Depression and health-related quality of life in cardiovascular patients: A cross-sectional study on the mediating roles of fear, attention, and avoidance
Aug 2026· Medicine· Vol 105· 0 citations· 43 references
Medicine
TL;DR
It is suggested that a complex interplay between depression and anxiety subdomains influences quality of life among patients with CVD, and future prospective or interventional studies are needed to evaluate whether interventions targeting depressive symptoms and maladaptive anxiety responses can improve HRQoL in this population.
Abstract
Depression and anxiety are prevalent among patients with cardiovascular disease (CVD) and detrimentally affect their health-related quality of life (HRQoL). Although current guidelines recommend screening for both conditions, the mechanisms underlying the association between depression and HRQoL, particularly through the anxiety subdomains of fear, attention, and avoidance, remain unclear. This study investigates how anxiety-related factors mediate the relationship between depression and HRQoL in patients with CVD. This cross-sectional study analyzed 204 CVD outpatients from a tertiary hospital in South Korea. Each patient completed the Patient Health Questionnaire-9 to assess depression, the Cardiac Anxiety Questionnaire to evaluate anxiety subdomains, and the 12-Item Short Form Health Survey to measure HRQoL. Serial multiple mediation analyses were conducted to examine the direct and indirect associations between depression and HRQoL. This approach allowed the potential pathways of mediators to be simultaneously tested, particularly the sequential path from fear to attention to avoidance. Higher depression scores showed a significant negative association with HRQoL (total effect: β = -0.5449, P < .001). Moreover, indirect pathways were observed: increased depression was associated with heightened levels of fear, attention, and avoidance. The direct association between depression and HRQoL remained significant when the indirect pathways were controlled (β = -0.3888, P < .001), supporting a partial mediation model. The overall mediation model explained 18% of the variance in HRQoL. Our findings suggest that a complex interplay between depression and anxiety subdomains influences quality of life among patients with CVD. Therefore, future prospective or interventional studies are needed to evaluate whether interventions targeting depressive symptoms and maladaptive anxiety responses can improve HRQoL in this population.
Background and Objectives: Anxiety and depression are among the most common psychological symptoms in patients with cancer and are associated with morbidity and impaired health-related quality of life (HRQoL), independent of the cancer stage. This study aimed to determine the prevalence of clinically significant anxiety and depression among adult oncology patients in Iraq and quantify the independent contribution of these symptoms to HRQoL. Materials and Methods: A cross-sectional study was conducted between 1 November and 15 December 2024, at the National Oncology Hospital in Najaf, Iraq. A total of 200 adult oncology patients were enrolled using consecutive sampling. Symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), and HRQoL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G). Descriptive statistics were used to summarize sample characteristics. Group comparisons were performed using Pearson’s chi-square test, the Fisher–Freeman–Halton exact test with Monte Carlo estimation, and one-way ANOVA, as appropriate. Associations among continuous variables were assessed using Pearson’s correlation and multiple linear regression. Statistical significance was set at p < 0.05. Results: The mean age (SD) was 52.2 (12.0) years, and 64.0% of the participants were male. Severe anxiety and severe depression were observed in 41.0% and 34.0% of the participants, respectively. Anxiety severity was significantly associated with age, sex, marital status, and treatment modality (all p < 0.01) and was significantly higher in females (58.3% vs. 31.2%) and unmarried patients. Depression severity was significantly associated with age (p = 0.005), sex (p < 0.001), and marital status (p < 0.001) but not with cancer stage (p = 0.223) or treatment modality (p = 0.530). The mean total FACT-G score was 58.2 (14.6), indicating low-to-moderate HRQoL. HADS-A and HADS-D were strongly intercorrelated (r = 0.741) and inversely correlated with FACT-G (r = −0.750 and r = −0.780, respectively; all p < 0.001). Multiple linear regression showed that higher HADS-A and HADS-D scores were independently associated with lower HRQoL, and the full seven-predictor model explained approximately 62% of the variance in FACT-G total scores (R2 = 0.62). Conclusions: Severe anxiety and severe depression were observed in 41.0% and 34.0% of participants, respectively. Higher anxiety and depression scores were independently associated with lower HRQoL.
