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. 2019 Feb 26;19(1):232.
doi: 10.1186/s12889-019-6561-3.

Depression and Anxiety Symptoms in Cardiac Patients: A Cross-Sectional Hospital-Based Study in a Palestinian Population

Free PMC article

Depression and Anxiety Symptoms in Cardiac Patients: A Cross-Sectional Hospital-Based Study in a Palestinian Population

H Allabadi et al. BMC Public Health. .
Free PMC article


Background: Mental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population.

Methods: This cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety.

Results: In total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience.

Conclusion: There was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.

Keywords: Anxiety; Cardiac rehabilitation; Cardiovascular diseases; Depression; Predictors; Prevalence.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Nordwest- und Zentral Schweiz (EKNZ) in Basel, Switzerland and by the Institutional Review Board (IRB) committee at An-Najah National University in Nablus, Palestine. All patients enrolled in the study provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Spearmen correlations between CDS, DASS-depression, DASS-anxiety, DASS-stress and other instruments used in the study. Note. CDS = Cardiac Depression Scale; PHQ = Patient Health Questionnaire-15; PTSD = Post-Traumatic Stress Disorder; MCS = Mental Component Summary; PCS = Physical Component Summary; RS = Resilience Scale-14; SE = Self-esteem; ESSI = ENRICHD Social Support Instrument. Blue colors represent positive correlations and red colors represent negative correlations. Correlations measured are expressed as rho spearman.

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