Vol. 53 | No. 1 | January-June 2025 Back

Open Access

Depression and Anxiety in Adult Cardiology Patients Consulting Through Telemedicine During the Covid-19 Pandemic Using the Validated Filipino Version of the Hospital Anxiety and Depression Score (Hads-P)

Paula Victoria Catherine Cheng-Bromeo, Jeffrey Valencia, Michael Vic Beluso, Felix Eduardo Punzalan
May 2025 DOI 10.69944/pjc.09ca7802e3

Abstract

Background and Objectives: Depression and anxiety are common among patients with cardiovascular disease. With increased stress from the ongoing pandemic, it is important to evaluate these conditions. Hence, this study aimed to identify the prevalence of depression and anxiety among outpatient consults via telemedicine through the HADS-P questionnaire and to compare the clinical and socioeconomic profile of patients with HADS-P score of >/=11.

Methods: This is a cross-sectional descriptive study including participants, outpatients in the cardiology clinic through an online survey regarding their socioeconomic demographic profile and the HADS-P questionnaire. Patients with scores of >/=11 for anxiety or depression were identified and the two groups were compared using a chi-square test analysis.

Results: One hundred and twelve patients were recruited. Majority were females, with a partner, unemployed and living below the poverty line. The most common cardiovascular condition was ischemic heart disease and most patients were at least functional class II. The measured prevalence of probable anxiety and depression were 22% and 8%, respectively. A significant difference between the presence of both anxiety and depression was seen in participants with no partners; and for depression alone, in employed participants.

Conclusion: Anxiety and depression are common in this sample population. HADS-P is a simple way of screening patients for these conditions so that holistic care may be instituted and appropriate referrals for psychological intervention may be done.

