Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis

Yun Lin; Hong Cai; Hong-Hong Liu; Xue-Jian Su; Chen-Yu Zhou; Jing Li; Yi-Lang Tang; Todd Jackson; Yu-Tao Xiang

doi:10.3389/fpsyt.2023.1084792

Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis

Front Psychiatry. 2023 Mar 16:14:1084792. doi: 10.3389/fpsyt.2023.1084792. eCollection 2023.

Authors

Yun Lin¹, Hong Cai^{2

3}, Hong-Hong Liu¹, Xue-Jian Su⁴, Chen-Yu Zhou⁴, Jing Li⁴, Yi-Lang Tang^{5

6}, Todd Jackson⁷, Yu-Tao Xiang^{2

3}

Affiliations

¹ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
² Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.
³ Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.
⁴ The National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital and the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
⁵ Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.
⁶ Atlanta VA Medical Center, Atlanta, GA, United States.
⁷ Department of Psychology, University of Macau, Macao, Macao SAR, China.

Abstract

Background: This study was designed to investigate the prevalence and predictors of depression in patients after pacemaker implantation during the COVID-19 pandemic in addition to identifying specific depressive symptoms associated with quality of life (QOL) using network analysis (NA).

Methods: This cross-sectional, observational study was conducted in China between July 1, 2021, and May 17, 2022. Descriptive analysis was used to calculate depression prevalence. Univariate analyses were used to compare differences in demographic and clinical characteristics between depressed and non-depressed patients following pacemaker implantation. Binary logistic regression analysis was used to assess factors independently associated with depression. Network analysis "expected influence," and flow function indexes were used to identify symptoms central to the depression network of the sample and depressive symptoms that were directly associated with QOL, respectively. Network stability was examined using a case-dropping bootstrap procedure.

Results: In total, 206 patients implanted with a pacemaker met the study entry criteria and completed the assessment. The overall prevalence of depression (PHQ-9 total score ≥ 5) was 39.92% [95% confidence interval (CI) = 29.37-42.47%]. A binary logistic regression analysis revealed that patients with depression were more likely to report a poor health status (p = 0.031), severe anxiety symptoms (p < 0.001), and fatigue (p < 0.001). In the network model for depression, "Sad mood," "Poor Energy," and "Guilt" were the most influential symptoms. "Fatigue" had the strongest negative association with QOL, followed by "Sad mood" and "Appetite".

Conclusion: Depression is common among patients having undergone pacemaker implantation during the COVID-19 pandemic. Anxiety, central symptoms of depression (i.e., "Sad mood", "Poor Energy", and "Guilt") and depressive symptoms linked to QOL (i.e., "Sad mood", "Appetite", and "Fatigue") identified in this study are promising targets for interventions and preventive measures for depression in patients who have undergone pacemaker implants.

Keywords: COVID-19; depression; network analysis; pacemaker implantation; quality of life.

Grants and funding

This study was supported by the National Science and Technology Major Project for Investigations of New Drugs (2018ZX09201-014), the Beijing Municipal Science & Technology Commission (no. Z181100001518005), and the University of Macau (MYRG2019-00066-FHS; MYRG2022-00187-FHS).