recommended that all cardiac patients be screened for depression after a cardiac event. However, there are some inherent problems with routine depression screening, particularly if undertaken soon after the event. There are risks of both unnecessary treatment of patients with transient symptoms and non-identification of patients whose symptoms appear later after physical recovery. This chapter outlines evidence regarding the prevalence and impacts of anxiety and depression in cardiac patients and issues regarding depression screening. Some alternative ways of identifying patients at risk of depression are discussed.