Keywords: Anxiety, Depression, Telemedicine

References
  1. Allabadi H, Alkaiyat A, Alkhayyat A, Hammoudi A, Odeh H, Shtayeh J, et al. Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population. BMC Public Health [Internet]. 2019;19(1):232. Available from: http://dx.doi.org/10.1186/s12889-019-6561-3
  2. Ormel J, Von Korff M, Burger H, Scott K, Demyttenaere K, Huang Y-Q, et al. Mental disorders among persons with heart disease - results from world mental health surveys. Gen Hosp Psychiatry [Internet]. 2007;29(4):325–34. Available from: http://dx.doi.org/10.1016/j.genhosppsych.2007.03.009 .
  3. Tully PJ, Harrison NJ, Cheung P, Cosh S. Anxiety and cardiovascular disease risk: A review. Curr Cardiol Rep [Internet]. 2016;18(12):120. Available from: http://dx.doi.org/10.1007/s11886-016-0800-3
  4. Depression and anxiety in adults with congenital heart disease using the validated Filipino version of the hospital anxiety and depression score (HADS-P). Philippine Journal of Internal Medicine. 2016;54(1):1-6.
  5. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun [Internet]. 2020;89:531–42. Available from: http://dx.doi.org/10.1016/j.bbi.2020.05.048
  6. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health [Internet]. 2020;16(1):57. Available from: http://dx.doi.org/10.1186/s12992-020-00589-w
  7. Lichtman JH, Froelicher ES, Blumenthal JA, Carney RM, Doering LV, Frasure-Smith N, et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association: A scientific statement from the American Heart Association. Circulation [Internet]. 2014;129(12):1350–69. Available from: http://dx.doi.org/10.1161/CIR.0000000000000019
  8. Walters K, Rait G, Petersen I, Williams R, Nazareth I. Panic disorder and risk of new onset coronary heart disease, acute myocardial infarction, and cardiac mortality: cohort study using the general practice research database. Eur Heart J [Internet]. 2008;29(24):2981–8. Available from: http://dx.doi.org/10.1093/eurheartj/ehn477
  9. Mathur R, Pérez-Pinar M, Foguet-Boreu Q, Ayis S, Ayerbe L. Risk of incident cardiovascular events amongst individuals with anxiety and depression: A prospective cohort study in the east London primary care database. J Affect Disord [Internet]. 2016;206:41–7. Available from: http://dx.doi.org/10.1016/j.jad.2016.07.046
  10. Silverman AL, Herzog AA, Silverman DI. Hearts and minds: Stress, anxiety, and depression: Unsung risk factors for cardiovascular disease. Cardiol Rev [Internet]. 2019;27(4):202–7. Available from: http://dx.doi.org/10.1097/CRD.0000000000000228
  11. Chauvet-Gelinier J-C, Bonin B. Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilitation. Ann Phys Rehabil Med [Internet]. 2017;60(1):6–12. Available from: http://dx.doi.org/10.1016/j.rehab.2016.09.002
  12. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand [Internet]. 1983;67(6):361–70. Available from: http://dx.doi.org/10.1111/j.1600-0447.1983.tb09716.x .
  13. De Guzman MLRE. A validation of the hospital anxiety and depression scale (HADS) in the medically-ill. Acta Med Philipp [Internet]. 2013;47(3):53-62. Available from: http://dx.doi.org/10.47895/amp.v47i3.1318
  14. Measurement of anxiety and depression among HIV patients seen in the Philippine General Hospital using the Hospital Anxiety and Depression Scale-Pilipino version (HADS-P). Acta Medical Philippina. 2018;52:40–52.
  15. Villanueva D, Bartolome R, Loyola A. The prevalence of anxiety and depression among patients with chronic kidney disease seen in the University of the Philippines-Philippine General Hospital in Manila using the Hospital Anxiety and Depression Scale- English/Pilipino version. Unpublished manuscript. 2016;
  16. Ambrosio G, Santiaguel J. Anxiety and depression among diagnosed tuberculosis patients seen at the University of the Philippines-Philippine General Hospital using the validated Filipino version of the Hospital Anxiety and Depression Score (HADS-P). Unpublished manuscript. 2015;
  17. The prevalence of anxiety and depression among cervical cancer patients seen in a tertiary government hospital using the Hospital Anxiety and Depression Scale-English/Pilipino version (HADS/HADS-P). PJOG. 2018;42:11–21.
  18. Bell CS, Florcruz NVDG. Risk factors for anxiety and depression in patients diagnosed with glaucoma at the Philippine General Hospital. Asian J Ophthalmol [Internet]. 2019;16(4):329–44. Available from: http://dx.doi.org/10.35119/asjoo.v16i4.415
  19. Gu G, Zhou Y, Zhang Y, Cui W. Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment. BMC Psychiatry [Internet]. 2016;16:259. Available from: http://dx.doi.org/10.1186/s12888-016-0972-9
  20. Tulloch H, Heenan A, Cupper L, Pelletier R, O’Farrell P, Pipe A. Depression and anxiety screening and Triage protocol for cardiac rehabilitation programs. J Cardiopulm Rehabil Prev [Internet]. 2018;38(3):159–62. Available from: http://dx.doi.org/10.1097/hcr.0000000000000276
  21. Rogers JG, Patel CB, Mentz RJ, Granger BB, Steinhauser KE, Fiuzat M, et al. Palliative care in heart failure: The PAL-HF randomized, controlled clinical trial. J Am Coll Cardiol [Internet]. 2017;70(3):331–41. Available from: http://dx.doi.org/10.1016/j.jacc.2017.05.030
  22. Murphy B, Le Grande M, Alvarenga M, Worcester M, Jackson A. Anxiety and depression after a cardiac event: Prevalence and predictors. Front Psychol [Internet]. 2019;10:3010. Available from: http://dx.doi.org/10.3389/fpsyg.2019.03010
  23. Bolier L, Haverman M, Kramer J, Westerhof GJ, Riper H, Walburg JA, et al. An Internet-based intervention to promote mental fitness for mildly depressed adults: randomized controlled trial. J Med Internet Res [Internet]. 2013;15(9):e200. Available from: http://dx.doi.org/10.2196/jmir.2603
  24. Kenter R, Warmerdam L, Brouwer-Dudokdewit C, Cuijpers P, van Straten A. Guided online treatment in routine mental health care: an observational study on uptake, drop-out and effects. BMC Psychiatry [Internet]. 2013;13:43. Available from: http://dx.doi.org/10.1186/1471-244X-13-43  
  25. Duffecy J, Sanford S, Wagner L, Begale M, Nawacki E, Mohr DC. Project onward: an innovative e-health intervention for cancer survivors: E-health intervention for cancer survivors. Psychooncology [Internet]. 2013;22(4):947–51. Available from: http://dx.doi.org/10.1002/pon.3075
  26. Cole SA, Farber NC, Weiner JS, Sulfaro M, Katzelnick DJ, Blader JC. Double-disease management or one care manager for two chronic conditions: pilot feasibility study of nurse telephonic disease management for depression and congestive heart failure. Dis Manag [Internet]. 2006;9(5):266–76. Available from: http://dx.doi.org/10.1089/dis.2006.9.266
  27. Marchevsky N. Errors in prevalence estimated in population studies: a practical method for calculation real prevalence. Zoonosis. 1974;16:98–109.
License

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, which permits use, share — copy and redistribute the material in any medium or format, adapt — remix, transform, and build upon the material, as long as you give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original. You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-sa/4.0/.