Stress, anxiety and depression in cardial infarct and bypass surgery patients

Introduction

Our study aimed at studying stress, anxiety and depression symptoms of ICU patients while focusing on a restricted pathology (i.e. patients with cardiac disease), and while comparing the impact of stress between patients exposed to different levels of medical information (i.e. informed bypass surgery patients versus uninformed inaugural infarct patients) and to a different perceived control of their medical treatment (i.e. controlled uncomplicated stay vs uncontrolled complicated stay).

Materials and methods

Thirty-two ICU patients not older than 75 were assigned to either one of four subgroups according to their medical history: complicated bypass (CB), uncomplicated bypass (UB), complicated infarct (CI) and uncomplicated infarct (UI). All patients were examined twice. On Time 1 (2 days after discharge from ICU) they answered stress (Perceived Stress Scale [PSS]) and post-traumatic stress questionnaires (the Impact of Events Scale [IES]), the Hospital Anxiety and Depression Scale (HADS) and the State subscale of the State-Trait Anxiety Inventory (STAI-T, testing constitutive anxiety). On Time 2 (6 weeks later), they answered the same scales minus the STAI-T. Assuming that bypass patients are better informed than infarct patients, and the fewer the complications the larger the sense of control, we tested the hypothesis that CI patients would performed badly on our scales whereas UB would do better.

Results

On Time 1, overall results indicated poor levels of stress, anxiety or depression. Yet UI patients steadily produced the lowest scores of the sample, whereas bypass patients produced the highest. UI patients thus presented less depressive symptoms on the HADS (H = 8.335, P = 0.039). The STAI-T results also showed a dissociation between those patients who experienced complications (CI and CB) and those who did not (UI and UB): self-rated 'anxious' patients were more numerous in the 'complicated' groups CI and CB (F = 4.614 and P = 0.005).

On Time 2, measures of stress remained low on the PSS. Yet signs of post-traumatic stress (IES) emerged in bypass patients (CB and UB) and to a lesser extent in CI patients, with significant group effects in the avoidance scale (F = 2.286 and P = 0.036) and in the total scale (F = 3.13 and P = 0.042) of the IES.

Conclusion

Our results show mild signs of stress, anxiety or depression shortly after release of ICU. Yet some consistent post-traumatic stress affects bypass patients several weeks later. UI patients steadily display the weakest symptoms of all. In contrast to our initial hypothesis, 'informed' bypass patients presented the strongest signs of stress, anxiety and depression, while the 'control' factor primarily impacts on infarct patients.