Exploring the relationship between anxiety and depression in the onset and recovery of coronary heart disease : a mixed methods study

Depression, anxiety and coronary heart disease (CHD) are common conditions. This thesis examines the association between depression and anxiety in both the development and recovery of CHD, to inform treatment and guide optimum management of these conditions. A mixed methods approach addresses three research aims; to understand the association between depression, anxiety and incident CHD; to investigate the effectiveness of cardiac rehabilitation (CR) at reducing depression and anxiety; and to examine the role of depression and anxiety on how people make the decision to attend and complete CR. Using longitudinal data from the 45 and Up study (N=143,815), women with comorbid anxiety and depression had an increased risk of an acute coronary syndrome (HR 1.85, 95% CI 1.31-2.61) and acute myocardial infarction (HR 2.15, 95% CI 1.33-3.46). Results from a systematic review and a second study using questionnaire data found no support for CR being effective at reducing either depression or anxiety. Depression and anxiety had no impact on CR attendance or completion using the same questionnaire data. However, the results from this study were unfortunately underpowered. Key findings from qualitative data demonstrated anxiety symptoms had a role in both CR attendance and non-completion and receiveing a telephone call from CR services facilitated attendance at CR. The overall conclusions drawn from this thesis support a need for future research to explore men and women’s CHD separately. To deliver effective treatments for depression and anxiety more randomised controlled trials recruiting cardiac patients with clinically significant levels of depression and anxiety are needed. Understanding the best time to identify patients with depression and anxiety requiring treatment should be a priority for clinical practice