Assessment Of Depression, Anxiety, and Quality Of Life in Patients with Coronary Artery Disease

Assessment Of Depression, Anxiety, and Quality Of Life in Patients with Coronary Artery Disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment Of Depression, Anxiety, and Quality Of Life in Patients with Coronary Artery Disease Dipesh Bhattarai, Shreeram Upadhyaya, Saroj Prasad Ojha, Chandra Mani Poudel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4205122/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Coronary artery disease (CAD) is the most prevalent cardiovascular condition. Individuals with CAD frequently experience depression and anxiety, which correlate with adverse outcomes. Depression and anxiety are important predictors of quality of life (QoL) among CAD patients. Objectives: To estimate the prevalence of anxiety and depression, and to find the effect of anxiety and depression on the quality of life in patients with CAD visiting cardiology outpatient at Manmohan Cardiothoracic Vascular and Transplant Center, Tribhuvan University from November 2019 to October 2020 . Materials and Methods: The study was a cross-sectional design comprising a total sample size of 96. Socio-demographic and clinical profiles were obtained using a semi-structured proforma. A validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. ICD-10 DCR was further used to categorize anxiety and depressive disorders. Quality of life was assessed using WHOQOL-BREF. Results: The majority of the participants were of the age group 40-64 years (61.5%) were male (70%) and had a diagnosis of STEMI (57.3%). Anxiety disorder was present in 27.1% and depressive disorder in 20.9% of patients with CAD. The most common anxiety disorder diagnosis was generalized anxiety disorder (11.5%) and the most common depressive disorder diagnosis was a mild depressive episode (12.5%). The WHOQOL-BREF scores were significantly negatively correlated with the HADS A score across domain one (p<0.05) and domain two (p<0.05) and also negatively correlated with the HADS D score across all four domains(p<0.05). Conclusion : A significant proportion of patients with Coronary Artery Disease suffer from anxiety and depression which adversely impact the QoL. Anxiety Coronary Artery Disease Depression HADS ICD-10 DCR Quality of life WHOQOL-BREF Introduction Coronary artery disease (CAD) also known as coronary heart disease or ischemic heart disease is the major cause of Disability Life Years (DALYs) in high-income countries and ranks only third in low and middle-income countries after unipolar major depression and road traffic accidents (RTA) (1) (2). CAD comprises stable angina, unstable angina, myocardial infarction, and sudden coronary death (3). The relationship between CAD and psychiatric disorders is bidirectional. For instance, depression is a risk factor for CAD and CAD is a risk factor for depression (4). However, the nature of the association whether causal or not remains unproven (5). Depression and anxiety are the most common psychiatric conditions among patients with CAD. CAD patients with depression and anxiety co-morbidities are associated with worse cardiac outcomes (5). The prevalence rates of depression and anxiety varied among studies and ranged from 15-60% across the globe (6) , (7) , (8) , (9) , (10) , (11). Depressive symptoms are frequently masked by physical illness and manifest as severe somatic symptoms inconsistent with disease severity, making a diagnosis and intervention difficult for clinicians (4). American Heart Association and the European Society of Cardiology guidelines on CAD management have emphasized the need to screen and treat depression in patients with CAD (12) , (13). Despite the abundance of investigations and demonstration of a clear relationship between mental health and cardiovascular diseases, patients with CAD are rarely assessed for mental health issues as a contributor to or resulting from cardiovascular disorders (4). Quality of life (QoL) is an individual’s perception of their position in life in the context of the culture and value systems in which they live, concerning their goals, expectations, standards, and concerns (14). CAD has a fluctuating and chronic course and can interfere significantly with day to day activities of patients (15). CAD and psychiatric morbidities independently adversely impact patients’ QoL. So, the comorbidity of CAD together with depression or anxiety further hampers patients’ QoL (16) , (15). Hence, the understanding occurrence of psychiatric morbidities in CAD is crucial in understanding the overall QoL in these patients. All these facts call for further research to understand the interrelationships between psychiatric comorbidities and CAD. Also, there is a paucity of research in the area of QoL and CAD. This is especially true when considering the context of low- and middle-income countries like Nepal. Thus, this study is an attempt in this direction. Materials and Methods This study is a cross-sectional Observational (Analytic) study. The study site was Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC), Tribhuvan University, Maharajgunj, Kathmandu, Nepal. The study period was one year from November 2019 to October 2020. The study comprised a total sample size of 96 and the purposive sampling technique was used. Socio-demographic and clinical profiles were obtained using a semi-structured proforma. A validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression (17). International Classification of Disease 10 th version diagnostic criteria for research (ICD-10 DCR) was further used to categorize anxiety and depressive disorders (18). Quality of life was assessed using the World Health Organization Quality of Life bref (WHOQOL-BREF) (14). Permission for the use of all tools was taken from the respective authors and organizations. Data was collected from the outpatient cardiology department at Manmohan Cardiothoracic Vascular and Transplant Center in Kathmandu, Nepal. The researcher identified the sample from OPD by verbally asking the patients about their age and the purpose of their visit to OPD. Then a medical file was reviewed and a brief history was taken by the cardiac physician to confirm the diagnosis of CAD. A total of 110 participants fulfilling the inclusion criteria were selected and explained about the nature and importance of the study and then informed consent was taken from all the patients. Patients were first administered the semi-structured clinical Performa followed by HADS. Thereafter diagnosis was made based on ICD-10 DCR. WHOQOL-BREF was administered at last. All instruments were administered in a single session of approximately 30 minutes to 45 minutes duration. Only 96 patients were included in the analysis and 14 participants were excluded due to incomplete information filled in the forms. Ethical approval was taken from the Institute of Medicine, and Institutional review committee, and informed consent was taken from all the patients. Inclusion criteria include Patients aged 18 years or above, belonging to either gender and fulfilling the criteria for CAD (myocardial infarction with ST-segment elevation, myocardial infarction without ST-segment elevation, unstable angina, and chronic stable angina). Patients having delirium, amnesic syndrome, dementia, patients with intellectual disability who may not be able to communicate due to speech disorder, patients having other systemic illnesses except for hypertension and dyslipidemia, those unable to participate or uncooperative due to any reason and who do not give consent for the study were excluded from the study. SPSS version 25 was used for data entry and analysis. Information not filled in the questionnaire was mentioned as “not mentioned” or “not answered” as appropriate and not taken into consideration in the data analysis. Data distributions were examined for normality and analyzed using descriptive statistics such as frequencies, means, and standard deviation. Student ‘t’ test, Pearson’s