Journal of Health and Medical Sciences

ISSN 2622-7258

Published: 14 September 2020

Depression: A Major Psychosocial-Lifestyle Sequela of Cardiac Disease Diagnosis

Mandreker Bahall

University of the West Indies, Trinidad and Tobago

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Pages: 393-402

Keywords: Depression, Diet, Exercise, Cardiac Patients, Lifestyles


Even the suspicion of cardiac disease diagnosis tends to have significant psychological, physical, and social repercussions for patients. The present study explored the psychosocial and physical lifestyle changes in stable, ambulant patients with suspected or newly diagnosed cardiac disease. This cross-sectional study of cardiac clinic attendees at a public health institution was conducted between July and August 2015. Face-to-face interviews were conducted with eligible patients (aged at least 18 years, not confused, and able to undergo a 20-minute interview) following patient consent. Collected data were analysed using descriptive and analytic methods (chi-squared test and multiple linear regression) using a 5% error and 95% confidence interval. The prevalence of depression increased from 1.7% pre-diagnosis to 36.6% following suspected or confirmed diagnosis. Among demographic variables, only gender was associated with depression, with females being more affected. Diabetes, stress, and eating seafood and sugary foods were associated with increased depression, while exercising at least three times per week was associated with diminished depression. Functional activities (social, communicative, and physical) worsened, with significant differences between pre- and post-diagnosis. Depression was relatively common in the sample, particularly among females. There is a need for increased focus on the development of interventions addressing depression, especially those encouraging physical exercise for optimum management of patients diagnosed with cardiac disease.


  1. Bahall, M. (2019). Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago. BMC Psychiatry, 19, 4.

  2. Bhattacharyya, M., Stevenson, F., & Walters, K. (2016). Exploration of the psychological impact and adaptation to cardiac events in South Asians in the UK: A qualitative study. BMJ Open, 6, e010195.

  3. Boden, W. E., Franklin, B., Berra, K., Haskell, W. L., Calfas, K. J., Zimmerman, F. H., & Wenger, N. K. (2014). Exercise as a therapeutic intervention in patients with stable ischemic heart disease: An underfilled prescription. The American Journal of Medicine, 127, 905–911.

  4. Brinks, J., Fowler, A., Franklin, B. A., & Dulai, J. (2017). Lifestyle modification in secondary prevention: Beyond pharmacotherapy. American Journal of Lifestyle Medicine, 11(2), 137–152.

  5. Brown, M. T., & Bussel, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304–314.

  6. Compare, A., Zarbo, C., Manzoni, G. M., Castelnuovo, G., Baldassari, E., Bonardi, A., ... Romagnoni, C. (2013). Social support, depression, and heart disease: A ten year literature review. Frontiers in Psychology, 4, 384.

  7. Denollet, J., Vaes, J., & Brutsaert, D. L. (2000). Inadequate response to treatment in coronary heart disease: Adverse effects of Type D personality and younger age on 5-year prognosis and quality of life. Circulation, 102, 630–635.

  8. De Smedt, D., Clays, E., & De Bacquer, D. (2016). Measuring health-related quality of life in cardiac patients. European Heart Journal – Quality of Care & Clinical Outcomes, 2(3), 149–150.

  9. Dexter, H. (2012). Psychosocial interventions for patients with chronic disease. BioPsychoSocial Medicine, 6, 2.

  10. Dhar, A. K., & Barton, D. A. (2016). Depression and the link with cardiovascular disease. Frontiers in Psychiatry, 7, 33.

  11. Doering, L. V., & Eastwood, J. (2011). A literature review of depression, anxiety, and cardiovascular disease in women. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(3), 348–361.

  12. Egede, L. E. (2007). Major depression in individuals with chronic medical disorders: Prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General Hospital Psychiatry, 29(5), 409–416.

  13. Finegold, J. A., Asaria, P., & Francis, D. P. (2012). Mortality from ischaemic heart disease by country, region, and age: Statistics from World Health Organisation and United Nations. International Journal of Cardiology, 168(2), 934–945.

  14. Fletcher, G. F., Balady, G., Blair, S. N., Blumenthal, J., Casperson, C., Chaitman, B., … Pollock, M. L. (1996). Statement on exercise: Benefits and recommendations for physical activity programs for all Americans. Circulation, 94(4), 857–862.

  15. Habibović, M., Broers, E., Piera-Jimenez, J., Wetzels, M., Ayoola, I., Denollet, J., & Widdershoven, J. (2018). Enhancing lifestyle change in cardiac patients through the Do CHANGE System (“Do Cardiac Health: Advanced New Generation Ecosystem”): Randomized controlled trial protocol. JMIR Research Protocols, 7(2), e40.