A. Alkhaqani, Miklós Sugár, A. Jaber et al.· Medicina· 0 citations
Abstract This study examined the associations of anxiety, insomnia, and psychological resilience with health-related quality of life (HRQoL) among maintenance dialysis patients and explored potential mediating roles. In this cross-sectional study, 207 adult patients undergoing maintenance dialysis were recruited. HRQoL was assessed using the Short Form-36 Health Survey (SF-36), generating Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Anxiety, insomnia, and psychological resilience were measured using the Generalized Anxiety Disorder-7 (GAD-7), Athens Insomnia Scale (AIS), and 25-item Connor–Davidson Resilience Scale (CD-RISC-25), respectively. Multivariable linear regression and bootstrap-based mediation analyses were conducted. Furthermore, subgroup analyses were conducted to examine the robustness of the results. Higher anxiety and insomnia scores were independently associated with lower PCS and MCS, whereas resilience was positively associated with both components. Each one-point increase in anxiety score was associated with a 1.61-point decrease in PCS and a 1.15-point decrease in MCS; corresponding decreases for insomnia were 1.01 and 0.91 points. Psychological resilience partially mediated the association between anxiety and HRQoL (23.46% for PCS; 30.37% for MCS), but no significant mediation was observed for insomnia. Subgroup analyses showed consistent associations for insomnia, while the anxiety–HRQoL relationship was modified by smoking status and diabetes. Anxiety and insomnia are independently associated with impaired HRQoL in dialysis patients. Psychological resilience partially explains the adverse impact of anxiety, but not insomnia, suggesting distinct patterns of association and potential targets for tailored psychosocial interventions.
Ruitong Liao, Xue-mei Zhang, Lian Lin et al.· Renal Failure· 0 citations
BACKGROUND
Patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) face significantly higher mortality and poorer health-related quality of life (HRQoL) than those with a single condition. However, evidence on HRQoL and its associated factors in these patients remains limited.
OBJECTIVES
To evaluate HRQoL in patients with CHD and T2DM and identify associated factors.
METHODS
A cross-sectional study was conducted among 207 patients with CHD and T2DM from a tertiary hospital in Shiyan. Sociodemographic questionnaire, Euro Quality-of-Life 5 Dimensions 5-Level Questionnaire, the Morisky Medication Adherence Scale-8, and the Center for Epidemiologic Studies-Depression scale were used to investigate the participants' HRQoL, medication adherence, and depression level. Data analysis was conducted using single-factor analysis and multiple linear regression to explore the factors influencing HRQoL.
RESULTS
The mean Euro Quality-of-Life 5 Dimensions 5-Level Questionnaire score was 0.96 (standard deviation = 0.09), with pain/discomfort and anxiety/depression being the most frequently reported. Multiple regression analysis revealed that family history of disease, whether or not an individual knows something about the Chinese Food Guide Pagoda, sleep duration, regularity of work schedule, and severity of depression as potential factors associated with HRQoL in patients with CHD and T2DM.
CONCLUSIONS
Patients with CHD and T2DM generally exhibited a relatively high HRQoL. However, family history of disease, unhealthy lifestyle behaviors, and depressive symptoms were significantly associated with lower HRQoL. Targeted interventions emphasizing health education, behavioral modification, and psychological support may effectively enhance both physical and mental health in this population, thereby contributing to improved long-term outcomes and overall quality of life.
Xin Yang Liu, Lele Bi, Qiao-Yun Jin et al.· Journal of Cardiovascular Nu...· 0 citations
ObjectiveThis study aimed to identify subgroups of stroke survivors based on multiple-adverse health conditions and determine the potential mediation effects of mental health in their relationship with health-related quality of life.DesignA cross-sectional study.SettingThree tertiary hospitals in Tianjin, China.ParticipantsA total of 558 stroke survivors were recruited between March and June 2023.Main measuresMultiple-adverse health conditions (multimorbidity, frailty and disability) were assessed using the age-corrected Charlson Comorbidity Index, FRAIL Scale, and Barthel Index. Mental health was measured with Patient Health Questionnaire-4, and health-related quality of life was evaluated using the EuroQol 5-dimension 5-level scale. Latent profile analysis identified subgroups, and mediation analysis explored mental health's role.ResultsThree subgroups were identified: Mild (65.4%, n = 365), Moderate (17.4%, n = 97), and Severe (17.2%, n = 96). Mediation analysis showed that, compared with the Mild subgroup, survivors in the Moderate subgroup (β = 0.138, 95% CI: 0.055 to 0.232) and the Severe subgroup (β = 0.217, 95% CI: 0.113 to 0.316) exhibited worse mental health, and poorer mental health was associated with lower health-related quality of life (β = -0.119, 95% CI: -0.170 to -0.075).ConclusionsThis study suggests heterogeneity in multiple-adverse health conditions and indicates that mental health may partially account for the association between these conditions and health-related quality of life in stroke survivors. The findings highlight the need for further research into subgroup-specific interventions-with particular attention to mental health-to determine whether such approaches could improve health-related quality of life.