correlation analysis and Chi-square tests were applied to find out the relationship between the variables. A P-value of less than 0.05 was taken as statistically significant. Results The sociodemographic and clinical profile of the study population has been presented in Table 1. Table 1 shows that the majority of the participants belonged to the age group 40-64 years (n=59,61.5%). The mean age of the sample population was 57.63±11.62 years. A total of 59.4 % (n=57) had a diagnosis of STEMI, and 33.3% (n=32) had a diagnosis of NSTEMI. The mean duration of coronary artery disease onset was 56.71±11.169 years and the majority had the duration of CAD between 1 month and 1 year (n=43, 44.8%). The majority of the participants had only one coronary event (n=81, 84.4%), and had undergone invasive procedures (n=72,75%) and had the co-morbidity of hypertension (n=60, 62.5%) Anxiety caseness was found in (n=26) 27.1 % of the participants. The mean HADS A score in the anxiety caseness group was 12.56±1.850. Thus, anxiety disorder was found in 27.1 % of the participants. The most common anxiety disorder diagnosis was generalized anxiety disorder (n=11,12%) followed by panic disorder (8%), specific phobia (4%), and anxiety disorder not otherwise specified (3%). Depression caseness was found in 21.9 % (n=21) of the study population. The mean HADS D score in the depression caseness group was 13±1.456. Thus, the prevalence of depressive disorder was 21.9 %. The most common depressive disorder diagnosis was a mild depressive episode (n=12, 13%) followed by adjustment disorder (brief depressive reaction) (5%), moderate depressive episode (3%), and dysthymia (1%). The mean scores across WHOQOL BREF domain 1 (physical health), domain 2 (psychological health), domain 3 (social relationship), and domain 4 (environmental health), were 50.66±10.27, 60.30±12.05, 68.30±9.791, 69.81±7.572 respectively. Table 2 shows the relationship between the four WHOQOL-BREF domain scores with HADS-A and HADS-D scores. All four domain scores were negatively correlated with the HADS-A score and statistically significant across domain 1, domain 2, and domain 4 (p< 0.05). All four domain scores were negatively correlated with the HADS-D score and statistically significant across all four domains (p<0.05). Table 3 shows the mean WHOQOL-BREF scores were lower across all four domains in the patients with the presence of anxiety disorder than those without anxiety disorder. This difference in mean scores was statistically significant only across WHOQOL-BREF domain 1 (p=0.0001), and domain 2 (p=0.0001), but not in domain 3 (p=0.889) and domain 4 (p=0.182). Likewise, Table 4 shows that the mean WHOQOL-BREF scores were lower across all four domains in patients with the presence of depressive disorder compared to those without a depressive disorder. The difference was statistically significant across all four domains of WHOQOL-BREF (p<0.05). Table 5 and Table 6 show the factors associated with anxiety depression and QoL. (Supplementary tables) Discussion Our finding of a higher proportion of male participants is analogous to the findings of other studies of CAD and psychiatric co-morbidities (19)(10). Being a male gender in itself is an independent risk factor for CAD (2). The most common CAD diagnosis among the participants was STEMI which is parallel to the findings of Sharma et. al. 2018 (10). We used Hospital Anxiety and Depression Scale to assess anxiety and depression which is a validated tool for screening and diagnosing patients with depression and anxiety in Nepal and it has been used in other similar studies (19)(10)(20). Our finding shows that anxiety and depressive disorders are common in CAD patients and are more prevalent than in the general population in Nepal (21) , (22). These findings on the prevalence of depression and anxiety disorders are similar to the studies by Sharma et al.,2018 and Smolderen et al., 2017 (10) (7). Using a HADS cut-off score of ≥11, Sharma et al., found the prevalence rates of anxiety and depression to be 27.4% and 23.8% respectively. The depression rate being slightly higher in this study might be due to other predictors of depression like being illiterate, and a low socioeconomic background found in the study (10). However, the prevalence rate of depression in our study is lower compared to studies by Al Zaru et al., 2020, Korean Depression in acute coronary syndrome (K-DEPACS) study, Yanping et al; 2014, and Murphy et al., 2020 (9) , (8). Our study excluded CAD patients with comorbidities except for hypertension and dyslipidemia and the rate of dyslipidemia was low in our study. Many similar studies have found concomitant comorbidities to be an important clinical predictor of anxiety and depression in CAD patients (8) (23) (6). A study by Yessennagger et al; 2015 among CAD patients from 2000 to 2013 found depression in 2.9% and anxiety disorder in 1.1% which was significantly lower in comparison to our findings and other literature (24). Thus, there are variations among the studies on the prevalence rates of anxiety and depressive disorders among CAD patients according to geographical locations, tools used for screening and evaluation and their cut-off values used, and inclusion and exclusion of co-morbidities (9) (8) (8) (23) (6). We used ICD-10 DCR to further categorize the anxiety and depressive disorders which many other similar studies have omitted in their methodology (10) (9) , (8). Our findings reveal that the most common anxiety disorder diagnosis was generalized anxiety disorder (11.5%) followed by panic disorder (8.3%) which is similar to a systematic review and meta-regression by Tully et al in 2014 (25). Likewise, another study from India in 2018 found panic disorder (12.10%) as the most common anxiety disorder in CAD patients followed by agoraphobia (2.40%) which is slightly different from our finding (11). Our findings suggest that the majority of depressive disorders are mild in severity which is consistent with the finding by Altino et al.,2017 and Yeshun et al 2019 who found that the majority of CAD patients had mild depression (26) (23). Consistent with the hypothesis that the diagnosis of depression and anxiety are found to be persistent in long-term follow-ups following the diagnosis of CAD, we did not find a statistically significant association of duration of CAD diagnosis on prevalence rates of anxiety and depression (27) , (9) , (6) , (28) , (11). Our study did not find a statistically significant difference in the prevalence of anxiety and depressive disorder among different age groups. Murphy et al. found that younger age (65 years) with higher rates of depression and anxiety disorders (9) , (6). This might be because of a smaller sample size of our study in comparison with other studies. In our study rates of depression were higher among females (38%) than in males (15%) and there was a statistically significant association between gender and diagnosis of depressive disorder (p=0.012). Our result is comparable with the finding of a meta-analysis done in 2012 which found that women had a greater prevalence of depressive disorder in comparison to men in CAD patients with an odds ratio of 1.77. Likewise, various other studies have found the female gender as an important predictor of depression (8) , (7) , (29) , (6). So, consistent with the general population the prevalence of depression is two times greater among female CAD patients (19) , (29). Our study showed that among the QoL domains physical domain is the most affected among followed by the psychological and social domains among CAD patients. Our findings highlighted that the quality of life further decreased in the presence of anxiety and depression co-morbidities with depression being the stronger predictor. Depression has been found to have a greater impact on QoL than symptoms related to the severity of the cardiac disease even in patients with stable CAD (30). K-DEPACS study using WHOQOL-BREF found that baseline QoL was significantly