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

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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

Original languageEnglish
Pages (from-to)85-93
Number of pages9
JournalPsychosomatic Medicine
Issue number1

Bibliographical 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: © 2021 Lippincott Williams and Wilkins. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.


King's Authors


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.

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