Elsevier

Heart & Lung

Volume 37, Issue 4, July–August 2008, Pages 286-295
Heart & Lung

Issues in cardiovascular nursing
Comparison of the Short Form 36 and the Hospital Anxiety and Depression Scale measuring emotional distress in patients admitted for elective coronary angiography

https://doi.org/10.1016/j.hrtlng.2007.08.001Get rights and content

Background

Anxiety and depression are frequently observed in patients with coronary artery disease. Because emotional distress is of prognostic importance in these patients, screening is recommended.

Objective

We compared the Short Form 36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS) in measuring emotional distress in patients admitted for elective coronary angiography.

Methods

A total of 587 patients were consecutively included (mean age 62 years, 75% were male). Gender-specific partial correlations were calculated for the associations between their SF-36 and HADS scores, whereas subgroup differences were evaluated using t tests or analysis of variance.

Results

In both genders, the HADS subscales for anxiety and depression were significantly related to all SF-36 subscales and most strongly related to the Mental Health subscale. Both HADS and the Mental Health subscale demonstrated a high occurrence of emotional distress and discriminated significantly between patients with and without severe angina. The HADS, but not the SF-36, demonstrated high levels of emotional distress (anxiety) among men without verified coronary artery disease.

Conclusion

Both instruments seem appropriate as screening instruments for emotional distress in patients with suspected coronary artery disease. Although the Mental Health subscale has the advantage of being shorter, we recommend the HADS because it shows anxiety more specifically.

Section snippets

Design and subjects

The present study has a cross-sectional design. Between August 2000 and February 2002, 1283 patients were consecutively admitted to elective coronary angiography at the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway. At least 214 of the patients were not invited to participate because of capacity reasons. This means that on particular days or weeks with limited staff resources, none of the patients were asked to participate. Among the remaining 1069 eligible

Characteristics of the study population

The characteristics of the 587 participants, 149 women and 438 men, are presented in Table I. The mean age was 63 years (standard deviation 10, range 32–86 years) for women and 61 years (standard deviation 10, range 31–84 years) for men. Most patients (95%) were examined because of suspected CAD, and significant CAD was more prevalent in men (86%) than in women (62%), as expected. Angina pectoris symptoms were similarly distributed in men and women, and none of the patients had unstable angina

Discussion

We compared the HADS and MH scales of SF-36 as measures of emotional distress among patients admitted for elective coronary angiography. In both men and women, the strongest association between the instruments was found between the SF-36 MH subscale and HADS-anxiety and HADS-depression subscales. Both instruments demonstrated high levels of emotional distress, particularly among the youngest patients. Both MH scales of the SF-36 and HADS were almost equally related to age. Our data may

Conclusion

Both the HADS and the SF-36 revealed a high occurrence of emotional distress in both women and men with suspected CAD who were referred to coronary angiography. However, because of its specificity, the HADS was the more feasible to detect anxiety, especially in the patients with negative angiography results. Anxiety is one aspect of mental health that is not specified by the SF-36 subscale. Thus, the HADS is recommended as a screening tool of mental health in patients with suspected CAD,

References (56)

  • C.R. Martin et al.

    A confirmatory factor analysis of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction

    Psychiatry Res

    (2003)
  • S.D. Fosså et al.

    Short Form 36 and Hospital Anxiety and Depression ScaleA comparison based on patients with testicular cancer

    J Psychosom Res

    (2002)
  • B. Ulvik et al.

    Relationship between provider-based measures of physical function and self-reported health-related quality of life in patients admitted for elective coronary angiography

    Heart Lung

    (2006)
  • J.H. Loge et al.

    Translation and performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritisI. Data quality, scaling assumptions, reliability, and construct validity

    J Clin Epidemiol

    (1998)
  • J.E. Ware et al.

    The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA project

    J Clin Epidemiol

    (1998)
  • J.A. Spertus et al.

    Association between depression and worse disease-specific functional status in outpatients with coronary artery disease

    Am Heart J

    (2000)
  • C.M. Dougherty et al.

    Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index-Cardiac Version III

    J Clin Epidemiol

    (1998)
  • D. Husser et al.

    Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life

    Eur J Pain

    (2006)
  • T. Dammen et al.

    The detection of panic disorder in chest pain patients

    Gen Hosp Psychiatry

    (1999)
  • C. Carter et al.

    Panic disorder and chest pain: a study of cardiac stress scintigraphy patients

    Am J Cardiol

    (1994)
  • R. Fleet et al.

    Is panic disorder associated with coronary artery disease?A critical review of the literature

    J Psychosom Res

    (2000)
  • J.C. Huffman et al.

    Predicting panic disorder among patients with chest pain: an analysis of the literature

    Psychosomatics

    (2003)
  • M.J. Zellweger et al.

    Coronary artery disease and depression

    Eur Heart J

    (2004)
  • N. Frasure-Smith et al.

