Introduction: The psychological implications of coronary artery disease impacts on the outcome of this disease (Clarke, 2000). Research has shown that anxiety and depression (A&D) are prevalent in both cardiac patients and their families (Mayou et al., 1978) and are associated with increased morbidity and mortality (Reich et al., 1981). Anxiety and/or depression occurs in an estimated 20–35% of patients post myocardial infarction (MI) and may impact on their recovery (Hemingway and Marmot, 1999). Symptoms may persist if action is not taken at an early stage to alleviate psychological upset in post MI patients. After 1 year, up to 50% of these patients will continue to have symptoms, 25% of which will be severe (Cay, 1982). Those with anxiety and/or depression are less likely to make the lifestyle changes necessary and therefore are at greater risk of further cardiac problems (Hemmingway, 1999).
Objectives: Cardiac rehabilitation aims to address psychological problems. At the Adelaide and Meath Hospital, Dublin our cardiac rehabilitation (CR) program includes psychological and educational interventions. Education improves knowledge and reduces anxiety (Clarke, 2000). The objectives of this study were two-fold: (1) to assess the levels of anxiety and depression in cardiac patients; and (2) to assess the practicalities of administering the HADS.
Methodology: In May 2001, CR at Adelaide and Meath hospital commenced a study of 25 patients. The objective was to view the levels of anxiety and depression in cardiac rehabilitation patients over 1 year. The CR nurse specialist met the patient in CCU during phase 1 of cardiac rehabilitation. Patients were asked to complete a Hospital Anxiety and Depression Scale (HADS). Zigmond and Snaith (1983) devised the HADS specifically for detecting anxiety and depression in the physically ill. This self-assessment scale is a useful instrument. It consists of two sub-scales, one measuring anxiety (A scale) and one measuring depression (D scale) which are scored separately. The scale was completed at three time points; (1) as an inpatient, (2) 4 months post discharge coinciding with participation in Phase 3 cardiac rehabilitation, and (3) 1 year post discharge.
Results: Of the 25 patients enrolled in the study, 92% (n = 23) responded at all time scales. The sample comprised of 78% men and 21% women with an age range of 31–72 years. No levels of ‘severe’ anxiety were recorded. Moderate anxiety was experienced in 30% of in-patients, which fell to 4% at 1 year. Mild levels of depression were experienced in 13% of inpatients, falling to 9% at 4 months which, however, increased to 17% at 1 year.
Conclusion: As expected, levels of anxiety were elevated during the inpatient period. The subsequent fall post cardiac rehabilitation was maintained at 1 year. As depression levels rose again at 1 year, follow-up for this group of patients is recommended. As a result of this study, CR at AMNCH administer the HADS pre- and post phase 3 routinely, following up those at higher risk at 1 year.