Background: Chronic pain is a multifaceted condition that significantly affects patients’ quality of life and has been closely associated with mental health disorders such as depression, anxiety, and stress-related conditions. This study aimed to explore the association between chronic pain and mental health disorders among patients at a tertiary care hospital in India.
Methods: We conducted a case-control study involving 200 participants at a tertiary care hospital, from January 2024 to June 2024. The case group consisted of 100 patients diagnosed with chronic pain for more than three months, while the control group included 100 matched individuals without chronic pain. Data on depression, anxiety, and stress were collected using the validated depression, anxiety and stress scale-21 (DASS-21). Dietary and lifestyle habits, sleep quality, and socioeconomic factors were assessed through structured questionnaires. Statistical analysis was conducted using multivariate logistic regression to adjust for confounding variables, including age, gender, socioeconomic status, and comorbidities.
Results: The prevalence of symptoms of depression, anxiety, and stress in the chronic pain group was significantly higher compared to controls. The adjusted odds ratio (OR) for depression among the chronic pain group was 3.82 (95% CI: 2.05-7.13, p<0.001), for anxiety it was 2.94 (95% CI: 1.61-5.38, p<0.001), and for stress it was 4.18 (95% CI: 2.23-7.81, p<0.001) compared to controls.
Conclusions: Chronic pain is strongly associated with increased symptoms of depression, anxiety, and stress, emphasizing the need for integrated care approaches that address both physical and psychological health in chronic pain management.
Payal Godria, Meet Ghonia, D. Verma et al.· International Journal of Res...· 0 citations
Caregivers of patients with Severe Persistent Mental Illness (SPMI) face tremendous challenges. They often experience elevated levels of burden, depression, and anxiety. These factors negatively impact their quality of life (QoL). However, few studies have examined caregiver burden and its psychological effects in Saudi Arabia. This study aims to assess caregiver burden in relation to socio-demographic characteristics and its correlation with depression, anxiety, and QoL. The study tool consisted of validated questionnaire, including the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), abridged Arabic version of the Zarit Burden Interview (ZBI), and the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). A cross-sectional convenience sample of 120 participants was recruited from the Psychiatry Outpatient Clinics at King Saud University Medical City in Riyadh, Saudi Arabia. Our results showed a significant positive correlation between caregiver burden and depression and anxiety scores (p < 0.001). Moreover, significantly higher burden levels were found among female caregivers and those residing with patients, p = 0.04 and p = 0.002, respectively. Additionally, the severity of mental illness was also associated with an increased burden level (p = 0.001). Notably, spouses and children reported significantly higher burden levels (p = 0.036). In multivariable analyses, caregiver anxiety and perceived severity of the patient’s mental illness were independently associated with higher caregiver burden, while depressive and anxiety symptoms were independently associated with poorer quality of life.Furthermore, a significant negative correlation was found between caregiver burden and the physical and psychological QoL domains (p < 0.001 and p = 0.013, respectively). Collectively, our findings highlight the mental health challenges faced by caregivers of individuals with SPMI in Saudi Arabia, which negatively impact their QoL. Consequently, these findings substantiate the urgent need for targeted support interventions, particularly those addressing caregiver anxiety, depression, and the challenges associated with severe mental illness, especially for caregivers who live with or care for individuals with SPMI.
Fatimah Albrekkan, Shuliweeh Alenezi, A. Ghesheyan et al.· PLoS ONE· 0 citations