lower in patients with comorbid depressive disorder than those without like in our study. Unlike our findings, a significant difference was found only across the physical domain but not in the social and environmental domains (16). Thus, consistent with our findings many studies have found that Quality of life is reduced in CAD patients who have co-morbid anxiety and depression which were strong independent predictors of QoL (31) , (32) , (15) (30) (16) (32). Our findings suggest that being male and having the diagnosis of CAD within a year positively impacted the QoL mainly across psychological and environmental domains respectively. Several studies have evaluated other clinical and demographic parameters and their influence on and QoL have found that patients receiving percutaneous coronary intervention reporting better QoL compared with patients receiving conservative management or medical therapy, age inversely related to QoL and female patients with CAD reporting poor QoL compared with male patients (32) (15). Conclusions We observed that a significant proportion of patients with CAD suffered from anxiety disorders (27.1%) and depressive disorders (20.9%). The presence of anxiety and depression negatively affected the quality of life in patients with CAD. Observing the above findings, we recommend screening for anxiety and depression in patients with CAD and addressing them as a part of the overall treatment approach to CAD. Declarations Data Availability All data generated or analysed during this study are included in this published article [and its supplementary information files] Conflicts of Interest The authors declare that there is no conflict of interest regarding the publication of this paper. Authors' contributions statement The authors confirm contribution to the paper as follows; study conception and design: Dipesh Bhattarai, Shreeram Upadhyaya, Saroj Prasad Ojha and Chandra Mani Poudel, data collection: Dipesh Bhattarai, Shreeram Upadhyaya, analysis and interpretation of results: Dipesh Bhattarai, Shreeram Upadhyaya, Saroj Prasad Ojha and Chandra Mani Poudel, draft manuscript and preparation: Dipesh Bhattarai, Shreeram Upadhyaya. All authors reviewed the results and approved the final version fo the manuscript Ethical approval Ethical approval was taken from the Institute of Medicine, and Institutional review committee, and informed consent was taken from all the patients for the study. Funding Statement The authors didn’t receive any funds/grants for the study. Acknowledgments It is my privilege to convey my sincere gratitude and regards to my esteemed teacher and guide, Professor Dr. Saroj Prasad Ojha, my co-guide Associate Professor Chandra Mani Poudel and Dr. Shreeram Upadhyaya for their endless constructive feedback, encouragement, and moral support throughout the research which added quality to my thesis. I am extremely grateful to the staff and the attendants of Manmohan Cardiothoracic Vascular and Transplant Center OPD of Tribhuvan University who extended their selfless help during the research. I am obliged to thank all those participants and their relatives without whom this work wouldn’t have been possible. Further, I would like to thank editorial team of the Liaison Faculty of RCPsych for highlighting this article in their winter newsletter issue on 2022. References Müller-Nordhorn J, Willich SN. Coronary Heart Disease. 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Available from: https://doi.org/10.1007/s11136-019-02207-8 Tables Table 1: Sociodemographic and clinical variables of the study population Sociodemographic and clinical variables Frequency (N=96) Percentage (%) Age groups (years) 18-39 4 4.2 40-64 59 61.5 65 above 33 34.4 Gender Male 67 69.8 Female 29 30.2 Diagnosis of the patient STEMI 55 57.3 NSTEMI 32 33.3 Unstable Angina 7 7.3 Chronic Stable Angina 2 2.1 Duration of CAD 5 years 5 5.2 History of Hypertension Yes 60 62.5 No 36 37.5 History of Dyslipidemia Yes 16 16.7 No 80 83.3 Table 2: Correlation of HADS-A, HADS-D, and WHOQOL-BREF scores Correlation HADS-A score p-value a HADS-D score p-value b WHOQOL Domain 1 score -0.592 0.0001 ** -0.486 0.0001 ** WHOQOL Domain 2 score -0.586 0.0001 ** -0.646 0.0001 ** WHOQOL Domain 3 score -0.198 0.053 -0.400 0.0001 ** WHOQOL Domain 4 score -0.325 0.001 ** -0.307 0.002 ** **Significant , Pearson Correlation, a Anxiety, b Depression Table 3: Comparison of mean values of WHOQOL-BREF domains among anxiety disorder and those without anxiety disorder WHOQOL-BREF Domains Anxiety disorder No anxiety disorder p-value Mean Score Mean Score WHOQOL Domain 1 Score 43.81 53.20 0.0001* WHOQOL Domain 2 Score 53.42 62.86 0.0001* WHOQOL Domain 3 Score 68.08 68.39 0.889 WHOQOL Domain 4 Score 68.12 70.44 0.182 *Significant, Independent sample t-test Table 4: Comparison of mean values of WHOQOL-BREF domains among depressive disorder and those without depressive disorder WHOQOL-BREF Domains Depressive disorder No depressive disorder p-value Mean Mean WHOQOL Domain 1 Score 43.62 52.63 0.0001* WHOQOL Domain 2 Score 48.57 63.59 0.0001* WHOQOL Domain 3 Score 62.00 70.07 0.005* WHOQOL Domain 4 Score 66.19 70.83 0.012* *Significant, Independent sample t-test Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4205122","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":288932986,"identity":"1e9457cb-c051-44a5-a4e0-aada9aec9009","order_by":0,"name":"Dipesh Bhattarai","email":"data:image/png;base64,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","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dipesh","middleName":"","lastName":"Bhattarai","suffix":""},{"id":288932987,"identity":"3cb62063-7490-4b03-84ea-2b7aa33d7cac","order_by":1,"name":"Shreeram Upadhyaya","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shreeram","middleName":"","lastName":"Upadhyaya","suffix":""},{"id":288932988,"identity":"148abceb-79b8-4f73-9006-c88ca4a97fb8","order_by":2,"name":"Saroj Prasad Ojha","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Saroj","middleName":"Prasad","lastName":"Ojha","suffix":""},{"id":288932989,"identity":"c3b85869-26c4-43b1-9dde-b0d0f0bbbcd5","order_by":3,"name":"Chandra Mani Poudel","email":"","orcid":"","institution":"Tribhuvan University Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chandra","middleName":"Mani","lastName":"Poudel","suffix":""}],"badges":[],"createdAt":"2024-04-02 08:38:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4205122/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4205122/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56623865,"identity":"87183f1d-3d0d-4e80-8eb7-b549cae0709d","added_by":"auto","created_at":"2024-05-16 19:31:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":527235,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4205122/v1/68f67a34-e457-4926-8e79-4c858f366e83.pdf"},{"id":54429096,"identity":"c09bbc6e-62dc-4c49-84a8-41f4771220cd","added_by":"auto","created_at":"2024-04-10 10:21:14","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16710,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsCAD.docx","url":"https://assets-eu.researchsquare.com/files/rs-4205122/v1/57f39df32b364a8cbfd1bb43.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment Of Depression, Anxiety, and Quality Of Life in Patients with Coronary Artery Disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCoronary artery disease (CAD) also known as coronary heart disease or ischemic heart disease is the major cause of Disability Life Years (DALYs) in high-income countries and ranks only third in low and middle-income countries after unipolar major depression and road traffic accidents (RTA) (1) (2). CAD comprises stable angina, unstable angina, myocardial infarction, and sudden coronary death (3). The relationship between CAD and psychiatric disorders is bidirectional. For instance, depression is a risk factor for CAD and CAD is a risk factor for depression (4). However, the nature of the association whether causal or not remains unproven (5).