Mt. Hegel et al., ANXIETY AND DEPRESSION IN PATIENTS RECEIVING IMPLANTED CARDIOVERTER-DEFIBRILLATORS - A LONGITUDINAL INVESTIGATION, International journal of psychiatry in medicine, 27(1), 1997, pp. 57-69
Objective: The implantable cardioverter-defibrillator (ICD) has dramat
ically improved survival rates following sudden cardiac death episodes
. However, researchers have devoted little attention to the psychosoci
al consequences of living with the device. The current study used a lo
ngitudinal design to evaluate the impact of adaptation to the ICD on i
ncidence and severity of anxiety and depression. Method: ICD recipient
s were administered standardized anxiety and depression questionnaires
as well as questions evaluating quality of life related to the ICD in
two consecutive yearly assessments. A preliminary evaluation of poten
tially important theoretical variables, such as the perceived predicta
bility and controllability of shock onset was also conducted. Results:
One-third of the study population (N = 38) had clinically significant
levels of anxiety, depressed mood, and fear of symptoms of autonomic
arousal. These negative affective states persisted over time, with 40
to 63 percent of subjects continuing to have ongoing difficulties over
a one-year time period. Anxiety about the ICD firing was closely asso
ciated with the occurrence of depression, while avoidance of activitie
s was associated with anxiety. ''Worry'' about the ICD and a belief th
at ICD firing can be predicted were associated with anxiety sensitivit
y. Conclusions: Depressive and anxiety states in ICD recipients may be
frequent, clinically significant, and resistant to spontaneous resolu
tion. Early signs of anxiety and depression in ICD recipients should b
e evaluated. Implications for future research are discussed.