Paper
Saturday, July 24, 2004
Factors Associated With Depression Three Months After Implantable Cardioverter Defibrillator (ICD) Insertion
Sandra B. Dunbar, RN, DSN, FAAN1, Bindu Viswanthan, PhD1, Chris O'Brien, RN, MPH2, and Laura P. Kimble, PhD, RN1. (1) Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA, (2) Nell Hogdson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| Learning Objective #1: Identify factors associated with depression three months after ICD insertion |
| Learning Objective #2: Identify possible targets of intervention to reduce depressive symptoms in ICD patients |
Objective: Psychological symptoms in patients after cardiac procedures represent an important component of quality of life, and understanding associated factors may lead to improved outcomes. This study described depressive symptoms at three months after implantable cardioverter defibrillator (ICD) insertion and examined associated demographic, clinical, illness appraisal and coping factors. Design: A descriptive correlational design was used to collect data during hospitalization for ICD insertion (baseline) and at 3 months. Population: Subjects (n=180) were ventricular arrhythmia patients receiving an initial ICD and were 58+11 years, 74% male, 70% NYHA Class II/III. Variables: Variables included demographics (age, gender, marital status), clinical data (NYHA Class, cormorbidities), optimism (Life Orientation Test), depressive symptoms, (Beck Depression Inventory-II; BDI-II), functional status (Duke Activity Status Index; DASI), threat illness appraisal (Meaning of Illness Questionnaire), and coping (Jalowiec Coping Scale). Defibrillator activity was obtained by computerized interrogation of arrhythmia events. Methods: Data were analyzed with descriptive statistics and univariate correlations. Multiple regression analysis was conducted to determine the ability of clinical, demographic, functional status and coping/appraisal variables to predict 3 month BDI-II scores. Findings: Three month BDI-II scores ranged from 0-40 with mean (S.D.) of 8.15 (7.51). Because the BDI-II scores were not normally distributed, log transformation was performed. Multiple regression analysis accounted for 50% of the variance with the DASI (p<.001), threat appraisal (p=.002), and baseline BDI-II scores (p<.001) as independent predictors. Conclusions: Higher threat illness appraisal scores, lower functional status and greater baseline depressive symptoms were associated with greater depressive symptoms at 3 months after ICD insertion. Implications: Attention to functional status, illness appraisal and depressive symptoms in the acute care setting may identify those at risk for depressive symptoms and adverse psychological recovery after ICD insertion. These data identify ICD patients who may benefit from targeted interventions to reduce threat appraisals and improve psychological outcomes.
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