Clinical condition | Prevalence (%)* | Main clinical picture |
Depressive disorders (major depression, dysthymia or persistent depressive disorder) | 6.923 | The core symptoms are depressed mood, loss of interest or pleasure and fatigue or loss of energy nearly every day for at least 2 weeks. Other symptoms are significant weight loss or weight gain, insomnia or hypersomnia, psychomotor agitation, self-critical ruminations, problems with concentration and indecisiveness and suicidal ideation. In patients with CVD, point-prevalence rates are around 20%. Depression often co-occurs with anxiety disorders, somatic symptom disorders and personality disorders. This comorbidity makes depression less responsive to antidepressants and increases the risk of poor outcomes. As depression is easy to measure, it was the most researched mental disorder in CVD. |
Anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalised anxiety disorder) | 14.023 | Anxiety disorders are characterised by excessive symptoms of anxiety (palpitations, sweating, trembling, shortness of breath, feelings of choking, chest pain or chest discomfort, nausea/vomiting and abdominal discomfort, feeling dizzy, chills or heat sensations, paresthesias, feelings of unreality or detachment from one-self (derealisation, depersonalisation), fear of losing control, ‘going crazy’ or dying) occurring out of the blue in panic disorder, or when exposed to phobic situations such as in agoraphobia or social anxiety disorder, or associated with excessive worrying and catastrophising ruminations in the case of GAD. Although the prevalence of anxiety disorders is less well investigated in CVD populations, the cardiologist can assume increased point-prevalences for panic and generalised anxiety around 5% and 10%, respectively.51 |
Somatic symptom disorders (medically unexplained symptoms, somatoform disorders) | 6.323 | Somatic symptom disorders are characterised by distressing somatic symptoms, such as back pain in the back, arms, legs and joints, headache, stomach or bowel problems, chest pain or shortness of breath, dizziness and fatigue, which are accompanied by excessive health concerns and inadequate medical care utilisation. The point prevalence rate in GP settings is around 30%.26 |
Personality disorder | 1252 | PDs are characterised by enduring disturbances in self and interpersonal functioning, leading to distress and impairment. Their onset is in adolescence or early adulthood. The course is stable over time (without treatment). Disturbances in self-functioning concern the capacity for self-directed behaviour (self-awareness, goal-directed behaviour, purpose of life), level of identity (eg, impaired sense of autonomy/agency, low self-esteem) and interpersonal functioning regarding empathy (capacity of understanding and relating to other persons) and intimacy (capacity of feeling connected with other persons, forming close and trusting reciprocal relationships). Persons with PD have high rates of healthcare consumption and non-compliance, increased risks for depression and anxiety, substance use disorders and suicide. A point-prevalence of 30% for heart transplant recipients was reported.35 Persons with PDs challenge the communicative capacities of mental health professionals. They are often extremely sensitive to rejection and exhibit avoidant or antagonistic behaviour. |
*12-month prevalence rates in the general population.
CVD, cardiovascular disease; GAD, generalised anxiety disorder; GP, general practitioner; PD, personality disorders.