@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(3):231-238

Background
Cardiovascular diseases are among the most chronic diseases, and the mortality rate resulting by these diseases is 28.5% in developing countries and 30-35% in Iran [1].
Previous Studies
… [2-11]. In some studies, the prevalence of preoperative anxiety (27-40.6%) and preoperative open-heart surgery depression (16-43%) were reported [12, 13]. In Karnich’s study, conducted in Germany in 2007, the anxiety and depression was assessed before, 2 days, and 10 days after the operation by Anxiety and Depression Scale (HADS). Depression before and after coronary artery bypass surgery was 25.8% and 17.5% and anxiety before and after surgery was 34% and 24.7%, respectively. There was a negative and significant relationship between age and anxiety [14]. According to another study, prevalence of pre-CABG depression and post-CABG depression was 47% and 61%, respectively. In a study conducted in 2016, depression in patients undergoing cardiac surgery was 17.1% [15]. Major depression was reported to be similar in the study of Touli in 2015 [16]. In a study carried out by Poul in 2017, over one-third of patients (35.9%) reported moderate to severe depression symptoms based on Beck's questionnaire [17].
Aim(s)
The aim of this study was to determine the prevalence of anxiety and depression based on gender and age differences in patients undergoing coronary artery bypass surgery.
Research type
This research is a cross sectional descriptive study.
Research society, place and time
This study was conducted from March to July 2009 among the population of patients aged 30-80 years, who were candidates for elective cardiac surgery at Dr. Heshmat Medical Center, Rasht, Iran.
Sampling method and number
205 out of 211 eligible subjects (97%) were selected by available sampling method. Three patients, due to lack of joints, 2 due to be worry of surgery, and 1 because of unwillingness to participate in the study, were excluded. The sample size was calculated to be 201 based on alpha 0.05, (p) prevalence of preoperative depression in [14] (p=0.25), and (d) accuracy of 0.062. The inclusion criteria of the study were patients candidate for elective heart surgery, aged between 30-80 years, who were referred to the hospital. Patients who needed emergency surgery as well as and blind, deaf, and speechless individuals were excluded from the study for the fact that they did not perform preoperative psychological examinations, and because of their inability to perform tests, respectively. This article is based on the data of a research in the Guilan University of Medical Sciences with an ethics code of 1930003572 in March 17th, 2015. Informed consent was obtained from all of the patients. Regarding the process of conducting the research and the purpose of the study, the patients were given the necessary explanations about the confidentiality of all the information they had obtained and that they could leave the study at any time.
Used devices&materials
… [18-20]. One day before the operation, demographic information (age, gender, marital status, living conditions, place of residence, educational level) and information about the operation (type of operation, history of diabetes, smoking, the surgical method) were collected by interviewing the patient and studying the case. HADS and Spielberger State-Trait Anxiety Inventory (STAI) were used to measure depression and anxiety of the patients. The information were collected by a trained questioner. The HADS scale was designed by Zigmond and Snaith to measure mood changes, especially anxiety and depression. The questionnaire is scored on the basis of a 4-scale score (1, 0, 2, and 3). Authors recommend a score of 11 as a cutoff point. This questionnaire was standardized and validated by Kaviani et al. in 2009 for use in Iranian societies. Its reliability was determined by calculating Cronbach's alpha for depression (α=0.70) and anxiety (α=0.85) [21]. STAI-X STAI was prepared in 1970 by Spielberger et al. The subject should evaluate his/her feelings about any material with a 4-point Likert scale. The range of scores in each item is from 20 to 80; greater scores indicate higher anxiety of the individual. In Iran, this tool was standardized by Panhahishahri (1993), and alpha coefficients in different groups were 0.92 for anxiety mood and 0.90 for anxiety trait [22]. The data were analyzed, using SPSS 19 software. Normality of the quantitative data was evaluated, using Kolmogrov-Smirnov test and reported as the mean and standard deviation and the qualitative data were shown as frequency and percentage. The comparison of the mean of quantitative variables, anxiety, and depression was evaluated by gender, using independent t-test and one-way ANOVA based on the studied groups. The frequency of qualitative variables in the studied groups was analyzed, using Chi-square analysis.