\u003c/p\u003e\n\u003cp\u003eDepression and anxiety are the most common psychiatric conditions among patients with CAD. CAD patients with depression and anxiety co-morbidities are associated with worse cardiac outcomes (5). The prevalence rates of depression and anxiety varied among studies and ranged from 15-60% across the globe (6)\u003csup\u003e,\u003c/sup\u003e(7)\u003csup\u003e,\u003c/sup\u003e(8)\u003csup\u003e,\u003c/sup\u003e(9)\u003csup\u003e,\u003c/sup\u003e(10)\u003csup\u003e,\u003c/sup\u003e(11). Depressive symptoms are frequently masked by physical illness and manifest as severe somatic symptoms inconsistent with disease severity, making a diagnosis and intervention difficult for clinicians (4). American Heart Association and the European Society of Cardiology guidelines on CAD management have emphasized the need to screen and treat depression in patients with CAD (12)\u003csup\u003e,\u003c/sup\u003e(13). Despite the abundance of investigations and demonstration of a clear relationship between mental health and cardiovascular diseases, patients with CAD are rarely assessed for mental health issues as a contributor to or resulting from cardiovascular disorders (4).\u003c/p\u003e\n\u003cp\u003eQuality of life (QoL) is an individual\u0026rsquo;s perception of their position in life in the context of the culture and value systems in which they live, concerning their goals, expectations, standards, and concerns (14). CAD has a fluctuating and chronic course and can interfere significantly with day to day activities of patients (15). CAD and psychiatric morbidities independently adversely impact patients\u0026rsquo; QoL. So, the comorbidity of CAD together with depression or anxiety further hampers patients\u0026rsquo; QoL (16)\u003csup\u003e,\u003c/sup\u003e(15). Hence, the understanding occurrence of psychiatric morbidities in CAD is crucial in understanding the overall QoL in these patients.\u003c/p\u003e\n\u003cp\u003eAll these facts call for further research to understand the interrelationships between psychiatric comorbidities and CAD. Also, there is a paucity of research in the area of QoL and CAD. This is especially true when considering the context of low- and middle-income countries like Nepal. Thus, this study is an attempt in this direction.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eThis study is a cross-sectional Observational (Analytic) study. The study site was Manmohan Cardiothoracic Vascular and Transplant Center (MCVTC), Tribhuvan University, Maharajgunj, Kathmandu, Nepal. The study period was one year from November 2019 to October 2020. The study comprised a total sample size of 96 and the purposive sampling technique was used.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSocio-demographic and clinical profiles were obtained using a semi-structured proforma. A validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression (17). International Classification of Disease 10\u003csup\u003eth\u003c/sup\u003e version diagnostic criteria for research (ICD-10 DCR) was further used to categorize anxiety and depressive disorders (18). Quality of life was assessed using the World Health Organization Quality of Life bref (WHOQOL-BREF) (14). Permission for the use of all tools was taken from the respective authors and organizations. Data was collected from the outpatient cardiology department at Manmohan Cardiothoracic Vascular and Transplant Center in Kathmandu, Nepal. The researcher identified the sample from OPD by verbally asking the patients about their age and the purpose of their visit to OPD. Then a medical file was reviewed and a brief history was taken by the cardiac physician to confirm the diagnosis of CAD. A total of 110 participants fulfilling the inclusion criteria were selected and explained about the nature and importance of the study and then informed consent was taken from all the patients. Patients were first administered the semi-structured clinical Performa followed by HADS. Thereafter diagnosis was made based on ICD-10 DCR. WHOQOL-BREF was administered at last. All instruments were administered in a single session of approximately 30 minutes to 45 minutes duration. Only 96 patients were included in the analysis and 14 participants were excluded due to incomplete information filled in the forms.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEthical approval was taken from the Institute of Medicine, and Institutional review committee, and informed consent was taken from all the patients.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eInclusion criteria include Patients aged 18 years or above, belonging to either gender and fulfilling the criteria for CAD (myocardial infarction with ST-segment elevation, myocardial infarction without ST-segment elevation, unstable angina, and chronic stable angina). Patients having delirium, amnesic syndrome, dementia, patients with intellectual disability who may not be able to communicate due to speech disorder, patients having other systemic illnesses except for hypertension and dyslipidemia, those unable to participate or uncooperative due to any reason and who do not give consent for the study were excluded from the study.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSPSS version 25 was used for data entry and analysis. Information not filled in the questionnaire was mentioned as \u0026ldquo;not mentioned\u0026rdquo; or \u0026ldquo;not answered\u0026rdquo; as appropriate and not taken into consideration in the data analysis. Data distributions were examined for normality and analyzed using descriptive statistics such as frequencies, means, and standard deviation. Student \u0026lsquo;t\u0026rsquo; test, Pearson\u0026rsquo;s correlation analysis and Chi-square tests were applied to find out the relationship between the variables. A P-value of less than 0.05 was taken as statistically significant.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Results","content":"\u003cp\u003eThe sociodemographic and clinical profile of the study population has been presented in Table 1. Table 1 shows that the majority of the participants belonged to the age group 40-64 years (n=59,61.5%). The mean age of the sample population was 57.63\u0026plusmn;11.62 years. A total of 59.4 % (n=57) had a diagnosis of STEMI, and 33.3% (n=32) had a diagnosis of NSTEMI. The mean duration of coronary artery disease onset was 56.71\u0026plusmn;11.169 years and the majority had the duration of CAD between 1 month and 1 year (n=43, 44.8%). The majority of the participants had only one coronary event (n=81, 84.4%), and had undergone invasive procedures (n=72,75%) and had the co-morbidity of hypertension (n=60, 62.5%)\u003c/p\u003e\n\u003cp\u003eAnxiety caseness was found in (n=26) 27.1 % of the participants. The mean HADS A score in the anxiety caseness group was 12.56\u0026plusmn;1.850. Thus, anxiety disorder was found in 27.1 % of the participants. The most common anxiety disorder diagnosis was generalized anxiety disorder (n=11,12%) followed by panic disorder (8%), specific phobia (4%), and anxiety disorder not otherwise specified (3%). Depression caseness was found in 21.9 % (n=21) of the study population. The mean HADS D score in the depression caseness group was 13\u0026plusmn;1.456. Thus, the prevalence of depressive disorder was 21.9 %. The most common depressive disorder diagnosis was a mild depressive episode (n=12, 13%) followed by adjustment disorder (brief depressive reaction) (5%), moderate depressive episode (3%), and dysthymia (1%).