Longitudinal Changes in Anxiety and Depression Following First Implantable Cardioverter-Defibrillator Implantation: A...

Background and Objectives: ICD implantation is associated with psychological distress, but longitudinal patterns of anxiety and depression remain incompletely characterized. To evaluate the prevalence and longitudinal evolution of anxiety and depressive symptoms in patients undergoing first-time ICD implantation. Materials and Methods: This prospective study included 96 patients undergoing first ICD implantation. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at implantation (T0), one week post-discharge (T1), and six months later (T2). Data distribution was assessed using the Shapiro-Wilk test. Changes over time were analyzed using the Friedman test, Wilcoxon signed-rank tests, and Linear Mixed-Effects Models (LMM), with effect size (Kendall's W) and Spearman correlations. A sensitivity analysis evaluated severe distress thresholds (HADS ≥ 11). Results: Significant longitudinal changes were observed for both anxiety (Friedman Q = 63.32, p < 0.001; Kendall's W = 0.34) and depression (Q = 68.36, p < 0.001; W = 0.37). Mean HADS-A scores increased from 7.40 ± 2.70 at T0 to 9.22 ± 3.35 at T1 and 8.55 ± 2.78 at T2. Mean HADS-D scores increased from 6.53 ± 2.47 to 8.06 ± 3.02 and 8.24 ± 2.41, respectively. Clinically relevant anxiety (HADS-A ≥ 8) increased from 41.7% to 66.3% and 58.7%, while clinically relevant depression (HADS-D ≥ 8) increased from 27.1% to 54.3% and 56.5%. Sensitivity analyses for severe cases (HADS ≥ 11) confirmed consistent temporal trajectories (p < 0.001). Subgroup analyses (sex, indication, age) revealed no significant differences (p > 0.15), and no ICD shocks were delivered during follow-up. Anxiety and depression were strongly correlated at all time points (p < 0.001). Conclusions: Anxiety and depression symptoms are highly prevalent among ICD recipients and follow distinct temporal trajectories during the post-implantation course, with anxiety peaking early and depressive symptoms showing a more sustained increase in the absence of device therapies. Routine psychological screening and stage-specific psychosocial support strategies should be evaluated for integration into standard ICD care.