Anxiety Among The Young Cardiac Patients Pak Armed Forces Med

Open Access Original Article Anxiety Among The Young Cardiac Patients Pak Armed Forces Med J 2017; 67 (4): 663-67 ANXIETY AMONG THE YOUNG CARDIAC PATIENTS - A NEGLECTED ILLNESS Nosheen Zaidi, Najma Javed*, Mahmood Ur Rahman** Foundation University Medical College Islamabad Pakistan, *Pakistan Health Research Center Islamabad Pakistan, **Army Medical College/ National University of Medical Sciences (NUMS) Rawalpindi Pakistan ABSTRACT Objective: To explore the prevalence of anxiety among young cardiac patients visiting tertiary care hospital, Rawalpindi. Study Design: Observational cross-sectional study. Place and Duration of Study: Rawalpindi Institute of Cardiology (RIC), from 27th Jun to 30th Sep 2016. Material and Methods: After ethical clearance and approval of the supervisor of Rawalpindi Institute of Cardiology, data were collected from the OPD patients of Rawalpindi Institute of Cardiology over a period of one month. Patients were briefed about the nature of study and after informed written consent, information was collected through face to face interviews by trained data collectors using General anxiety Disorder (GAD) scale. SPSS-21 was used for data analysis. Results: A total 237 patients were interviewed and male to female ratio was 1.4:1 (140:97). Age ranged from 20-40 years with mean of 32 ± 5.2 years. Overall prevalence of anxiety was 25.5%. There was not statistically significant difference observed in anxiety levels between male (23, 9%) and females (25, 11%), (p-value: 1.000). The participants were divided into 4 age groups and group 4 (36-40 years) was most affected group. However, none of the group showed statistically association with age groups. A statistically significant relationship is found with unemployment and anxiety (OR: 2.8, p-value: <.005). However there was no relationship between duration of cardiac illness and anxiety (p-value: .588). Conclusion: Moderate level of anxiety was most prevalent among the 30-40 years age group. Keywords: Anxiety, Cardiac, Patients, Young adult. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION contribute to increased levels of stress and anxiety. The fast life and competition among people in the developed world has badly affected the trend of outdoor activity and social interaction, resulting not only in obesity in these people, but also the psychological disorders such as depression, anxiety and personality disorders3. It is estimated that over 80% of the deaths and 85% of disabilities from cardiovascular disease (CVD) occur in low and middle-income countries4. Pakistan, being a developing country itself is also facing the high burden of cardiovascular diseases. According to WHO statistics, cardiovascular diseases contribute 19% to Pakistan’s total mortality (WHO NCD profile 2014)5. Globally, people are not only threatened by the communicable but also by non-communicable diseases. Majority of the deaths worldwide are due to non-communicable diseases (35 million), out of which 17 million deaths are attributed to the cardiovascular diseases including coronary heart disease, cardiac arrhythmias, angina, myocardial infarction and thrombolytic diseases1. Out of the total 17 million deaths due to cardiovascular diseases worldwide, 3.6 million deaths occur in South East Asia alone2. One of the contributing factors to the modifiable risk factors is having “type A personality”, which has shown tendency of showing early signs leading to cardiovascular diseases3, which ultimately Although anxiety is a normal human response to cope up with daily stressful tasks, every individual responds differently to a stressful condition according to his/her own Correspondence: Dr Nosheen Zaidi, House No. 66 Citti Villas near High Court Road Rawalpindi Pakistan Email: [email protected] Received: 05 Jan 2017; revised received: 07 Mar 2017; accepted: 29 Mar 2017 663 Anxiety Among The Young Cardiac Patients Pak Armed Forces Med J 2017; 67 (4): 663-67 ability. This is the reason that why everyone does not suffer from the same level of anxiety. Anxiety can be broadly divided into different levels according to its severity, no anxiety at all, mild anxiety, moderate anxiety and severe anxiety6. suffering from cardiovascular diseases to plan treatment of anxiety well in time as a prophylactic measures for cardiovascular disease among young patient. According to a study in Pakistan, prevalence of anxiety and depressive disorders is 34%7. Similarly a study conducted in Karachi revealed that anxiety is more prevalent in women (39.4%) as compared to males (23.3%)8. Study was conducted at public sector Rawalpindi Institute of Cardiology (RIC). It was conducted over a period of four months from 27th June to 30th September 2016. MATERIAL AND METHODS Sample size was calculated by using Epi Info software; a sample of 237 was calculated. Non During chronic illness overall well-being of a Table-I: Distribution of GAD scores among study population. GAD Scores Number of patients Percentage 1 0-4 28 12 2 5-9 72 30 3 10-14 91 38 4 Above 10 46 20 237 100 Table-II: Distribution of different anxiety levels among age groups. Age No of Patients No anxiety Mild n(%) Moderate Severe p-value Groups n(%) n(%) n(%) n(%) 20-25 (1) 26 (11) 7(27) 6 (23) 6 (23) 7 (27) 0.352 26-30 (2) 42 (18) 4 (10) 15 (36) 14 (33) 9 (21) 31-35 (3) 50 (21) 3 (6) 17 (34) 20 (40) 10 (20) 36-40 (4) 119 (50) 15 (13) 35 (27) 47 (41) 22 (19) 237 29 73 87 48 Table-III: Independent predictors of severe anxiety symptoms in patients with cardiac illness. Variable OR 95% - CI Z statistics p-value Gender 1.610 0.841 - 3.05 1.45 0.145 Age 0.882 0.657 - 1.18 0.150 0.403 probability consecutive sampling was used. Inclusion subject must be a diagnosed as a case of a cardiac disease and of age between 20 to 40 years of either gender and willing to participate. Patient suffering from any other chronic illnesses will be excluded from study. person is affected causing anxiety and other related disorders9. Some studies have evaluated the correlation between chronic illness and anxiety9,10. Verkerk AJ et al in his study reported that anxiety