A Single, One-Off Measure of Depression and Anxiety Predicts Future Symptoms, Higher Healthcare Costs, and Lower Quality of Life in Coronary Heart Disease Patients: Analysis from a Multi-Wave, Primary Care Cohort Study

PLoS One. 2016 Jul 27;11(7):e0158163. doi: 10.1371/journal.pone.0158163. eCollection 2016.


Objective: To determine whether a one-off, baseline measure of depression and anxiety in a primary care, coronary heart disease (CHD) population predicts ongoing symptoms, costs, and quality of life across a 3-year follow-up.

Design: Longitudinal cohort study.

Setting: 16 General Practice surgeries across South-East London.

Participants: 803 adults (70% male, mean age 71 years) contributing up to 7 follow-up points.

Main outcome measures: Ongoing reporting of symptoms, health care costs, and quality of life.

Results: At baseline, 27% of the sample screened positive for symptoms of depression and anxiety, as measured by the Hospital Anxiety and Depression Scale (HADS). The probability of scoring above the cut-off throughout the follow-up was 71.5% (p<0.001) for those screening positive at baseline, and for those screening negative, the probability of scoring below the cut-off throughout the follow-up was 97.6% (p<0.001). Total health care costs were 39% higher during follow-up for those screening positive (p<0.05). Quality of life as measured by the SF-12 was lower on the mental component during follow-up for those screening positive (-0.75, CI -1.53 to 0.03, p = 0.059), and significantly lower on the physical component (-4.99, CI -6.23 to -.376, p<0.001).

Conclusions: A one-off measure for depression and anxiety symptoms in CHD predicts future symptoms, costs, and quality of life over the subsequent three-years. These findings suggest symptoms of depression and anxiety in CHD persist throughout long periods and are detrimental to a patient's quality of life, whilst incurring higher health care costs for primary and secondary care services. Screening for these symptoms at the primary care level is important to identify and manage patients at risk of the negative effects of this comorbidity. Implementation of screening, and possible collaborative care strategies and interventions that help mitigate this risk should be the ongoing focus of researchers and policy-makers.

MeSH terms

  • Anxiety / complications
  • Anxiety / diagnosis*
  • Anxiety / economics
  • Anxiety / physiopathology
  • Cohort Studies
  • Coronary Disease / complications*
  • Coronary Disease / economics
  • Coronary Disease / psychology
  • Depression / complications
  • Depression / diagnosis*
  • Depression / economics
  • Depression / physiopathology
  • Health Care Costs*
  • Humans
  • London
  • Quality of Life*