\u003c/p\u003e\n\u003cp\u003eThe mean scores across WHOQOL BREF domain 1 (physical health), domain 2 (psychological health), domain 3 (social relationship), and domain 4 (environmental health), were 50.66\u0026plusmn;10.27, 60.30\u0026plusmn;12.05, 68.30\u0026plusmn;9.791, 69.81\u0026plusmn;7.572 respectively. Table 2 shows the relationship between the four WHOQOL-BREF domain scores with HADS-A and HADS-D scores. All four domain scores were negatively correlated with the HADS-A score and statistically significant across domain 1, domain 2, and domain 4 (p\u0026lt; 0.05). All four domain scores were negatively correlated with the HADS-D score and statistically significant across all four domains (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eTable 3 shows the mean WHOQOL-BREF scores were lower across all four domains in the patients with the presence of anxiety disorder than those without anxiety disorder. This difference in mean scores was statistically significant only across WHOQOL-BREF domain 1 (p=0.0001), and domain 2 (p=0.0001), but not in domain 3 (p=0.889) and domain 4 (p=0.182).\u003c/p\u003e\n\u003cp\u003eLikewise, Table 4 shows that the mean WHOQOL-BREF scores were lower across all four domains in patients with the presence of depressive disorder compared to those without a depressive disorder. The difference was statistically significant across all four domains of WHOQOL-BREF (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eTable 5 and Table 6 show the factors associated with anxiety depression and QoL.\u003c/p\u003e\n\u003cp\u003e(Supplementary tables)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur finding of a higher proportion of male participants is analogous to the findings of other studies of CAD and psychiatric co-morbidities (19)(10). Being a male gender in itself is an independent risk factor for CAD (2). The most common CAD diagnosis among the participants was STEMI which is parallel to the findings of Sharma et. al. 2018 (10). We used Hospital Anxiety and Depression Scale to assess anxiety and depression which is a validated tool for screening and diagnosing patients with depression and anxiety in Nepal and it has been used in other similar studies (19)(10)(20).\u003c/p\u003e\n\u003cp\u003eOur finding shows that anxiety and depressive disorders are common in CAD patients and are more prevalent than in the general population in Nepal (21)\u003csup\u003e,\u003c/sup\u003e(22). These findings on the prevalence of depression and anxiety disorders are similar to the studies by Sharma et al.,2018 and Smolderen et al., 2017 (10)\u003csup\u003e \u003c/sup\u003e(7). Using a HADS cut-off score of \u0026ge;11, Sharma et al., found the prevalence rates of anxiety and depression to be 27.4% and 23.8% respectively. The depression rate being slightly higher in this study might be due to other predictors of depression like being illiterate, and a low socioeconomic background found in the study (10). However, the prevalence rate of depression in our study is lower compared to studies by Al Zaru et al., 2020, Korean Depression in acute coronary syndrome (K-DEPACS) study, Yanping et al; 2014, and Murphy et al., 2020 (9)\u003csup\u003e,\u003c/sup\u003e(8). Our study excluded CAD patients with comorbidities except for hypertension and dyslipidemia and the rate of dyslipidemia was low in our study. Many similar studies have found concomitant comorbidities to be an important clinical predictor of anxiety and depression in CAD patients (8)\u003csup\u003e \u003c/sup\u003e(23)\u003csup\u003e \u003c/sup\u003e(6). A study by Yessennagger et al; 2015 among CAD patients from 2000 to 2013 found depression in 2.9% and anxiety disorder in 1.1% which was significantly lower in comparison to our findings and other literature (24). Thus, there are variations among the studies on the prevalence rates of anxiety and depressive disorders among CAD patients according to geographical locations, tools used for screening and evaluation and their cut-off values used, and inclusion and exclusion of co-morbidities (9)\u003csup\u003e \u003c/sup\u003e(8) (8)\u003csup\u003e \u003c/sup\u003e(23)\u003csup\u003e \u003c/sup\u003e(6).\u003c/p\u003e\n\u003cp\u003eWe used ICD-10 DCR to further categorize the anxiety and depressive disorders which many other similar studies have omitted in their methodology\u003cu\u003e \u003c/u\u003e(10) (9)\u003csup\u003e,\u003c/sup\u003e(8). Our findings reveal that the most common anxiety disorder diagnosis was generalized anxiety disorder (11.5%) followed by panic disorder (8.3%) which is similar to a systematic review and meta-regression by Tully et al\u003csup\u003e \u003c/sup\u003ein 2014 (25). Likewise, another study from India in 2018 found panic disorder (12.10%) as the most common anxiety disorder in CAD patients followed by agoraphobia (2.40%) which is slightly different from our finding (11). Our findings suggest that the majority of depressive disorders are mild in severity which is consistent with the finding by Altino et al.,2017 and Yeshun et al 2019 who found that the majority of CAD patients had mild depression (26)\u003csup\u003e \u003c/sup\u003e(23). Consistent with the hypothesis that the diagnosis of depression and anxiety are found to be persistent in long-term follow-ups following the diagnosis of CAD, we did not find a statistically significant association of duration of CAD diagnosis on prevalence rates of anxiety and depression (27)\u003csup\u003e,\u003c/sup\u003e(9)\u003csup\u003e,\u003c/sup\u003e(6)\u003csup\u003e,\u003c/sup\u003e(28)\u003csup\u003e,\u003c/sup\u003e(11).\u003c/p\u003e\n\u003cp\u003eOur study did not find a statistically significant difference in the prevalence of anxiety and depressive disorder among different age groups. Murphy et al. found that younger age (\u0026lt;55 years) was associated with an increased rate of depression and anxiety while another study found an association of older age (\u0026gt;65 years) with higher rates of depression and anxiety disorders (9)\u003csup\u003e,\u003c/sup\u003e(6). This might be because of a smaller sample size of our study in comparison with other studies.\u003c/p\u003e\n\u003cp\u003eIn our study rates of depression were higher among females (38%) than in males (15%) and there was a statistically significant association between gender and diagnosis of depressive disorder (p=0.012). Our result is comparable with the finding of a meta-analysis done in 2012 which found that women had a greater prevalence of depressive disorder in comparison to men in CAD patients with an odds ratio of 1.77. Likewise, various other studies have found the female gender as an important predictor of depression (8)\u003csup\u003e,\u003c/sup\u003e(7)\u003csup\u003e,\u003c/sup\u003e(29)\u003csup\u003e,\u003c/sup\u003e(6). So, consistent with the general population the prevalence of depression is two times greater among female CAD patients (19)\u003csup\u003e,\u003c/sup\u003e(29). Our study showed that among the QoL domains physical domain is the most affected among followed by the psychological and social domains among CAD patients. Our findings highlighted that the quality of life further decreased in the presence of anxiety and depression co-morbidities with depression being the stronger predictor. Depression has been found to have a greater impact on QoL than symptoms related to the severity of the cardiac disease even in patients with stable CAD (30). K-DEPACS study using WHOQOL-BREF found that baseline QoL was significantly lower in patients with comorbid depressive disorder than those without like in our study. Unlike our findings, a significant difference was found only across the physical domain but not in the social and environmental domains (16). Thus, consistent with our findings many studies have found that Quality of life is reduced in CAD patients who have co-morbid anxiety and depression which were strong independent predictors of QoL (31)\u003csup\u003e,\u003c/sup\u003e(32)\u003csup\u003e,\u003c/sup\u003e(15) (30) (16) (32).\u003c/p\u003e\n\u003cp\u003eOur findings suggest that being male and having the diagnosis of CAD within a year positively impacted the QoL mainly across psychological and environmental domains respectively. Several studies have evaluated other clinical and demographic parameters and their influence on and QoL have found that patients receiving percutaneous coronary intervention reporting better QoL compared with patients receiving conservative management or medical therapy, age inversely related to QoL and female patients with CAD reporting poor QoL compared with male patients (32)\u003csup\u003e \u003c/sup\u003e(15).