Prevalence of Cardiac Depression and its Related Factors among Patients with Acute Coronary Syndrome


  • Mazandaran University of Medical Sciences, Student Research Committee, Sari, Iran, Islamic Republic of
  • Mazandaran University of Medical Sciences, School of Nursing and Midwifery Amol, Sari, Iran, Islamic Republic of
  • Mazandaran University of Medical Sciences, Imam Reza Hospital Amol, Sari, Iran, Islamic Republic of
  • Qazvin University of Medical Sciences, Social Determinants of Health Research Center, Qazvin, Iran, Islamic Republic of
  • Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of
  • Tehran University of Medical Sciences, School of Nursing and Midwifery, Tehran, Iran, Islamic Republic of
  • Kerman University of Medical Sciences, School of Nursing and Midwifery Razi, Kerman, Iran, Islamic Republic of


Cardiac depression is one of the most common psychological reactions of patients with acute coronary syndrome (ACS). This study aimed to determine the prevalence of cardiac depression and its related factors among patients with ACS. This cross-sectional study was conducted during 2016 in patients with ACS who were admitted to hospitals affiliated to the Mazandaran University of Medical Sciences, Iran. In the present study, 407 patients completed the Cardiac Depression Scale (CDS) within two months (March - June). The data were analyzed by a chi-square test and a general linear model multivariate analysis. According to the results, the mean cardiac depression score in patients with ACS was 109.00 ± 16.49 (CI95: 107.39 to 110.60). Among the participants, 37 (9.1%), 72 (17.7%), and 298 (73.2%) patients had mild, moderate, and severe levels of depression, respectively. Although the two-way ANOVA was not significant, but there was a difference between cardiac depression score of a type of ACS. Given the high prevalence of cardiac depression among these patients, it is necessary to develop measures for routine screening in cardiac treatment units.


Acute Coronary Syndrome, Depression, Sleep Quality

Subject Discipline


Full Text:


Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM. Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine. 2013; 368(14):1279–90.

Basampour SS. The effect of education on anxiety before and after open heart surgery. 2004.

Greenlund KJ, Keenan NL, Giles WH, Zheng ZJ, Neff LJ, Croft JB, Mensah GA. Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001. American Heart Journal. 2004; 147(6):1010–6.

Naghavi M, Jafari N. Mortality in the 29 provinces of Iran in 2004. Tehran: Vice-Chancellor for Health, Ministry of Health and Medical Education. 2007.

Taghipour B, Nia HS, Soleimani MA, Afshar MH, Far SS. Comparison of the clinical symptoms of myocardial infarction in the middle-aged and elderly. Journal of Kermanshah University of Medical Sciences. 2014; 18(5):40–45.

Abedini A, Akbari H. Comparison of different methods of education on reducing the anxiety of patients with myocardial infarction. Iran Journal of Nursing. 2012; 24(74):36–44.

Dunderdale K, Thompson DR, Miles JN, Beer SF, Furze G. Quality‐of‐life measurement in chronic heart failure: do we take account of the patient perspective? European Journal of Heart Failure. 2005; 7(4):572–82.

Fried EI, Nesse RM. Depression sum-scores don’t add up: why analyzing specific depression symptoms is essential. BMC Medicine. 2015; 13(1):1–2.

Grippo AJ, Johnson AK. Biological mechanisms in the relationship between depression and heart disease. Neuroscience and Biobehavioral Reviews. 2002; 26(8):941–62.

Meneses R. Depression in patients with myocardial infarction. Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia=Portuguese Journal of Cardiology: an official Journal of the Portuguese Society of Cardiology. 2007; 26(11):1143–65.

Jr CV. Association between depression and development of coronary artery disease: pathophysiologic and diagnostic implications. Vascular Health and Risk Management. 2011; 7(1):159–64.

Schrader G, Cheok F, Hordacre AL, Guiver N. Predictors of depression three months after cardiac hospitalization. Psychosomatic Medicine. 2004; 66(4):514–20.

Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F, Mark DB, Sheps DS, Taylor CB, Froelicher ES. Depression and coronary heart disease recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008; 118(17):1768–75.

Williams RB. Depression after heart attack: why should I be concerned about depression after a heart attack? Circulation. 2011; 123(25):639–40.

Hosseini H, Tabiban S, Samarbakhsh A. Depression following the first attack of myocardial infarction. Bimonthly Research Journal Pejouhandeh. 2006; 5(10):317–20.

