Screening for anxiety disorders in patients with coronary artery disease using self-rating scales

Abstract

Purpose: Anxiety disorders and elevated anxiety symptoms are highly prevalent in patients with coronary artery disease (CAD) and are associated with increased risk for adverse cardiovascular outcomes and with poor patients-centered outcomes [1,2]. However, there remains a paucity of studies evaluating identification of anxiety disorders in CAD patients. In clinical practice self-rating scales are used in large samples of patients for screening purposes. Most commonly used anxiety self-rating scales are the Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), Spielberger State Anxiety Inventory (STAI) and the Spielberger State Anxiety Inventory (SSAI). Therefore, in the current study we evaluated psychometric properties of the HADS-A, STAI and SSAI for screening of anxiety disorders in CAD patients undergoing rehabilitation. Methods: A total of 632 consecutive CAD patients admitted to the rehabilitation program within two weeks after in-patients treatment for acute cardiac events were included to this study. At the beginning of rehabilitation program all patients completed the HADS-A, STAI and SSAI, and were interviewed for current anxiety disorders, including generalized anxiety disorder, social phobia, panic disorder and agoraphobia using the structured Mini International Neuropsychiatric Interview (MINI) according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text revision criteria. We evaluated sensitivities, specificities and positive predictive values (PPV) of anxiety self-rating scales at optimal cut-off values for screening of any anxiety disorders. Results: Mean age of study patients was 57.9±9.2 years. The majority of patients were men (74%), were New York Heart Association functional class II (73%), had hypertension (79%), a history of acute MI (70%) and previous percutaneous coronary interventions (76%). According to results of the MINI interview 61 (9%) patients had any anxiety disorder. The most p