and depression among cardiac patients lead to poor disease outcomes11. After ethical clearance from the Institutional Ethical Committee and approval from the supervisor of Rawalpindi Institute of Cardiology, patients visiting the OPD were invited to participate in study as per inclusion criteria. After taking a written consent, information was collected using pretested validated questionnaire. Data were collected on employment, duration of To decrease the morbidity and mortality associated with cardiac illnesses, awareness through health promotion and reduction of risk factors is the most appropriate strategy12. Current study is designed to assess the level of anxiety in young patients (20-40 years of age) 664 Anxiety Among The Young Cardiac Patients Pak Armed Forces Med J 2017; 67 (4): 663-67 illness and presence of anxiety. General anxiety disorder (GAD) scale was used for this purpose. GAD 7 scale is a tool for screening and measuring severity of anxiety disorders. It comprises of seven questions, which measure the severity of signs observed in anxiety. The level of anxiety in an individual can be assessed according to the total score obtained in the GAD questionnaire. The GAD 7 score is calculated by assigning scores of 0, 1, 2 and 3 to the response categories “not at all”, “several days”, “more than half the days” and “nearly every day” respectively and the adding the scores for the 7 questions. The score of 5-9 suggests mild anxiety; 10-14 moderate and 15 ranged from 20-40 years with mean of 32 ± 5.2 years. Overall prevalence of anxiety was 25.5%. No statistically significant difference was observed in anxiety levels between male (23, 9%) and females (25, 11%) (p-value 1.000). Participants were divided into 4 age groups. About (11%) were in 20 to 25 years age group (Gp-1), 18% were 26 to 30 years of age (Gp-2), 21% were 31 to 35 (Gp-3) and 50% were 36 to 40 years of age (Gp-4) table-II. None of the group showed statistical association with age groups. Regarding final scores of GAD, details are given in table-I. Further analysis showed that the overall Figure: Comparison of anxiety levels among employed and unemployed cardiac patients. or greater indicates severe anxiety. GAD scale was translated into Urdu. Data were recorded by trained data collectors through face to face interviews. anxiety levels are significantly high in the male population as compared with the female (fig). However, it varies at severe levels of anxiety which were higher in females. Data were cleaned after collection; it was coded and entered in statistical package for the social sciences (SPSS)-21 for analysis. The categorical variables were presented as percentages and the continuous ones as means and standard deviations whereas odds ratios calculated and risk factors were analyzed using logistic regression. Severe anxiety was more common in unemployed group of cardiac patients as compared to employed (table-III). A statistically significant relationship was found with unemployment and anxiety (OR: 2.8, p-value <.005). However there was no relationship between duration of cardiac illness and anxiety (p-value .588). RESULTS DISCUSSION A total 237 patients were interviewed and male to female ratio was 1.4:1 (140:97). Age Anxiety is one of the most major and common reactions to a cardiac illness. A latest 665 Anxiety Among The Young Cardiac Patients Pak Armed Forces Med J 2017; 67 (4): 663-67 study from Pakistan has revealed high levels of anxiety (50.2%)11 whereas the average total prevalence of depression and anxiety found in public samples is 33.62%, with a point prevalence of 45.5% amongst females and 21.7% amongst males12. Employment and education status were found to be significantly associated (p=0.01) with anxiety. In current study prevalence of anxiety among cardiac patients was 25.5% whereas the prevalence of anxiety in patients coming to the primary care centers ranges from 21% to 57%11. The difference may be due to the fact that our study population though relatively having serious disease, does not affect major population whereas in primary health care centers patients of all disciplines and functional also visit. suffering from anxiety15. The results are in accordance with our findings. ACKNOWLEDGEMENT We thank Mr Hamza Tahir, Mr Muhammad Jala Ud Din and Ms Aiman Mahmood Minhan for Data collection, Designing and analysis. We thank all the faculty and the participants of the study. CONCLUSION Moderate level of anxiety was prevalent and the most affected age group was 30-40 years. CONFLICT OF INTEREST This study has no conflict of interest to declare by any author. REFERENCES It has been found that adults (20-40 yrs) suffering from congenital heart13 usually show high levels of anxiety. Same is shown in our study i.e. unemployed patients have highest level of anxiety as compared to employed patients. 1. Park K. Preventive and social medicine. 20th ed. India. Banarsidas Bhanot 2010. 2. Pikart F, Mcdonald M. The global burden of noncommunicable diseases, pfizer corp, USA 2011 (15). 3. Allan R, Am J Cardiol, John Hunter: Early Association of Type a Behavior with Cardiac Mortality 2014; 114(1): 14850. 4. Suchert V, Hanewinkel R, Isensee B. 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Same study has shown that there is no significant correlation between age and anxiety symptoms in any of the study groups comprising coronary artery disease (r=-0.037, p=0.384). Our results are compatible with their findings as age groups show no statistical relationship with severe anxiety. A Canadian study reported that unemployment among people with higher age and presence of chronic illnesses particularly cardiovascular disease are more likely to be 666 Anxiety Among The Young Cardiac Patients Pak Armed Forces Med J 2017; 67 (4): 663-67 12. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ 2004; 328: 794. 13. Institute of medicine, committee on nervous system disorders in developing countries. neurological, psychiatric, and developmental disorders: meeting the challenge in the developing world. Washington, DC: National Academy Press 2001. 14. 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