Findings by Text
The mean age of the samples was 59.6 years with a standard deviation of 4.9. 136 (66.3%) patients were male and the rest were female. Most of the patients (94.6%) were married and the rest were single, widowed, or divorced. More than 50% of the patients enrolled in this study had less education than the diploma (26.3% were illiterate, 42% were under diploma). About 5% of the patients lived alone and did not have a person to care. 69% of the patients lived in cities. There was no significant difference between two groups in terms of demographic characteristics, including marital status, education, living conditions, and living place. Only the frequency of diabetes was significantly higher in women than men (p<0.01). The frequency of moderate and severe situation state anxiety in patients was 79.22% and 3.41%, respectively, and only 18% of the patients had no state anxiety. The prevalence of state anxiety was not different in women and men (p=0.4). By comparing the mean of state anxiety in men and women, women showed milder degrees of higher rates of anxiety than men, but this difference was not statistically significant (p=0.3). The prevalence of moderate and severe state anxiety was reported in 78.4% of the patients, and 4.8% of the patients had severe anxiety and 73.6% had moderate anxiety. The mean score of the state anxiety inventory was not different in men and women (p=0.9). The mean depression score in all subjects was 7.5±3.1, which did not significantly differ between men and women (p=0.9). 58.1% of men and 55.1% of women report some degrees of depression. The frequency of mild, moderate, and severe depression in men and women was not significantly different (p=0.8). Trait anxiety was significantly lower in smokers than non-smokers (p=0.009). The mean of state anxiety score in people with university education was lower than that of lower education level (p=0.008). Hospital depression scores, state anxiety, and trait anxiety were not different based on other studied variables.
Main comparison to the similar studies
The prevalence of depression in our study was consistent with many similar studies, all of which reported a high incidence of depression in patients under CABG [5, 19, 23]. In the Burker’s study, the level of depression was 47% and the CES-D test was used to determine depression in patients [23]. A number of studies reported a lower percentage of preoperative depression [2, 12, 14]. In a study carried out by Rymaszewska, conducted between October 1998 and November 1999 at Cardiac Surgery Department, Faculty of Medicine, Roc Laver, preoperative depression was reported in 32% of patients, which was lower than the findings of the present study. The tool used in the study of Rymaszewska was Beck Depression Inventory, while in the present study, the HADS was used and the sample size in the study of Rymaszewska was 53 [2]. … [24]. In our study, there was no significant difference between depression and gender. In contrast to our study, in a study performed by Rankin, pre- and post-operative depression was higher in men than in women [25]. In various studies, including Artinian [26], Brezinka [27], Pirraglia [28], Moore [29], and Behrozian et al. [30], depression was higher in women. The results of these studies were inconsistent with the present study. There was no statistical significant difference between two genders in terms of mood disorders in studies conducted by Timberlake et al. [31], Dunkel et al. [32], and McCrone [33], which was consistent with our study. In Fathi et al.’s study, as in our study, most patients reported moderate anxiety [34]. However, in our study, state and trait anxiety in men and women were not statistically significant, but women reported higher levels of state anxiety. This finding was in line with studies carried out by Korbmacher et al. [24] and Timberlake et al. [31]. ... [35-40].
Suggestions
Increasing sample size will have more favorable results.
Limitations
None declared by the authors.
Conclusions
Depression and anxiety are common in women and men in open-heart surgery.
Acknowledgments
The authors express their gratitude to the research deputy of the University for financial support. We are also grateful to the Head of Department and the staff of the Heart Surgery Department of Heshmat Hospital, who helped us with this sincere research.
Conflict of interest
None declared by the authors.
Ethical Permissions
This research was approved at Guilan University of Medical Sciences with the ethics code of 1930003572 in March 17th, 2015.
Funding Sources
The research was funded by the research deputy of the University of Medical Sciences.