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eWe observed that a significant proportion of patients with CAD suffered from anxiety disorders (27.1%) and depressive disorders (20.9%). The presence of anxiety and depression negatively affected the quality of life in patients with CAD. Observing the above findings, we recommend screening for anxiety and depression in patients with CAD and addressing them as a part of the overall treatment approach to CAD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files]\u003c/p\u003e\n\u003ch2\u003eConflicts of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest regarding the publication of this paper.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions statement\u003c/h2\u003e\n\u003cp\u003eThe authors confirm contribution to the paper as follows; study conception and design: Dipesh Bhattarai, Shreeram Upadhyaya, Saroj Prasad Ojha and Chandra Mani Poudel, data collection: Dipesh Bhattarai, Shreeram Upadhyaya, analysis and interpretation of results: Dipesh Bhattarai, Shreeram Upadhyaya, Saroj Prasad Ojha and Chandra Mani Poudel, draft manuscript and preparation: Dipesh Bhattarai, Shreeram Upadhyaya. All authors reviewed the results and approved the final version fo the manuscript\u003c/p\u003e\n\u003ch2\u003eEthical approval\u003c/h2\u003e\n\u003cp\u003eEthical approval was taken from the Institute of Medicine, and Institutional review committee, and informed consent was taken from all the patients for the study.\u003c/p\u003e\n\u003ch2\u003eFunding Statement\u003c/h2\u003e\n\u003cp\u003eThe authors didn\u0026rsquo;t receive any funds/grants for the study.\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eIt is my privilege to convey my sincere gratitude and regards to my esteemed teacher and guide, Professor Dr. Saroj Prasad Ojha, my co-guide Associate Professor Chandra Mani Poudel and Dr. Shreeram Upadhyaya for their endless constructive feedback, encouragement, and moral support throughout the research which added quality to my thesis. I am extremely grateful to the staff and the attendants of Manmohan Cardiothoracic Vascular and Transplant Center OPD of Tribhuvan University who extended their selfless help during the research. I am obliged to thank all those participants and their relatives without whom this work wouldn\u0026rsquo;t have been possible. Further, I would like to thank editorial team of the Liaison Faculty of RCPsych for highlighting this article in their winter newsletter issue on 2022.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eM\u0026uuml;ller-Nordhorn J, Willich SN. Coronary Heart Disease. Int Encycl Public Heal. 2016;2:159\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eCenters for Disease. Coronary Artery Disease. 2020. \u003c/li\u003e\n\u003cli\u003eWHO. International statistical classification of diseases and related health problems ICD-10: instruction manual. WORLD Heal Organ -WHO nternational Stat Classif Dis Relat Heal Probl ICD-10 Instr Man [Internet]. 2016;2:252. Available from: https://icd.who.int/browse10/Content/statichtml/ICD10Volume2_en_2016.pdf\u003c/li\u003e\n\u003cli\u003eChaddha A, Robinson EA, Kline-Rogers E, Alexandris-Souphis T, Rubenfire M. Mental Health and Cardiovascular Disease. Am J Med. 2016;129(11):1145\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eDickens C. Depression in People with Coronary Heart Disease: Prognostic Significance and Mechanisms. Curr Cardiol Rep. 2015;17(10). \u003c/li\u003e\n\u003cli\u003eKang HJ, Stewart R, Bae KY, Kim SW, Shin IS, Hong YJ, et al. Predictors of depressive disorder following acute coronary syndrome: Results from K-DEPACS and EsDEPACS. J Affect Disord [Internet]. 2015;181:1\u0026ndash;8. Available from: http://dx.doi.org/10.1016/j.jad.2015.04.004\u003c/li\u003e\n\u003cli\u003eSmolderen KG, Buchanan DM, Gosch K, Whooley M, Chan PS, Vaccarino V, et al. 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\u0026rsquo; Health Status). Circulation. 2017;135(18):1681\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eAl-Zaru IM, Alhalaiqa F, Dalky HF, Arramadan KA, Batiha AM. Depression in Nonhospitalized Jordanian Patients With Coronary Artery Disease. J Nurs Res. 2020;28(1):e66. \u003c/li\u003e\n\u003cli\u003eMurphy B, Le Grande M, Alvarenga M, Worcester M, Jackson A. Murphy B, Le Grande M, Alvarenga M, Worcester M and Jackson A (2020) Anxiety and Depression After a Cardiac Event: Prevalence and Predictors. Front. Psychol. 10:3010. doi: 10.3389/fpsyg.2019.03010 Anxiety. Front Psychol. 2020;10(January):1\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eSharma K, Poudel P, Dhital PR. Anxiety and Depression among Patients with Coronary Artery Disease Attending at a Cardiac Center , Kathmandu , Nepal. 2018;2018. \u003c/li\u003e\n\u003cli\u003eShruthi DR, Kumar SS, Desai N, Raman R, Rao TSS. Psychiatric comorbidities in acute coronary syndromes : Six ‑ month follow ‑ up study. Indian J Psychiatry [Internet]. 2018;60(1). Available from: www.indianjpsychiatry.org\u003c/li\u003e\n\u003cli\u003eFihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24). \u003c/li\u003e\n\u003cli\u003eLahtinen M, Kiviniemi AM, Junttila MJ, K\u0026auml;\u0026auml;ri\u0026auml;inen M, Huikuri H V., Tulppo MP. Depressive Symptoms and Risk for Sudden Cardiac Death in Stable Coronary Artery Disease. Am J Cardiol [Internet]. 2018;122(5):749\u0026ndash;55. Available from: https://doi.org/10.1016/j.amjcard.2018.05.006\u003c/li\u003e\n\u003cli\u003eWHO. WORLD HEALTH ORGANIZATION. 1996. \u003c/li\u003e\n\u003cli\u003eMuhammad I, He HG, Kowitlawakul Y, Wang W. Narrative review of health-related quality of life and its predictors among patients with coronary heart disease. Int J Nurs Pract. 2016;22(1):4\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eKim JM, Stewart R, Bae KY, Kang HJ, Kim SW, Shin IS, et al. Effects of depression co-morbidity and treatment on quality of life in patients with acute coronary syndrome: The Korean depression in ACS (K-DEPACS) and the escitalopram for depression in ACS (EsDEPACS) study. Psychol Med. 2015;45(8):1641\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003eRisal A, Manandhar K, Linde M, Steiner TJ, Holen A. Anxiety and depression in Nepal: Prevalence, comorbidity and associations. BMC Psychiatry [Internet]. 2016;16(1):1\u0026ndash;9. Available from: http://dx.doi.org/10.1186/s12888-016-0810-0\u003c/li\u003e\n\u003cli\u003eICD-10. The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research. 1993; \u003c/li\u003e\n\u003cli\u003eShanmugasegaram S, Russell KL, Kovacs AH, Stewart DE, Grace SL. Gender and sex differences in prevalence of major depression in coronary artery disease patients: A meta-analysis. Maturitas. 2012;73(4):305\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eThombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, et al. Prevalence of Depression in Survivors of Acute Myocardial Infarction. J Gen Intern Med [Internet]. 2005;21(1):30\u0026ndash;8. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1484630\u0026amp;tool=pmcentrez\u0026amp;rendertype=abstract\u003c/li\u003e\n\u003cli\u003eSandmire HF, Austin SD, Bechtel RC. WHO 2017 Common mental disorders. WHO. 2017;48(1):56\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eNational Mental Health Survey. National Mental Health Survey, Nepal 2020. 2020;1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eWu Y, Zhu B, Chen Z, Duan J, Luo A, Yang L, et al. Prevalence and predisposing factors of depressive symptoms in patients with stable coronary artery disease: A cross-sectional single-center study. Aging (Albany NY). 2019;11(12):3958\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eYssennagger L, Gollop ND, Gorantla RS, Nimmagadda M, Potluri S, Uppal H, et al. Increasing burden of psychiatric comorbidities amongst patients with Ischaemic Heart Disease. Int J Cardiol [Internet]. 2015;186:200\u0026ndash;1. Available from: http://dx.doi.org/10.1016/j.ijcard.2015.03.193\u003c/li\u003e\n\u003cli\u003eTully PJ, Cosh SM, Baumeister H. 