COLLEGE OF MEDICINE AND HEALTH
Medicine, Nursing and Allied Health Professions

Worry and depression in CHD

The role of perseverative negative thinking in predicting depression in people with coronary heart disease.

Background

Approximately 20% of people with coronary heart disease (CHD) also experience depression, which is associated with reduced quality of life and increased morbidity and mortality. Although proof that depression causes worse medical outcomes is lacking, a better understanding of the causes of depression in people with CHD could help predict which patients are at increased risk of worse medical outcomes. In turn, this could inform the development of novel interventions that could benefit both physical and mental health.

Some people may worry and ruminate following CHD, which could contribute to the development of depression. Worry and rumination are examples of ‘perseverative negative thinking’. In otherwise healthy people, a strong association has been shown between perseverative negative thinking and depression.

We have conducted a systematic review* to assess the strength of the prospective association of perseverative negative thinking with subsequent depression and anxiety in people with long term conditions. The findings revealed only a limited amount of research investigating the association of perseverative negative thinking with depression in people with CHD. The majority of studies supported an association, although some were small and of limited quality.

To build on the review we have conducted an observational prospective cohort study. The aim is to describe perseverative negative thinking in people with CHD, and to investigate the strength and mechanisms of the association between perseverative negative thinking with subsequent depression, anxiety and health-related quality of life in people with CHD. One hundred and sixty-nine acute coronary syndrome (ACS) patients completed a battery of self-report questionnaires assessing worry, rumination, depression, anxiety, and quality of life. These were completed soon after hospitalisation and repeated again 2 and 6 months later. In addition, social support, problem solving, engagement in pleasant activities, and information processing biases were assessed in order to investigate potential mechanisms by which perseverative negative thinking might lead to depression. For more information, please read the patient information sheet. Data collection is complete and we are currently analysing the data.

This cohort study will confirm whether perseverative negative thinking predicts the development of depression in people with CHD, and will clarify mechanisms by which perseverative negative thinking might impact on both mood and physical health outcomes. This could lead to the development of novel interventions for people with CHD that could improve not only depression but also cardiac outcomes.

*Trick L, Watkins E, Windeatt S, Dickens C (2016) The association of perseverative negative thinking with depression, anxiety and psychological distress in people with long term conditions: A systematic review. Journal of Psychosomatic Research, 91: 89-101. http://dx.doi.org/10.1016/j.jpsychores.2016.11.004

This research is being carried out by a team of researchers from the University of Exeter (Leanne TrickJessica BollenChris DickensEd WatkinsWilliam Henley) and the Royal Devon & Exeter Hospital Cardiology department (Dr Manish Gandhi). For more information please contact Leanne Trick by email or telephone (01392 725947).