    Social support, depression, and mortality during the first year after myocardial infarction

    Circulation

    (2000)
  • H. Hemingway et al.

    Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart diseaseSystematic review of prospective cohort studies

    Br Med J

    (1999)
  • A. Rozanski et al.

    Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy

    Circulation

    (1999)
  • D. Lane et al.

    The prevalence and persistence of depression and anxiety following myocardial infarction

    Br J Health Psychol

    (2002)
  • I. Wiklund et al.

    Prognostic importance of somatic and psychosocial variables after a first myocardial infarction

    Am J Epidemiol

    (1988)
  • Cited by (19)

    • The effects of Citrus aurantium aroma on anxiety and fatigue in patients with acute myocardial infarction: A two-center, randomized, controlled trial

      2020, Journal of Herbal Medicine
      Citation Excerpt :

      By its contribution to the release of catecholamine, anxiety results in impaired cardiac function, increased blood pressure and heart rate, dysrhythmia, pain aggravation, ischemia and heart failure. Anxiety is also associated with an increase in the need for mechanical ventilation and hospital stay and thereby reduces the quality of life and may even cause death (Huffman et al., 2008; Nematollahi et al., 2017; Ulvik et al., 2008). A study by Watkins et al. showed that anxiety increases the risk of mortality after discharge in cardiac patients (Watkins et al., 2013).

    • Socioeconomic inequalities in mental health in Australia: Explaining life shock exposure

      2020, Health Policy
      Citation Excerpt :

      This study used the Mental Health Inventory (MHI-5) of the Short Form 36 instrument (SF-36), a widely validated and reliable mental health measure [18,19]. This instrument has been used in a large body of medical literature [20–22] and health economics literature [23,24]. The scale is constructed from five items (nervous, down in dumps, peaceful, sad and happy) and its value ranges from 0-100.

    • Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries

      2018, American Journal of Medicine
      Citation Excerpt :

      One study supported an association between the HADS-D and QoL because patients with depression after myocardial infarction were more likely than those without depression to have poor QoL.18 Furthermore, when comparing the HADS-A and HADS-D with the SF-36, 1 study of patients with coronary heart disease found associations with all SF-36 subscales, most strongly with the mental health subscale, which indicates that the surveys measure similar aspects of mental health.19 Anxiety and depression are common and are associated with increased mortality in patients with coronary heart disease, even more strongly if the conditions coexist.20,21

    • Psychometric evaluation of the Hospital Anxiety and Depression Scale 3 months after acute lung injury

      2015, Journal of Critical Care
      Citation Excerpt :

      However, taken together, our correlations, κ values, and ROC results suggest that neither the EQ-5D-3L anxiety/depression item nor the SF-36 mental health–related domains are measuring precisely the same thing as either of the HADS subscales. Although the SF-36 mental health domain was particularly strongly related to the HADS-A subscale in the current study, in another study involving a medical sample [36], this domain was strongly and approximately equally correlated with the HADS-A and HADS-D subscales. Thus, we conclude that the SF-36 mental health domain may be a particularly good measure of psychological distress, but not general anxiety or depressive symptoms in particular.

    • Is shared misery double misery?

      2014, Social Science and Medicine
      Citation Excerpt :

      The measure of mental health we use is the 14 items relating to mental health within the Short-Form 36 questions (SF-36 henceforth), a widely used measure of psychological wellbeing with demonstrable validity and reliability in an Australian setting (Butterworth and Crosier, 2004; Sanson-Fisher and Perkins, 1998). The same instrument has been used in a large medical and psychiatric literature such as Crosier et al. (2007), Leese et al. (2008), Tunis et al. (1999), and Ulvik et al. (2008), and in health-economics research by, for example, Green (2010). Our measure of mental health combines 14 items from the SF-36 and covers four health domains: 1) vitality, e.g. feeling tired, feeling worn out, feeling full of life, and having a lot of energy; 2) social functioning, e.g. how emotional problems interfere with social activities; 3) role-emotional, e.g. changes in amount of time spent on work as a result of any emotional problems; and 4) mental health, e.g. being a nervous person, being calm and peaceful, feeling down, being a happy person, and feeling down in the dumps.2

    • Health-Related Quality of Life and Emotional Status of Anophthalmic Patients in Korea

      2010, American Journal of Ophthalmology
      Citation Excerpt :

      There were 40 (29.9%) and 38 (28.4%) anophthalmic patients, respectively, who scored 8 or more on the HADS-A and HADS-D. These percentages are similar to those reported for other chronic diseases, including cancer and coronary artery disease, which have used HADS for evaluation.17,18 Among the sociodemographic factors that we assessed, higher age and female gender were associated with a lower quality of life, which is similar to reports for other chronic diseases.6,19–22

    View all citing articles on Scopus

    This project was aided by EXTRA funds from the Norwegian Foundation for Health and Rehabilitation, the Norwegian Nurses Association, and the Vesta Insurance Company.

    View full text