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 Both depression and anxiety treatment options include cardiac rehabilitation and exercise therapy, disease management programs, cognitive behavior therapy and pharmacotherapy. 38 Data from the Secondary Prevention in Uppsala Primary Health Care study further support the heart-helping benefits of cognitive-behavioral therapy since at follow-up, the psychotherapy intervention group had 45% fewer recurrent heart attacks and a 41% lower rate of both non-fatal and fatal first recurrent cardiovascular events than the group receiving traditional care. 39 On the other hand, there are still ongoing discussions concerning the optimal treatment algorithm, as a few studies have had disappointing results concerning behavior therapy. For example, the ENRICHD study found that a six-month intervention focused on treating patients' depression made patients feel better, but had no positive impact when it came to preventing repeat heart attacks or death. 40 Possible limitations of our study include unequal sample sizes between genders, with the male group being larger. However, this gender inequality reflects the real rates of patients with MI admitted to hospitals in Lithuania. Second, the absence of a control group can be considered a limitation, though we have attempted to mitigate this by discussing and comparing our data with results of previous similar studies. Third, the study design did not include mental health evaluation by a psychiatrist. Finally, our study was not a longitudinal one and patients were not reassessed several times to determine a more long-term association between MI and mental disease. Conclusions MI is especially closely associated with anxiety and depression. More than two-thirds of patients with MI had a depression and/or anxiety comorbidity within the first month of MI. Women showed an elevated risk of having anxiety and/ or depression disorder compared to men. Furthermore, both anxiety and depression severity had a tendency to be higher in women. In addition, depression severity increased with age in men, while anxiety severity decreased. In contrast, depression and anxiety severity are similar for women of all ages after MI. A higher depression score was associated with diabetes and physical inactivity, whereas a higher anxiety score was associated with smoking in men. Hypercholesterolemia was associated with both higher anxiety and depression scores, whereas a higher depression score was associated with physical inactivity in women. Acknowledgements PS conceived the study, wrote the protocol, designed and adopted the database system, and oversaw data collection. PN, LL, AN performed the statistical data analysis, wrote the manuscript and contributed to the design of the study. RA, RS, AD contributed to study design, provided other technical support and edited the manuscript. SG, ZP, RS oversaw data collection and edited the manuscript. All authors approved this version for publication. Author contributions Conception and design of the research: Serpytis P, Navickas A, Deksnyte A; Acquisition of data: Serpytis P, Serpytis R, Petrulioniene Z, Samalavicius R; Analysis and interpretation of the data: Navickas P, Lukaviciute L, Glaveckaite S, Samalavicius R; Statistical analysis: Aranauskas R, Serpytis R, Deksnyte A; Writing of the manuscript: Navickas P, Lukaviciute L; Critical revision of the manuscript for intellectual content: Serpytis P, Navickas A, Petrulioniene Z. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Regional Biomedical Research Ethics Committee in Vilnius based at the Medical Faculty of Vilnius University under the protocol number 158200-04-301-78, 2011-04-06. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 1. Feng HP, Chien WC, Cheng WT, Chung CH, Cheng SM, Tzeng WC. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study. Medicine (Baltimore). 2016;95(34):e4464. 2. FigueiredoJHC,SilvaN,PereiraBB,OliveiraGMM.Majordepressionandacute coronary syndrome-related factors. Arq Bras Cardiol. 2017;108(3):217-27. 3. van LooHM, van denHeuvel ER, Schoevers RA, AnselminoM, Carney RM, Denollet J, et al. 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