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 [Internet]. 2014;77(6):439\u0026ndash;48. Available from: http://dx.doi.org/10.1016/j.jpsychores.2014.10.001\u003c/li\u003e\n\u003cli\u003eAltino DM, Nogueira-martins LA, Lucia A, Leite B, Lopes JDL. Archives of Psychiatric Nursing Predictive Factors of Anxiety and Depression in Patients with Acute Coronary Syndrome. Arch Psychiatr Nurs [Internet]. 2017;2015\u0026ndash;8. Available from: http://dx.doi.org/10.1016/j.apnu.2017.07.004\u003c/li\u003e\n\u003cli\u003eMailloux LM, Haas MT, Kennedy SP, DeJongh BM. Implementation and evaluation of depression screening in patients with recently diagnosed coronary artery disease. Ment Heal Clin. 2020;10(1):12\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKorbmacher B, Ulbrich S, Dalyanoglu H, Lichtenberg A, Schipke JD, Franz M, et al. Perioperative and long-term development of anxiety and depression in CABG patients. Thorac Cardiovasc Surg. 2013;61(8):676\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eShoja S. Prevalence of Psychiatric Morbidities in Acute Coronary Heart Disease. 2014;2014. \u003c/li\u003e\n\u003cli\u003eVaccarino V, Badimon L, Bremner JD, Cenko E, Cubedo J, Dorobantu M, et al. Depression and coronary heart disease: 2018 ESC position paper of the working group of coronary pathophysiology and microcirculation developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J. 2019;1\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003ePalacios JE, Khondoker M, Achilla E, Tylee A, Hotopf M. A Single, One-Off Measure of Depression and Anxiety Predicts Future Symptoms, Higher Healthcare Costs, and Lower Quality of Life in Coronary Heart Disease Patients: Analysis from a Multi-Wave, Primary Care Cohort Study. PLoS One. 2016;11(7):e0158163. \u003c/li\u003e\n\u003cli\u003eLu Y, Jiang Y, Gu L. Using path analysis to investigate the relationships between depression, anxiety, and health-related quality of life among patients with coronary artery disease. Qual Life Res [Internet]. 2019;(0123456789). Available from: https://doi.org/10.1007/s11136-019-02207-8\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Sociodemographic and clinical variables of the study population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"656\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.603658536585364%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic and clinical variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6219512195122%\" valign=\"top\" style=\"width: 20.5227%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (N=96)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.77439024390244%\" colspan=\"2\" valign=\"top\" style=\"width: 17.0194%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\" style=\"width: 59.3174%;\"\u003e\n \u003cp\u003eAge groups (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.603658536585364%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18-39\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6219512195122%\" valign=\"top\" style=\"width: 20.5227%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.77439024390244%\" colspan=\"2\" valign=\"top\" style=\"width: 17.0194%;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.603658536585364%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40-64\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6219512195122%\" valign=\"top\" style=\"width: 20.5227%;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.77439024390244%\" colspan=\"2\" valign=\"top\" style=\"width: 17.0194%;\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.603658536585364%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65 above\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6219512195122%\" valign=\"top\" style=\"width: 20.5227%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.77439024390244%\" colspan=\"2\" valign=\"top\" style=\"width: 17.0194%;\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\" style=\"width: 59.3174%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.603658536585364%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6219512195122%\" valign=\"top\" style=\"width: 20.5227%;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.77439024390244%\" colspan=\"2\" valign=\"top\" style=\"width: 17.0194%;\"\u003e\n \u003cp\u003e69.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.603658536585364%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.6219512195122%\" valign=\"top\" style=\"width: 20.5227%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.77439024390244%\" colspan=\"2\" valign=\"top\" style=\"width: 17.0194%;\"\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003eDiagnosis of the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"65.44901065449011%\" colspan=\"3\" style=\"width: 37.5421%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003eSTEMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003eNSTEMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003eUnstable Angina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003eChronic Stable Angina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of CAD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u0026lt;1 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e1 month-1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e1 year-5 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u0026gt;5 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Hypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of Dyslipidemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.55098934550989%\" valign=\"top\" style=\"width: 21.7753%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.02891933028919%\" colspan=\"2\" valign=\"top\" style=\"width: 20.7154%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.65905631659056%\" valign=\"top\" style=\"width: 19.8482%;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Correlation of HADS-A, HADS-D, and WHOQOL-BREF scores\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"640\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.03125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-A score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.8125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46875%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHADS-D score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.375%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.03125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 1 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e\n \u003cp\u003e-0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46875%\" valign=\"top\"\u003e\n \u003cp\u003e-0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.03125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 2 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e\n \u003cp\u003e-0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46875%\" valign=\"top\"\u003e\n \u003cp\u003e-0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.03125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 3 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e\n \u003cp\u003e-0.198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46875%\" valign=\"top\"\u003e\n \u003cp\u003e-0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.03125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 4 score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.3125%\" valign=\"top\"\u003e\n \u003cp\u003e-0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.8125%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.46875%\" valign=\"top\"\u003e\n \u003cp\u003e-0.