Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda

Detalhes bibliográficos
Autor(a) principal: Altino, Denise Meira [UNIFESP]
Data de Publicação: 2017
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5070244
http://repositorio.unifesp.br/handle/11600/50460
Resumo: Objective. Assess the impact of an anxious profile and symptoms of depression on the morbidity and mortality of patients with acute coronary syndrome (ACS) and identify predictive factors for anxiety and depression among these patients. Method. This retrospective cohort study was conducted in two phases in a coronary care unit. The first phase assessed predictive factors for anxiety and depression in 120 patients with ACS. Data were obtained from a previous study’s database. The second phase assessed the morbidity and mortality of 94 patients over a two-year period following hospital discharge. Data were collected from the patients’ electronic medical files and through telephone contact established at three points in time: immediately after hospital discharge; one year after discharge; and two years after discharge. The need to be readmitted due to a cardiovascular disease or the need for myocardial revascularization (MR) was considered for morbidity. Depression and anxiety were assessed using the Beck’s Depression Inventory and the Beck Anxiety Inventory-Trait. The variables collected to identify predictive factors were obtained using an instrument addressing sociodemographic and clinical data. Pearson’s chi-square test, Fisher’s exact test, Likelihood Ratio, the Mann-Whitney, Student’s t-test, and Spearman’s correlation coefficient were used to assess the relationship between anxiety and depression with the study’s variables. Variables associated with p<0.10 in the univariate analysis were used in the fitting of the logistic regression model. To describe the behavior of morbidity and mortality over time in the second phase, the Kaplan-Meier curve was used and the association of survival curves per category of depression and anxiety were compared using the log-rank test. The level of significance adopted was 0.05. The study was submitted to and approved by the Institutional Review Board. Results. Sex, diabetes mellitus, stress, anxiety, obesity, and number of years of education were related to depression. Sex, stress, depression and years of education were related to anxiety. Obesity increased the likelihood of depression by approximately 4.5 times (p-value=0.037) and each added unit in the anxiety score increased the likelihood of depression by 1.2 times (p-value<0.001). Depression, in turn, increased the likelihood of anxiety by 7.9 times (p-value<0.001), while one extra year of education is a protective factor from anxiety (OR=0.874, p-value=0.036). The two-year follow-up showed that 23.4% of the patients had been readmitted after the first year and 12.8% after the second. During hospitalization, 17% underwent a MR, 4.2% of which had one after the first year and none of the patients after the second year. Only 9.6% died in the follow-up period. Depression and anxiety were not related to morbidity or mortality. Conclusion. No significant relationship was found between anxiety and depression and morbidity or mortality. Obesity and anxiety were predictive factors for depression, while depression and fewer years of education were predictive factors for anxiety.
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spelling Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana agudaThe impact of an anxious profile and symptoms of depression on the morbidity and mortality of patients with acute coronary syndromeAcute coronary syndromeMyocardial InfarctionMyocardial ischemiaAnxietyDepressionSíndrome coronariana agudaInfarto do miocárdioIsquemia miocárdicaAnsiedadeDepressãoObjective. Assess the impact of an anxious profile and symptoms of depression on the morbidity and mortality of patients with acute coronary syndrome (ACS) and identify predictive factors for anxiety and depression among these patients. Method. This retrospective cohort study was conducted in two phases in a coronary care unit. The first phase assessed predictive factors for anxiety and depression in 120 patients with ACS. Data were obtained from a previous study’s database. The second phase assessed the morbidity and mortality of 94 patients over a two-year period following hospital discharge. Data were collected from the patients’ electronic medical files and through telephone contact established at three points in time: immediately after hospital discharge; one year after discharge; and two years after discharge. The need to be readmitted due to a cardiovascular disease or the need for myocardial revascularization (MR) was considered for morbidity. Depression and anxiety were assessed using the Beck’s Depression Inventory and the Beck Anxiety Inventory-Trait. The variables collected to identify predictive factors were obtained using an instrument addressing sociodemographic and clinical data. Pearson’s chi-square test, Fisher’s exact test, Likelihood Ratio, the Mann-Whitney, Student’s t-test, and Spearman’s correlation coefficient were used to assess the relationship between anxiety and depression with the study’s variables. Variables associated with p<0.10 in the univariate analysis were used in the fitting of the logistic regression model. To describe the behavior of morbidity and mortality over time in the second phase, the