Symptoms of Depression, Anxiety, and Posttraumatic Stress among Patients with Cardiac Pacemakers

Abstract

Despite being a prerequisite for tailoring specific therapeutic interventions, knowledge of pattern and prevalence of clinically significant psychiatric symptomatology among patients with cardiac pacemakers (PMs), especially of symptoms of posttraumatic stress, is limited. We studied symptoms of depression, anxiety, and posttraumatic stress among PM patients (PM due to syncope or presyncope) compared to participants of (i) a cardiac, (ii) a chronic disease, and (iii) a healthy control group. Symptoms of depression, anxiety and posttraumatic stress were measured by validated self-report scales at least 6 months after implantation of the PM (PM group; n = 38), percutaneous coronary intervention (PCI; PCI control group; n = 23), and first dialysis (Dialysis control group; n = 17). Blood donors constituted the Healthy control group (n = 42). Both PM, PCI, and dialysis patients reported depressive symptoms above clinical cut-off more frequently than the healthy controls (16.2, 26.1, 41.2, and 0%, respectively; p < 0.001). Self-report of symptoms of anxiety and posttraumatic stress did not differ significantly across study groups. However, a non-negligible proportion of PM patients reported on symptoms of posttraumatic stress of anticipated clinical relevance. Identification and treatment of depression deserves attention in clinical routine in all three patient populations. Further study of posttraumatic stress in PM patients seems advisable.

Keywords: anxiety; artificial pacemaker; coronary balloon angioplasty; depression; patients and public health; posttraumatic stress disorders; renal dialysis; social implications.

Figure 1

Gender and age distribution (n = 120 in total study sample). Panel (A) illustrates the gender distribution. Panel (B) illustrates the age distribution. Abbreviations: Dialysis: Dialysis control group. HC: Healthy control group. PCI: Percutaneous coronary intervention (PCI) control group. PM: Pacemaker (PM) group.

Figure 2

Proportion of participants with self-report of clinically significant depression and anxiety. Clinically significant depression is defined as PHQ-9 total score ≥ 10. Clinically significant anxiety is defined as GAD-7 total score ≥ 8. Clinically significant depression: p < 0.001 across study groups with the following statistically significant posthoc pairwise group comparisons after Bonferroni correction: PM vs. HC, PCI vs. HC, and Dialysis vs. HC. Clinically significant anxiety: p = 0.36 across study groups. Abbreviations: Dialysis: Dialysis control group. GAD-7: Generalized Anxiety Disorder—7 scale. HC: Healthy control group. PCI: Percutaneous coronary intervention (PCI) control group. PHQ-9: Patient Health Questionnaire—9. PM: Pacemaker (PM) group.