Negative Emotions: Depression, Exhaustion, and Anxiety

Abstract

This chapter reviews the role of depression and anxiety as risk factors for coronary heart disease. The epidemiology and methods of assessment for these disorders are discussed as well as the role of sub-threshold levels and related conditions including chronic psychological distress and exhaustion. The degree of risk of coronary heart disease associated with depression is as high as that associated with traditional cardiovascular risk factors (e.g., cholesterol, smoking, hypertension). Anxiety is also a significant risk indicator for coronary heart disease, but most studies show that the strength of the association is less than for depression. Anti-depressive interventions in patients with coronary heart disease show modest effects in reducing depression and improving quality of life but have minimal effects on adverse cardiac prognosis. Post-hoc analyses indicate, however, that anti-depressive interventions do reduce adverse cardiac events in the subgroup of patients where treatment results in marked improvements in depression. Little is known about behavioral or pharmacological interventions for anxiety in patients at risk of adverse cardiac events.