Kaplan-Meier curve was used and the association of survival curves per category of depression and anxiety were compared using the log-rank test. The level of significance adopted was 0.05. The study was submitted to and approved by the Institutional Review Board. Results. Sex, diabetes mellitus, stress, anxiety, obesity, and number of years of education were related to depression. Sex, stress, depression and years of education were related to anxiety. Obesity increased the likelihood of depression by approximately 4.5 times (p-value=0.037) and each added unit in the anxiety score increased the likelihood of depression by 1.2 times (p-value<0.001). Depression, in turn, increased the likelihood of anxiety by 7.9 times (p-value<0.001), while one extra year of education is a protective factor from anxiety (OR=0.874, p-value=0.036). The two-year follow-up showed that 23.4% of the patients had been readmitted after the first year and 12.8% after the second. During hospitalization, 17% underwent a MR, 4.2% of which had one after the first year and none of the patients after the second year. Only 9.6% died in the follow-up period. Depression and anxiety were not related to morbidity or mortality. Conclusion. No significant relationship was found between anxiety and depression and morbidity or mortality. Obesity and anxiety were predictive factors for depression, while depression and fewer years of education were predictive factors for anxiety.Objetivo. Avaliar o impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda (SCA); identificar os fatores preditivos para ansiedade e depressão destes pacientes. Método. Estudo de coorte retrospectivo, realizado em unidade coronariana, dividido em duas fases. A primeira avaliou os fatores preditivos para ansiedade e depressão de 120 pacientes com SCA. Os dados desta fase foram obtidos de um banco de dados coletados de estudo prévio. Na segunda fase avaliou-se a morbidade e mortalidade de 94 destes pacientes no período de dois anos após alta hospitalar. Estes dados foram coletados por meio do prontuário eletrônico e contato telefônico nos seguintes momentos: imediatamente após a alta hospitalar; após um ano e após dois anos da alta. Para morbidade, considerou-se a necessidade de readmissão devido doença cardiovascular e necessidade de revascularização miocárdica (RM). A ansiedade e a depressão foram avaliadas por meio do Inventário de Ansiedade Traço e Inventário de Depressão de Beck, respectivamente. As variáveis coletadas para identificar os fatores preditivos foram obtidas por meio de um instrumento contendo dados sociodemográficos e clínicos. Para avaliar a relação da ansiedade e depressão com as variáveis foram utilizados os testes Pearson Chi-Square, Exato de Fisher, Likehood Ratio, Mann-Whitney, t-Student e o Coeficiente de Correlação de Spearman. As variáveis que apresentaram p<0,10, na análise univariada, foram utilizadas no ajuste do modelo de regressão logística. Na segunda fase, para descrever o comportamento da morbidade e mortalidade ao longo do tempo foram utilizados os gráficos de Kaplan-Meier e, a associação das curvas de sobrevida por categoria de depressão e ansiedade foram comparadas por meio do teste logrank. O nível de significância adotado foi de 0,05. O estudo foi apreciado e aprovado pelo Comitê de Ética em Pesquisa. Resultados. Sexo, diabetes mellitus, estresse, ansiedade, obesidade e número de anos estudados se associaram com a depressão. Sexo, estresse, depressão e número de anos estudados se associaram com a ansiedade. Observou-se que a presença de obesidade aumenta em aproximadamente 4,5 vezes a chance de depressão (p-valor=0,037) e para cada unidade que se aumenta no escore da ansiedade, pode aumentar em 1,2 vezes a chance de o paciente apresentar depressão (p-valor<0,001). A depressão, por sua vez, aumenta em aproximadamente 7,9 vezes a chance do paciente apresentar ansiedade (p-valor<0,001), enquanto que cada ano a mais estudado é um fator protetor para ansiedade (OR= 0,874, p-valor=0,036). Ao avaliar os pacientes no seguimento de dois anos, 23,4% apresentaram uma nova internação após o primeiro ano e 12,8% após o segundo ano. Durante a internação, 17% dos pacientes realizaram RM, 4,2% após o primeiro ano e nenhum após o segundo. Apenas 9,6% evoluíram a óbito durante o período de seguimento. A depressão e ansiedade não se relacionaram à morbidade e a mortalidade. Conclusão. Não houve associação significativa entre níveis de ansiedade e depressão com a morbidade e mortalidade dos pacientes. A obesidade e a ansiedade foram fatores preditivos para a depressão e a depressão e o menor número de anos estudados para a ansiedade.Dados abertos - Sucupira - Teses e dissertações (2017)Universidade Federal de São Paulo (UNIFESP)Lopes, Juliana de Lima [UNIFESP]Barros, Alba Lucia Bottura Leite de [UNIFESP]http://lattes.cnpq.br/3089430786971948http://lattes.cnpq.br/1478157388713375http://lattes.cnpq.br/0009905887482691Universidade Federal de São Paulo (UNIFESP)Altino, Denise Meira [UNIFESP]2019-06-19T14:57:57Z2019-06-19T14:57:57Z2017-06-29info:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersion89 f.application/pdfhttps://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5070244http://repositorio.unifesp.br/handle/11600/50460porSão Pauloinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-02T17:46:02Zoai:repositorio.unifesp.br/:11600/50460Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-08-02T17:46:02Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