Carney RM, Blumenthal JA, Stein PK, Watkins L, Catellier D, Berkman LF, Czajkowski SM, O’Connor C, Stone PH, Freedland KE. Depression, heart rate variability, and acute myocardial infarction. Circulation. 2001; 104(17):2024–8.

Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine. 2003; 65(2):201–10.

Bayani B, Yousefi S, Bayani M, Shirmohammadi M, Alimoradi A, Falsoleiman H, Yazdi N, Arbabi M. Depression and anxiety in a cardiovascular outpatient clinic: a descriptive study. Iranian Journal of Psychiatry. 2011; 6(3):125.

Carney RM, Freedland KE, Jaffe AS. Insomnia and depression prior to myocardial infarction. Psychosom Med. 1990; 52(6):603–19.

Mavrides N, Nemeroff C. Treatment of depression in cardiovascular disease. Depression and Anxiety. 2013; 30(4):328–41.

Sharif Nia H, Haghdoost AA, Nazari R, Bahrami N, Soleimani MA, Pormand K. Relationship of risk factors and ST segment changes with symptoms of acute coronary syndrome. Koomesh. 2013 Sep 15; 15(1):46–53.

Hare DL, Davis CR. Cardiac depression scale: validation of a new depression scale for cardiac patients. Journal of Psychosomatic Research. 1996; 40(4):379–86.

Wang W, Thompson DR, Chair SY, Hare DL. A psychometric evaluation of a Chinese version of the Cardiac Depression Scale. Journal of Psychosomatic Research. 2008; 65(2):123–9.

Di Benedetto M, Lindner H, Hare DL, Kent S. Depression following acute coronary syndromes: a comparison between the cardiac depression scale and the Beck depression inventory II. Journal of Psychosomatic Research. 2006; 60(1):13–20.

Perez GH, Nicolau JC, Romano BW, Laranjeira R. Depression and acute coronary syndromes: gender-related differences. Arquivos Brasileiros de Cardiologia. 2005; 85(5):319–26.

Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK, Krumholz HM, Amin A, Weintraub WS, Lichtman J, Dawood N, Vaccarino V. Time course of depression and outcome of myocardial infarction. Archives of Internal Medicine. 2006; 166(18):2035–43.

Dias CC, Mateus PS, Mateus C, Bettencourt N, Santos L, Adao L, Sampaio F, Fonseca C, Simões L, Coelho R, Ribeiro VG. Acute coronary syndrome and depression. Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia=Portuguese journal of cardiology: an official Journal of the Portuguese Society of Cardiology. 2005; 24(4):507–16.

Gholizadeh L. Cross-cultural validation of the Cardiac Depression Scale in Iran. Br J Clin Psychol. 2010; 49(4):517– 28.

Eng HS, Yean LC, Das S, Letchmi S, Yee KS, Bakar RA, Hung J, Choy CY. Anxiety and depression in patients with coronary heart disease: a study in a tertiary hospital. Iranian Journal of Medical Sciences. 2011; 36(3):201–6.

Moraska AR, Chamberlain AM, Shah ND, Vickers KS, Rummans TA, Dunlay SM, Spertus JA, Weston SA, McNallan SM, Redfield MM, Roger VL. Depression, healthcare utilization, and death in heart failure a community study. Circulation: Heart Failure. 2013 May 1; 6(3):387–94.

Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, Jones R, Mathew JP, Newman MF, NORG Investigators. Depression as a risk factor for mortality after coronary artery bypass surgery. The Lancet. 2003; 362(9384):604–9.

Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald’s heart disease: a textbook of cardiovascular medicine. Philadelphia, US: Elsevier Health Sciences; 2014 Jul 30.

Druss BG, Bradford DW, Rosenheck RA, Radford MJ, Krumholz HM. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000; 283(4):506–11.

Safaie N, Jodati AR, Raoofi M, Khalili M. Depression in Coronary Artery Disease. Journal of Cardiovascular and Thoracic Research. 2012; 4(3):77.

Shokrgozar S, Ahmadi R, Khairkhah J, Moorosi M. Severity of Depression in Hospitalized Patients with Cardiovascular Diseases by Cardiac Depression Scale (CDS). Journal of Guilan University of Medical Sciences. 2015; 24(2):9–15.


  • There are currently no refbacks.