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Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation
Chelsea Moran1, Michelle Flynn, Tavis Campbell
1Department of Psychology, University of Calgary, Calgary, Alberta, Canada (Mss Moran and Flynn and Drs Campbell and Rouleau); TotalCardiology Rehabilitation, Calgary, Alberta, Canada (Drs Rouleau and Chirico); TotalCardiology Research Network (TCRN), Calgary, Alberta, Canada (Drs Rouleau, Arena, Chirico, and Aggarwal); Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago (Drs Arena and Laddu); and University of Calgary Libin Cardiovascular Institute, Calgary, Alberta, Canada (Dr Aggarwal).
Purpose:
The objective of this study was to determine whether type 2 diabetes status is associated with an increased likelihood of depressed mood and anxiety in patients attending cardiac rehabilitation (CR) and to explore predictors of depression and anxiety after CR completion in patients with diabetes.
Methods:
A retrospective analysis was conducted in patients who completed a 12-wk CR program between 2002 and 2016. Patients were classified as reporting normal-to-mild or moderate-to-severe symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Logistic regression models were used to compare predictors of depression and anxiety prior to CR enrollment and investigate predictors of post-CR HADS scores among a subset of patients with diabetes.
Results:
Data from 6746 patients (mean age 61 ± 11 yr, 18% female, 18% with diabetes) were analyzed. After controlling for known predictors of depression, patients with diabetes were not more likely to report moderate-to-severe levels of depression prior to or after completing CR. In patients with diabetes, younger age predicted moderate-to-severe depression post-CR (OR = 0.95: 95% CI, 0.93-0.98). Patients with diabetes were also more likely to report moderate-to-severe levels of anxiety after completing CR (OR = 1.45: 95% CI, 1.02-2.07). Younger age (OR = 0.93: 95% CI, 0.88-0.97) and smoking status (OR = 3.3: 95% CI, 1.15-7.06) predicted moderate-to-severe post-CR anxiety in patients with diabetes.
Conclusions:
Patients with diabetes, particularly younger patients who currently smoke or recently quit, are more likely to report having anxiety following CR. These patients may therefore require additional management of anxiety symptoms during CR. Larger studies of CR patients with diabetes and more variable depression and anxiety levels are needed.
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