The impact of an anxious profile and symptoms of depression on the morbidity and mortality of patients with acute coronary syndrome
title Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
spellingShingle Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
Altino, Denise Meira [UNIFESP]
Acute coronary syndrome
Myocardial Infarction
Myocardial ischemia
Anxiety
Depression
Síndrome coronariana aguda
Infarto do miocárdio
Isquemia miocárdica
Ansiedade
Depressão
title_short Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
title_full Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
title_fullStr Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
title_full_unstemmed Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
title_sort Impacto do perfil ansioso e dos sintomas de depressão na morbidade e mortalidade de pacientes com síndrome coronariana aguda
author Altino, Denise Meira [UNIFESP]
author_facet Altino, Denise Meira [UNIFESP]
author_role author
dc.contributor.none.fl_str_mv Lopes, Juliana de Lima [UNIFESP]
Barros, Alba Lucia Bottura Leite de [UNIFESP]
http://lattes.cnpq.br/3089430786971948
http://lattes.cnpq.br/1478157388713375
http://lattes.cnpq.br/0009905887482691
Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Altino, Denise Meira [UNIFESP]
dc.subject.por.fl_str_mv Acute coronary syndrome
Myocardial Infarction
Myocardial ischemia
Anxiety
Depression
Síndrome coronariana aguda
Infarto do miocárdio
Isquemia miocárdica
Ansiedade
Depressão
topic Acute coronary syndrome
Myocardial Infarction
Myocardial ischemia
Anxiety
Depression
Síndrome coronariana aguda
Infarto do miocárdio
Isquemia miocárdica
Ansiedade
Depressão
description Objective. Assess the impact of an anxious profile and symptoms of depression on the morbidity and mortality of patients with acute coronary syndrome (ACS) and identify predictive factors for anxiety and depression among these patients. Method. This retrospective cohort study was conducted in two phases in a coronary care unit. The first phase assessed predictive factors for anxiety and depression in 120 patients with ACS. Data were obtained from a previous study’s database. The second phase assessed the morbidity and mortality of 94 patients over a two-year period following hospital discharge. Data were collected from the patients’ electronic medical files and through telephone contact established at three points in time: immediately after hospital discharge; one year after discharge; and two years after discharge. The need to be readmitted due to a cardiovascular disease or the need for myocardial revascularization (MR) was considered for morbidity. Depression and anxiety were assessed using the Beck’s Depression Inventory and the Beck Anxiety Inventory-Trait. The variables collected to identify predictive factors were obtained using an instrument addressing sociodemographic and clinical data. Pearson’s chi-square test, Fisher’s exact test, Likelihood Ratio, the Mann-Whitney, Student’s t-test, and Spearman’s correlation coefficient were used to assess the relationship between anxiety and depression with the study’s variables. Variables associated with p<0.10 in the univariate analysis were used in the fitting of the logistic regression model. To describe the behavior of morbidity and mortality over time in the second phase, the Kaplan-Meier curve was used and the association of survival curves per category of depression and anxiety were compared using the log-rank test. The level of significance adopted was 0.05. The study was submitted to and approved by the Institutional Review Board. Results. Sex, diabetes mellitus, stress, anxiety, obesity, and number of years of education were related to depression. Sex, stress, depression and years of education were related to anxiety. Obesity increased the likelihood of depression by approximately 4.5 times (p-value=0.037) and each added unit in the anxiety score increased the likelihood of depression by 1.2 times (p-value<0.001). Depression, in turn, increased the likelihood of anxiety by 7.9 times (p-value<0.001), while one extra year of education is a protective factor from anxiety (OR=0.874, p-value=0.036). The two-year follow-up showed that 23.4% of the patients had been readmitted after the first year and 12.8% after the second. During hospitalization, 17% underwent a MR, 4.2% of which had one after the first year and none of the patients after the second year. Only 9.6% died in the follow-up period. Depression and anxiety were not related to morbidity or mortality. Conclusion. No significant relationship was found between anxiety and depression and morbidity or mortality. Obesity and anxiety were predictive factors for depression, while depression and fewer years of education were predictive factors for anxiety.
publishDate 2017
dc.date.none.fl_str_mv 2017-06-29
2019-06-19T14:57:57Z
2019-06-19T14:57:57Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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http://repositorio.unifesp.br/handle/11600/50460
url https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5070244
http://repositorio.unifesp.br/handle/11600/50460
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dc.publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
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repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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