ABC | Volume 111, Nº5, November 2018

Original Article Serpytis et al Anxiety and depression after myocardial infarction Arq Bras Cardiol. 2018; 111(5):676-683 diseases and emotional disorders. 11 We, therefore, aimed to evaluate depression and anxiety levels in patients suffering from MI and to assess the association between cardiovascular disease risk factors, demographic indicators and emotional disorders, as well as to determine whether there are gender‑based differences or similarities. Methods Participants and Recruitment Patients with a documented MI who were admitted to a tertiary health care institution from 1 November 2012 to 31 May 2013 were included. Patients were included in the study according to the following inclusion criteria: 1. Possessing a full understanding of the survey instructions; 2. Age > 18 years; 3. Either gender; 4. A diagnosis of acute MI verified based on two of the three standard criteria: typical chest pain, ECG presentation, elevated cardiac biomarkers; 5. Time after MI < 31 days; 6. Knowledge of Lithuanian language; 7. Completion of the survey. Exclusion criteria were: 1. Cognitive impairment or physical inability to complete the survey; 2. Diagnosed depression or anxiety disorder prior to MI; 3. Antidepressant or benzodiazepine use prior to MI; 4. Patient refusal; 5. Participation in another research study. Of the 180 patients recruited, a total of 160 patients met the inclusion criteria and were assessed. This survey included demographic questions (gender, age), clinical characteristics and questions about cardiovascular disease risk factors: diabetes mellitus, arterial hypertension, hypercholesterolemia, smoking, hypodynamia, and obesity. Furthermore, the Hospital Anxiety and Depression Scale [HADS] was used to determine anxiety and depression symptomatology. The scale contains 14 items: seven to assess anxiety and seven to assess depression. The score can be interpreted according to the following range: 0–7 – no depression or anxiety disorder; 8–10 – mild depression or anxiety disorder; 11–14 – moderate disorder; and 15–21 – severe disorder. The anxiety subscale (HADS-A) specificity is 0.78 and the sensitivity is 0.9, while the depression subscale (HADS-D) specificity is 0.79 and the sensitivity is 0.83. 12 Statistical analysis The analysis was conducted using SPSS (IBM Corp. Released 2011. IBM SPSS Statistics for Windows. Version 20.0. Armonk, NY: IBM Corp) software. The Shapiro-Wilk’s test of normality was performed to verify the assumption of normality. Categorical variables were compared using the χ 2 test. Binary logistic regression analysis and the χ 2 test were used for categorical variables to assess the odds ratio [OR] for depression and anxiety presence associated with gender. The independent sample t- test, when the distribution of variables was normal, and the Mann–Whitney–Wilcoxon test, when variables showed an abnormal distribution, were used to assess continuous variables. Normally-distributed continuous variables are expressed as mean (mean ± standard deviation), whereas those with an abnormal distribution are expressed as median and interquartile range (IQR, Q1 – Q3). Correlation was assessed using Spearman’s rank correlation coefficient (p). All statistical tests were two-sided, and p values < 0.05 were considered statistically significant. Results Of the 180 patients recruited, a total of 160 met the inclusion criteria (88.8%) and were assessed. A total of 101 patients (63.1%) were males and 59 (36.9%) were females. The mean age of female patients was 69.9 years, whilst the mean age of male patients was significantly lower, at 62.3 years (p < 0.001). The youngest female patient was 33 and the oldest was 92 years of age. Similarly, the youngest male patient was 26 and the oldest was 85 years of age. The overall age range of 59 years was identical for both genders. Based on the accumulated data, it was determined that 71.4% of female and 60.4% of male respondents (68.1% of all respondents) had concomitant anxiety and/or depression symptomatology (Table 1). Logistic regressions were used to assess the differences regarding the risk of each psychiatric disorder according to gender. Using men as the reference point, women had an increased risk of having some type of psychiatric disorder (odds ratio, 2.86, p = 0.007) (Table 1). The all-patient mean HADS-D subscale score was 7.54 ± 4.322. It is particularly important to note that the HADS-D score was notably higher in women (8.66 ± 3.717) than in men (6.87 ± 4.531, p = 0.004). About 54.2% of female and 47.5% of male patients exhibited a depression disorder, being mild in 30.5%, moderate in 16.9% and severe in 6.8% of females, while the respective percentages for males were mild in 24.8%, moderate in 16.8% and severe in 5.9% (Table 2). It should be noted that the distribution of the aforementioned depression symptomatology severity degrees did not statistically differ between genders (p = 0.841). The HADS-A subscale score analysis revealed that all‑patient mean HADS-A subscale score was 7.59 ± 4.335 and women had a higher mean score of 8.2 ± 3.938, while the mean score in men was 7.18 ± 4.532 (p = 0.142). 64.4% of female and 39.6% of male respondents had anxiety symptoms (mild in 35.6%, moderate in 23.7% and severe in 5.1% of females, while the respective percentages for males were mild in 17.8%, moderate in 15.8% and severe in 5.9%) (Table 2). According to the anxiety severity degree data, the prevalence of anxiety was considerably higher in women (p = 0.014), with this difference being more significant in the mild anxiety group (p = 0.012). Logistic regression analysis demonstrated that women had an elevated risk of having an anxiety disorder, with an OR of 2.76 (Table 2). 677