  16. Harvard Health Publishing: Harvard Medical School. (2018). Food and mood: Is there a connection? Retrieved from

  17. Havranek, E. P., Mujahid, M. S., Barr, D. A., Blair, I. V., Cohen, M. S., Cruz-Flores, S., … Yancy C. W. (2015). Social determinants of risk and outcomes for cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 132(9), 873–898.

  18. Higuera, V., & Holland, K. (2019). Everything you want to know about depression. Healthline. Retrieved from

  19. Hlatky, M. A., Rogers, W. J., Johnstone, I., Boothroyd, D., Brooks, M. M., Pitt, B., … Mark, D. B. (1997). Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. The New England Journal of Medicine, 336, 92–99.

  20. Hobbs, F. D. R. (2004). Cardiovascular disease: Different strategies for primary and secondary prevention? Heart, 90(10), 1217–1223.

  21. Ilić, S., & Apostolović, S. (2002). Psychological aspects of cardiovascular diseases. Medicine and Biology, 9(2), 138–141. Retrieved from

  22. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

  23. Kromhout, D., Menotti, A., Kesteloot, H., & Sans, S. (2002). Prevention of coronary heart disease by diet and lifestyle evidence from prospective cross-cultural, cohort, and intervention studies. Circulation, 105(7), 893–898.

  24. Lawler, P. R., Filion, K. B., & Eisenberg, M. J. (2011). Efficacy of exercise-based cardiac rehabilitation post–myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. American Heart Journal, 162(4), 571–584.

  25. Lesperance, F., Fraisure-Smith, N., & Talajic, M. (1996). Major depression before and after myocardial infarction: Its nature and consequences. Psychosomatic Medicine, 58(2), 99–110.

  26. Lichtman, J. H., Bigger, J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lesperance, F., … Froelicher, E. S. (2008). Depression and coronary heart disease. Circulation, 118(17), 1768–1775.

  27. Lichtman, J. H., Bigger, J. T., Blumenthal, J. A., Frasure-Smith, N., Kaufmann, P. G., Lespérance, F., … American Psychiatric Association. (2008). 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, 118(17), 1768–1775.

  28. Martin, L. R., Williams, S. L., Haskard, K. B., & Dimatteo, M. R. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189–199.

  29. McColl-Kennedy, J.R., Danaher, T. S., Gallan, A. S., Orsingher, C., Lervik-Olsen, L., & Verma, R. (2017). How do you feel today? Managing patient emotions during health care experiences to enhance well-being, Journal of Business Research, 79, 247−259.

  30. McSweeney, J. C., Rosefeld, A. G., Abel, W. M., Braun, L. T., Burke, L. E., Daugherty, S. L., … Reckelhoff, J. F. (2016). Preventing and experiencing ischemic heart disease as a woman: State of the science: A scientific statement from the American Heart Association. Circulation, 133(13), 1302–1331.

  31. Mendis, S., Puska, P., & Norrving, B. (Eds.). (2011). Global Atlas on cardiovascular disease prevention and control. World Health Organization: Geneva. Retrieved from

  32. Ministry of Health, Government of Trinidad and Tobago. (2012). PanAmerican steps: Chronic non-communicable disease risk factor survey: Final report. Retrieved from

  33. O’Connor, G., Buring, J. E., Yusuf, S., Goldhaber, S. Z., Olmstead, E. M., Paffenbarger, R. S., & Hennekens, C. H. (1989). An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation, 80(2), 234–244.

  34. Pina, I. L., Apstein, C. S., Balady, G. J., Belardineli, R., Chaitman, B. R., Duscha, B. D., … Sullivan, M. J. (2003). Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation, 107, 1210–1225.

  35. Pozuelo, L. (2019). Depression & heart disease. In Cleveland Clinic. Retrieved from

  36. Rutledge, T., Kenkre, T. S., Thompson, D. V., Bittner, V. A., Whittaker, K., Eastwood, J., … Bairey Merz, C. N. (2014). Depression, dietary habits, and cardiovascular events among women with suspected myocardial ischemia. The American Journal of Medicine, 127(9), 840–847.

  37. South-West Regional Health Authority (SWRHA). (2020). San Fernando General Hospital. Retrieved from

  38. Tennant, C., & McLean, L. (2001). The impact of emotions on coronary heart disease risk. Journal of Cardiovascular Risk, 8(3), 175–183.

  39. Tsu, L. V. (2012). Depression in cardiac patients: Underrecognized and undertreated. U.S. Pharmacist, 37(11), HS 12–HS 15.

  40. Turner, J., & Kelly, B. (2000). Emotional dimensions of chronic disease. The Western Journal of Medicine, 172(2), 124–128.

  41. Unützer, J., & Park, M. (2012). Strategies to improve the management of depression in primary care primary care. Primary Care: Clinics in Office Practice, 39(2), 415–431.

  42. World Federation for Mental Health. (2012). Depression: A global crisis. World Health Day. Retrieved from

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