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.375%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e**Significant , Pearson Correlation, \u003csup\u003ea\u003c/sup\u003eAnxiety,\u0026nbsp;\u003csup\u003eb\u003c/sup\u003eDepression\u003c/p\u003e\n\u003cp\u003eTable 3: Comparison of mean values of WHOQOL-BREF domains among anxiety disorder and those without anxiety disorder\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"519\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.65510597302505%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL-BREF Domains\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.85549132947977%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.616570327552985%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo anxiety disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"41.883116883116884%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003cp\u003eScore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.74025974025974%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eScore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.376623376623378%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.65510597302505%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 1 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.85549132947977%\" valign=\"top\"\u003e\n \u003cp\u003e43.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.616570327552985%\" valign=\"top\"\u003e\n \u003cp\u003e53.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.65510597302505%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 2 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.85549132947977%\" valign=\"top\"\u003e\n \u003cp\u003e53.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.616570327552985%\" valign=\"top\"\u003e\n \u003cp\u003e62.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.65510597302505%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 3 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.85549132947977%\" valign=\"top\"\u003e\n \u003cp\u003e68.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.616570327552985%\" valign=\"top\"\u003e\n \u003cp\u003e68.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.889\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.65510597302505%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 4 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.85549132947977%\" valign=\"top\"\u003e\n \u003cp\u003e68.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.616570327552985%\" valign=\"top\"\u003e\n \u003cp\u003e70.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.872832369942197%\" valign=\"top\"\u003e\n \u003cp\u003e0.182\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Significant, Independent sample t-test\u003c/p\u003e\n\u003cp\u003eTable 4: Comparison of mean values of WHOQOL-BREF domains among depressive disorder and those without depressive disorder\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.86348122866894%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL-BREF Domains\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.77133105802048%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepressive disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.77133105802048%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo depressive disorder\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.593856655290104%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.18181818181818%\" valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51.81818181818182%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.86348122866894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 1 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.088737201365188%\" valign=\"top\"\u003e\n \u003cp\u003e43.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.453924914675767%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e52.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.593856655290104%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.86348122866894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 2 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.088737201365188%\" valign=\"top\"\u003e\n \u003cp\u003e48.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.453924914675767%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e63.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.593856655290104%\" valign=\"top\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.86348122866894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;WHOQOL Domain 3 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.088737201365188%\" valign=\"top\"\u003e\n \u003cp\u003e62.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.453924914675767%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e70.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.593856655290104%\" valign=\"top\"\u003e\n \u003cp\u003e0.005*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.86348122866894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWHOQOL Domain 4 Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.088737201365188%\" valign=\"top\"\u003e\n \u003cp\u003e66.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.453924914675767%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e70.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.593856655290104%\" valign=\"top\"\u003e\n \u003cp\u003e0.012*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Significant, Independent sample t-test\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anxiety, Coronary Artery Disease, Depression, HADS, ICD-10 DCR Quality of life, WHOQOL-BREF","lastPublishedDoi":"10.21203/rs.3.rs-4205122/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4205122/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Coronary artery disease (CAD) is the most prevalent cardiovascular condition. Individuals with CAD frequently experience depression and anxiety, which correlate with adverse outcomes. Depression and anxiety are important predictors of quality of life (QoL) among CAD patients.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003eTo estimate the prevalence of anxiety and depression, and to find the effect of anxiety and depression on the quality of life in patients with CAD visiting cardiology outpatient at Manmohan Cardiothoracic Vascular and Transplant Center, Tribhuvan University from November 2019 to October 2020\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods: \u003c/strong\u003eThe study was a cross-sectional design comprising a total sample size of 96. Socio-demographic and clinical profiles were obtained using a semi-structured proforma. A validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. ICD-10 DCR was further used to categorize anxiety and depressive disorders. Quality of life was assessed using WHOQOL-BREF.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe majority of the participants were of the age group 40-64 years (61.5%) were male (70%) and had a diagnosis of STEMI (57.3%). Anxiety disorder was present in 27.1% and depressive disorder in 20.9% of patients with CAD. The most common anxiety disorder diagnosis was generalized anxiety disorder (11.5%) and the most common depressive disorder diagnosis was a mild depressive episode (12.5%). The WHOQOL-BREF scores were significantly negatively correlated with the HADS A score across domain one (p\u0026lt;0.05) and domain two (p\u0026lt;0.05) and also negatively correlated with the HADS D score across all four domains(p\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: A significant proportion of patients with Coronary Artery Disease suffer from anxiety and depression which adversely impact the QoL.\u003c/p\u003e","manuscriptTitle":"Assessment Of Depression, Anxiety, and Quality Of Life in Patients with Coronary Artery Disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-10 10:21:09","doi":"10.21203/rs.3.rs-4205122/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb09c301-8d1e-4c4c-a80c-e933ee3852b1","owner":[],"postedDate":"April 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-16T19:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-10 10:21:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4205122","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4205122","identity":"rs-4205122","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}