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Changes in anxiety and depression over 2 years in medically stable patients after myocardial infarction and their spouses in the Home Automatic External Defibrillator Trial (HAT): a longitudinal observational study
  1. Sue A Thomas1,
  2. Erika Friedmann1,
  3. Hyeon-Joo Lee2,
  4. Heesook Son1,
  5. Patricia G Morton1,
  6. the HAT Investigators
  1. 1University of Maryland School of Nursing, Baltimore, Maryland USA
  2. 2Greater Baltimore Medical Center, Maryland, USA
  1. Correspondence to Dr Sue A Thomas, University of Maryland School of Nursing, 655 W Lombard St, Baltimore, MD 21201 USA; thomas{at}


Objective To compare the long-term effects of cardiopulmonary resuscitation (CPR) training and CPR/automatic external defibrillator (AED) training on anxiety and depression of patients who were medically stable after myocardial infarction (MI) and of their spouses/companions.

Design Longitudinal.

Participants Post-MI patients (N=460) and their spouses/companions from the Home Automatic External Defibrillator Trial.

Main outcome measures Depression (Beck Depression Inventory-II scores) and anxiety (State Trait Anxiety Inventory scores).

Results At study entry, 25% of the patients and 15% of their spouses were depressed and 21% of the patients and 19% of the spouses were anxious. The prevalence of depression and anxiety did not change over time in the patients or their spouses. Average depression and anxiety decreased for patients but not for spouses. An intervention group did not contribute significantly to these changes. Psychological distress, indicated by depression or anxiety of the spouse or the patient, occurred in 191 couples. Among psychologically distressed patients (N=128), depression and anxiety decreased over time; the intervention group did not contribute to these changes. The reduction in anxiety among male patients was greater than in female patients (p=0.012, 95% CI 0.002 to 0.018). Among psychologically distressed spouses (N=118), depression decreased over time independently of the intervention. Changes in spouse anxiety depended on the intervention group (p=0.012, 95% CI 0.001 to 0.012); anxiety decreased significantly in the CPR and remained high in the CPR/AED group.

Conclusion There was no evidence that home AEDs caused psychological distress among patients. Even among those who were psychologically distressed when they were assigned to receive either CPR training or CPR/AEDs, home AEDs did not influence changes in patients' depression or anxiety or spouses' depression in comparison with CPR training. Among psychologically distressed spouses, AEDs may keep anxiety higher than it would be otherwise. Interventions to reduce anxiety of spouses who are psychologically distressed may be indicated when their partners receive an AED.

  • Anxiety
  • depression
  • defibrillation
  • acute coronary syndrome
  • community cardiology

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  • The authors are solely responsible for the study design, data collection, analysis, interpretation, manuscript preparation and decision to publish. The researchers have complete access to all data.

  • A complete list of HAT investigators has been published previously2.

  • Funding This research was partially supported by grants R01 NR008550 from the National Institute of Nursing Research, National Institutes of Health, Bethesda, MD USA and grant UO1-HL67972 from the National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD USA. These were researcher initiated proposals.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Maryland and each site collecting data.

  • Provenance and peer review Not commissioned; externally peer reviewed.