Cardiac outpatients commonly have psychiatric disorders

Psychiatric disorders were common among cardiac outpatients in the Middle East, according to results of a cross-sectional study published in Psychiatric Annals.

“Results from several studies confirmed that depressive disorders were associated with detrimental cardiac outcomes, including worsened medical morbidity, increased mortality, poor quality of life, adverse occupational impairment and reduced treatment adherence,” Ahmad Saad Alzahrani, MD, consultant of psychiatry and psychosomatic medicine at Alfaisal University in Saudi Arabia, and colleagues wrote. “A recent systematic analysis showed that the risk of [coronary artery disease] patients with depression dying in the 2 years after the initial cardiac assessment was 2 times higher than that of [coronary artery disease] patients without depression. For CVD patients with anxiety disorders, continuous anxiety was found to be predictive of worsened physical signs and symptoms, disability and reduced functional status.”

Moreover, other studies showed cardiac patients with anxiety returned to work more slowly vs. patients without anxiety and an association between panic disorder and myocardial perfusion deficits, as well as poorer clinical outcomes. Most of these prior studies focused on one group of psychological symptoms or a discrete psychiatric condition, and others observed one cardiac condition in a specific setting. Further, the prevalence of psychiatric conditions among cardiac outpatients remains largely understudies, particularly in the Middle East.

In the current study, Alzahrani and colleagues sought to estimate the prevalence of psychiatric disorders among a general cardiac outpatient setting in Saudi Arabia. They performed a semi-structured interview among 343 cardiac outpatients and confirmed psychiatric diagnoses using a validated version of the Mini International Neuropsychiatric Interview. A total of 93 patients (27.1%) were classified as having at least one psychiatric disorder.

Results showed past major depressive disorder (14%) as the most prevalent disorder, followed by current generalized anxiety disorder (GAD) (12.8%) and current MDD (8.5%). Psychiatric illness diagnosis was more likely among cardiac patients who were divorced (OR = 6.14; 95% CI, 1.27-29.7), had past psychiatric illness history (OR = 2.83; 95% CI, 1.3-6.15) or currently smoked (OR = 2.11; 95% CI, 1.09-4.09). The researchers noted the overall common occurrence of psychiatric disorder among cardiac outpatients, with MDD and GAD as the most common.

“Studies on risk factors for psychiatric disorders in cardiac patients are lacking and warrant further exploration,” Alzahrani and colleagues wrote.