ANXIETY AND DEPRESSION IN PATIENTS RECEIVING IMPLANTED CARDIOVERTER-DEFIBRILLATORS - A LONGITUDINAL INVESTIGATION

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.