Anxiety, depression and myocardial infarction: a survey of their impact on consultation rates before and after an acute primary episode

May 2006    Volume 13, Issue 3   Br J Cardiol 2006;13:220-4

Authors:
Everard W Thornton, Peter Bundred, Michelle Tytherleigh, Ann DM Davies

The study documents general practitioner (GP) consultations before and after a primary, acute myocardial infarction (MI) and examines how these relate to psychological distress. Data were derived from the numbers and category of consultations and their outcome, documented from medical records of 194 patients with a primary acute MI over a two-year period pre-MI and a six-month period post-MI. Objective measures of anxiety and depression were collated using the Hospital Anxiety and Depression Scale in four phased assessments over a six-month period following the MI. There was a high probability of consultation for cardiovascular and psychological symptoms before a MI. Post-MI, almost all patients receive an early consultation: high consultation rates continue for cardiovascular concerns but they are relatively low for psychological issues. However, questionnaire responses indicated a substantial minority of patients with clinical or borderline clinical levels of anxiety (30%) and depression (20%) post-MI.

Patients are willing and able to make demands on their GPs post-MI, but not for psychological issues despite evidence of high levels of anxiety and depression; patients may be too accepting of distress. While GPs advise and are prepared to provide drug treatment for psychological concerns, they did not make referral for psychological support.

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