Anxiety and depression among out-of-hospital cardiac arrest survivors

G Lilja; G Nilsson; N Nielsen; H Friberg; C Hassager; M Koopmans; M Kuiper; A Martini; J Mellinghoff; P Pelosi; M Wanscher; M P Wise; I Östman; T Cronberg

doi:10.1016/j.resuscitation.2015.09.389

Anxiety and depression among out-of-hospital cardiac arrest survivors

Resuscitation. 2015 Dec:97:68-75. doi: 10.1016/j.resuscitation.2015.09.389. Epub 2015 Oct 9.

Authors

G Lilja¹, G Nilsson², N Nielsen³, H Friberg⁴, C Hassager⁵, M Koopmans⁶, M Kuiper⁷, A Martini⁸, J Mellinghoff⁹, P Pelosi¹⁰, M Wanscher¹¹, M P Wise¹², I Östman¹³, T Cronberg¹⁴

Affiliations

¹ Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences, Neurology, Lund University, 221 85 Lund, Sweden. Electronic address: gisela.lilja@med.lu.se.
² Department of Clinical Sciences, Neurology, Lund University, 221 85 Lund, Sweden. Electronic address: gabriella.nilsson@hotmail.com.
³ Department of Intensive care and Anesthesiology, Helsingborg Hospital, Södra Vallgatan 5, 251 87 Helsingborg, Sweden; Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, 221 85 Lund, Sweden. Electronic address: niklas.nielsen@telia.com.
⁴ Department of Clinical Sciences, Anesthesiology and Intensive Care, Lund University, 221 85 Lund, Sweden; Department of Intensive and Perioperative Care, Skåne University Hospital, 221 85 Lund, Sweden. Electronic address: hans.a.friberg@gmail.com.
⁵ Department of Cardiology, The Heart Centre, Copenhagen University, Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark. Electronic address: hassager@dadlnet.dk.
⁶ Department of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands. Electronic address: matty.koopmans@znb.nl.
⁷ Department of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, The Netherlands; Department of Intensive Care, Academic Medical Center, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands. Electronic address: mi.kuiper@wxs.nl.
⁸ Department of Anaesthesia, Intensive Care and Emergency Medical Service, Santa Maria degli Angeli Hospital, Via Montereale 24, 33170 Pordenone (PN), Italy. Electronic address: alice.martini.2@gmail.com.
⁹ Department of Intensive and Perioperative Care, St. George's University Hospitals NHS Foundation Trust, 1st floor St. James Wing, Blackshaw Road, London SW17 0QT, United Kingdom. Electronic address: j.mellinghoff@nhs.net.
¹⁰ Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino IST, University-Hospital Genoa, Genoa 16132, Italy. Electronic address: ppelosi@hotmail.com.
¹¹ Department of Cardiothoracic Anaesthesia 4142, The Heart Center, Copenhagen University Hospital, Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark. Electronic address: michael.jaeger.wanscher@regionh.dk.
¹² Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom. Electronic address: mattwise@doctors.org.uk.
¹³ Department of Cardiology, Örebro University Hospital, Södra Grevrosengatan, 701 85 Örebro, Sweden. Electronic address: ingela.ostman@orebroll.se.
¹⁴ Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, 221 85 Lund, Sweden; Department of Clinical Sciences, Neurology, Lund University, 221 85 Lund, Sweden. Electronic address: tobias.cronberg@skane.se.

PMID: 26433116
DOI: 10.1016/j.resuscitation.2015.09.389

Abstract

Aim: Survivors of out-of-hospital cardiac arrest (OHCA) may experience psychological distress but the actual prevalence is unknown. The aim of this study was to investigate anxiety and depression within a large cohort of OHCA-survivors.

Methods: OHCA-survivors randomized to targeted temperature of 33 °C or 36 °C within the Target Temperature Management trial (TTM-trial) attended a follow-up after 6 months that included the questionnaire Hospital Anxiety and Depression Scale (HADS). A control group with ST-elevation myocardial infarction (STEMI) completed the same follow-up. Correlations to variables assumed to be associated with anxiety and depression in OHCA-survivors were tested.

Results: At follow-up 278 OHCA-survivors and 119 STEMI-controls completed the HADS where 24% of OHCA-survivors (28% in 33 °C group/22% in 36 °C group, p=0.83) and 19% of the STEMI-controls reported symptoms of anxiety (OR 1.32; 95% CI (0.78-2.25), p=0.30). Depressive symptoms were reported by 13% of OHCA-survivors (equal in both intervention groups, p=0.96) and 8% of STEMI-controls (OR 1.76; 95% CI (0.82-3.79), p=0.15). Anxiety and depression among OHCA-survivors correlated to Health-Related Quality-of-Life, and subjectively reported cognitive deterioration by patient or observer. In addition, depression was associated with a poor neurological outcome.

Conclusion: One fourth of OHCA-survivors reported symptoms of anxiety and/or depression at 6 months which was similar to STEMI-controls and previous normative data. Subjective cognitive problems were associated with an increased risk for psychological distress. Since psychological distress affects long-term prognosis of cardiac patients in general it should be addressed during follow-up of survivors with OHCA due to a cardiac cause. ClinicalTrials.gov NCT01020916/NCT01946932.

Keywords: Anxiety; Depression; Out-of-hospital cardiac arrest; Patient outcome assessment; Resuscitation; Target temperature management.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / epidemiology*
Depression / epidemiology*
Female
Humans
Hypothermia, Induced
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / psychology*
Out-of-Hospital Cardiac Arrest / therapy
Survivors / psychology*

Associated data

ClinicalTrials.gov/NCT01020916
ClinicalTrials.gov/NCT01946932