Psychological distress and mortality in patients with acute dyspnea: data from the Akershus Cardiac Examination (ACE) 2 Study

• Published in: General hospital psychiatry Vol. 37; no. 6; pp. 548 - 553
• Main Authors: Einvik, Gunnar, M.D., Ph.D, Dammen, Toril, M.D., Ph.D, Høiseth, Arne Didrik, M.D., Ph.D, Brynildsen, Jon, M.D, Hagve, Tor-Arne, M.D., Ph.D, Christensen, Geir, M.D. Ph.D, Omland, Torbjørn, M.D., Ph.D., M.P.H, Røsjø, Helge, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: Acute Disease; Aged; Aged, 80 and over; Anxiety; Anxiety - epidemiology; Chronic obstructive pulmonary disease; Depression; Depression - epidemiology; Dyspnea - etiology; Dyspnea - mortality; Dyspnea - psychology; Female; Heart failure; Heart Failure - complications; Heart Failure - psychology; Humans; Male; Middle Aged; Mortality; Norway - epidemiology; Prevalence; Proportional Hazards Models; Psychiatry; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - psychology; Stress, Psychological - complications; Norway; Heart failure; Depression; Anxiety; Chronic obstructive pulmonary disease; Mortality
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2015.07.007

Abstract Objective To test the hypotheses that anxiety and depression are associated with etiology, disease severity and mortality in patients hospitalized with acute dyspnea. Methods The Hospital Anxiety and Depression Scale was completed within 48 h of admission in 185 patients. A subscale score of ≥ 8 was regarded as clinically significant. The etiology and severity of dyspnea on admission and all-cause mortality during follow-up (median, 2.3 years) were recorded. Results Anxiety and depression were more prevalent in patients with chronic obstructive pulmonary disease (COPD) ( n = 53; 42% and 31%) and heart failure (HF) ( n = 80; 33% and 23%) than in other causes of acute dyspnea (15% and 11%). Psychological distress was not associated with clinical status or cardiac biomarkers. Anxiety, but not depression, was associated with increased mortality, also when adjusting for cardiac biomarkers in multivariate Cox analysis. In contrast, anxiety was not associated with mortality after adjustment for body mass index, history of COPD and disease severity (hazard ratio, 1.67; 95% confidence interval, 0.92–3.00). Conclusion Psychological distress was associated with COPD and HF as etiology of acute dyspnea, but not with disease severity. Anxious patients had a higher mortality rate, but this association was related to the presence and severity of COPD.