Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery: A meta-analysis of 94 studies

Stella Rosson; 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

doi:10.1097/PSY.0000000000000872

Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery: A meta-analysis of 94 studies

Stella Rosson, 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^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

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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 withmetabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.

Original language	English
Pages (from-to)	85-93
Number of pages	9
Journal	Psychosomatic Medicine
Volume	83
Issue number	1
DOIs	https://doi.org/10.1097/PSY.0000000000000872
Publication status	Published - 2021

Keywords

Anxiety
Cardiovascular diseases
Depression
Heart surgery
Posttraumatic stress disorder

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/PSY.0000000000000872

Longitudinal course of depressive, anxiety and post-traumatic stress disorder symptoms after heart surgery- a meta-analysis of 94 studies

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Rosson, S., Monaco, F., Miola, A., Cascino, G., Stubbs, B., Correll, C. U., Firth, J., Ermis, C., Perrotti, A., Marciello, F., Carvalho, A. F., Brunoni, A. R., Fusar-Poli, P., Fornaro, M., Gentile, G., Granziol, U., Pigato, G., Favaro, A., & Solmi, M. (2021). Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery: A meta-analysis of 94 studies. Psychosomatic Medicine, 83(1), 85-93. https://doi.org/10.1097/PSY.0000000000000872

@article{a3a462f5b0c24109a2e171ee1f4d2c9f,

title = "Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery: A meta-analysis of 94 studies",

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 withmetabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.",

keywords = "Anxiety, Cardiovascular diseases, Depression, Heart surgery, Posttraumatic stress disorder",

author = "Stella Rosson and Francesco Monaco and Alessandro Miola and Giammarco Cascino and Brendon Stubbs and Correll, {Christoph U.} and Joseph Firth and Cagatay Ermis and Andrea Perrotti and Francesca Marciello and Carvalho, {Andr{\`e} F.} and Brunoni, {Andre R.} and Paolo Fusar-Poli and Michele Fornaro and Giovanni Gentile and Umberto Granziol and Giorgio Pigato and Angela Favaro and Marco Solmi",

note = "Funding Information: Source of Funding and Conflicts of Interest: S.R., F.Mo., A.M., G.C., B.S., A.P., F.Ma., A.F.C., A.R.B., M.F., G.G., U.G., G.P., and A.F. have no conflict of interest to declare. C.U.C. has been a consultant and/or advisor to or has received honoraria from the following: Alkermes, Allergan, Angelini, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma. C.E. was supported by a grant from The Scientific and Technological Research Council of Turkey (TUBITAK). J.F. is supported by a University of Manchester Presidential Fellowship (P123958) and a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1). P.F.-P. has received honoraria from Lundbeck and Menarini and grant support from Lundbeck. M.S. received honoraria as consultant/advisor in advisory boards and/or for talks/presentations from Angelini and Lundbeck. This research received no specific grant from any funding agency, or commercial or not-for-profit sectors. Publisher Copyright: {\textcopyright} 2021 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

doi = "10.1097/PSY.0000000000000872",

language = "English",

volume = "83",

pages = "85--93",

journal = "Psychosomatic Medicine",

issn = "0033-3174",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

Rosson, S, Monaco, F, Miola, A, Cascino, G, Stubbs, B, Correll, CU, Firth, J, Ermis, C, Perrotti, A, Marciello, F, Carvalho, AF, Brunoni, AR, Fusar-Poli, P, Fornaro, M, Gentile, G, Granziol, U, Pigato, G, Favaro, A & Solmi, M 2021, 'Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery: A meta-analysis of 94 studies', Psychosomatic Medicine, vol. 83, no. 1, pp. 85-93. https://doi.org/10.1097/PSY.0000000000000872

TY - JOUR

T1 - Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery

T2 - A meta-analysis of 94 studies

AU - Rosson, Stella

AU - Monaco, Francesco

AU - Miola, Alessandro

AU - Cascino, Giammarco

AU - Stubbs, Brendon

AU - Correll, Christoph U.

AU - Firth, Joseph

AU - Ermis, Cagatay

AU - Perrotti, Andrea

AU - Marciello, Francesca

AU - Carvalho, Andrè F.

AU - Brunoni, Andre R.

AU - Fusar-Poli, Paolo

AU - Fornaro, Michele

AU - Gentile, Giovanni

AU - Granziol, Umberto

AU - Pigato, Giorgio

AU - Favaro, Angela

AU - Solmi, Marco

N1 - Funding Information: Source of Funding and Conflicts of Interest: S.R., F.Mo., A.M., G.C., B.S., A.P., F.Ma., A.F.C., A.R.B., M.F., G.G., U.G., G.P., and A.F. have no conflict of interest to declare. C.U.C. has been a consultant and/or advisor to or has received honoraria from the following: Alkermes, Allergan, Angelini, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received royalties from UpToDate and grant support from Janssen and Takeda. He is also a stock option holder of LB Pharma. C.E. was supported by a grant from The Scientific and Technological Research Council of Turkey (TUBITAK). J.F. is supported by a University of Manchester Presidential Fellowship (P123958) and a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1). P.F.-P. has received honoraria from Lundbeck and Menarini and grant support from Lundbeck. M.S. received honoraria as consultant/advisor in advisory boards and/or for talks/presentations from Angelini and Lundbeck. This research received no specific grant from any funding agency, or commercial or not-for-profit sectors. Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021

Y1 - 2021

N2 - 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 withmetabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.

AB - 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 withmetabolic comorbidities, valve disease, or ventricular arrhythmias are at higher risk for continued depressive and anxiety symptoms and should be monitored closely.

KW - Anxiety

KW - Cardiovascular diseases

KW - Depression

KW - Heart surgery

KW - Posttraumatic stress disorder

UR - http://www.scopus.com/inward/record.url?scp=85098674178&partnerID=8YFLogxK

U2 - 10.1097/PSY.0000000000000872

DO - 10.1097/PSY.0000000000000872

M3 - Article

C2 - 33021524

AN - SCOPUS:85098674178

SN - 0033-3174

VL - 83

SP - 85

EP - 93

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

IS - 1

ER -

Longitudinal course of depressive, anxiety, and posttraumatic stress disorder symptoms after heart surgery: A meta-analysis of 94 studies

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Keywords

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