DEPRESSION AND ANXIETY IN PATIENTS WITH CARDIOVASCULAR DISEASES: A NARRATIVE REVIEW OF PREVALENCE, MECHANISMS AND CLINICAL IMPLICATIONS
DOI:
https://doi.org/10.31435/ijitss.1(49).2026.5397Keywords:
Cardiovascular Diseases, Coronary Artery Disease, Depression, Anxiety, PsychocardiologyAbstract
Background: Cardiovascular diseases (CVD), including coronary artery disease, heart failure, and atrial fibrillation, remain major causes of morbidity and mortality worldwide. Depression and anxiety are highly prevalent in these populations and are associated with impaired quality of life, reduced functional status, and worse clinical outcomes.
Objective: This narrative review aimed to summarise current evidence on the prevalence, prognostic significance, and underlying mechanisms of depression and anxiety in patients with cardiovascular disease, and to discuss major diagnostic challenges, screening strategies, and treatment approaches relevant to clinical practice.
Methods: A narrative review of the literature was conducted using PubMed as the primary database, supplemented by searches in PubMed Central, Google Scholar, and selected open-access journals. Priority was given to meta-analyses, systematic reviews, clinical reviews, consensus statements, and key prospective or interventional studies published mainly between 2000 and early 2026, with a focus on coronary artery disease, heart failure, and atrial fibrillation. The review primarily emphasised studies published from 2020 onward, while earlier landmark papers were included when considered essential for contextual understanding.
Results: Depression and anxiety are common across major cardiovascular conditions and are associated with increased risks of incident cardiovascular disease, recurrent events, mortality, hospitalisation, and reduced health-related quality of life. Proposed mechanisms include autonomic and hypothalamic- pituitary-adrenal axis dysregulation, inflammation, endothelial dysfunction, platelet activation, and adverse health behaviours. Diagnostic overlap between cardiac and psychological symptoms contributes to underrecognition. Brief screening instruments such as the PHQ‑9, GAD‑7, and HADS appear feasible in routine care when linked to structured follow‑up. Psychological interventions, selected antidepressants, and collaborative care models may improve mental health outcomes, although evidence for their effects on hard cardiovascular endpoints remains limited.
Conclusions: Depression and anxiety are clinically important comorbidities in cardiovascular disease and should be systematically addressed in cardiovascular care. Integrating mental health screening and multidisciplinary management into routine practice may enhance overall patient outcomes.
References
Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J. R., Catapano, A. L., Chugh, S., Cooper, L. T., Coresh, J., ... Fuster, V. (2020). Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study. Journal of the American College of Cardiology, 76(25), 2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010
Mensah, G. A., Roth, G. A., & Fuster, V. (2019). The global burden of cardiovascular diseases and risk factors: 2020 and beyond. Journal of the American College of Cardiology, 74(20), 2529–2532. https://doi.org/10.1016/j.jacc.2019.10.009
Celano, C. M., Daunis, D. J., Lokko, H. N., Campbell, K. A., & Huffman, J. C. (2016). Anxiety disorders and cardiovascular disease. Current Psychiatry Reports, 18(11). https://doi.org/10.1007/s11920-016-0739-5
Chernoff, R. A., Messineo, G., Kim, S., Pizano, D., Korouri, S., Danovitch, I., & Ishak, W. W. (2022). Psychosocial interventions for patients with heart failure and their impact on depression, anxiety, quality of life, morbidity, and mortality: A systematic review and meta-analysis. Psychosomatic Medicine, 84(5), 560–580. https://doi.org/10.1097/PSY.0000000000001073
Wu, J., Tian, Z., Qi, Z., Liu, X., & Yu, P. (2026). Cardiovascular disease and depression: A bidirectional relationship and its clinical implications. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1675680
Zeng, J., Qiu, Y., Yang, C., Fan, X., Zhou, X., Zhang, C., Zhu, S., Long, Y., Hashimoto, K., Chang, L., & Wei, Y. (2025). Cardiovascular diseases and depression: A meta-analysis and Mendelian randomization analysis. Molecular Psychiatry, 30(9), 4234–4246. https://doi.org/10.1038/s41380-025-03003-2
Karami, N., Kazeminia, M., Karami, A., Salimi, Y., Ziapour, A., & Janjani, P. (2023). Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis. Journal of Affective Disorders, 324, 175–189. https://doi.org/10.1016/j.jad.2022.12.055
Emdin, C. A., Odutayo, A., Wong, C. X., Tran, J., Hsiao, A. J., & Hunn, B. H. M. (2016). Meta-analysis of anxiety as a risk factor for cardiovascular disease. American Journal of Cardiology, 118(4), 511–519. https://doi.org/10.1016/j.amjcard.2016.05.041
Ogunmoroti, O., Osibogun, O., Spatz, E. S., Okunrintemi, V., Mathews, L., Ndumele, C. E., & Michos, E. D. (2022). A systematic review of the bidirectional relationship between depressive symptoms and cardiovascular health. Preventive Medicine, 154, 106891. https://doi.org/10.1016/j.ypmed.2021.106891
Gan, Y., Gong, Y., Tong, X., Sun, H., Cong, Y., Dong, X., Wang, Y., Xu, X., Yin, X., Deng, J., Li, L., Cao, S., & Lu, Z. (2014). Depression and the risk of coronary heart disease: A meta-analysis of prospective cohort studies. BMC Psychiatry, 14(1). https://doi.org/10.1186/s12888-014-0371-z
Gathright, E. C., Goldstein, C. M., Josephson, R. A., & Hughes, J. W. (2017). Depression increases the risk of mortality in patients with heart failure: A meta-analysis. Journal of Psychosomatic Research, 94, 82–89. https://doi.org/10.1016/j.jpsychores.2017.01.010
Batelaan, N. M., Seldenrijk, A., Bot, M., van Balkom, A. J. L. M., & Penninx, B. W. J. H. (2016). Anxiety and new onset of cardiovascular disease: Critical review and meta-analysis. The British Journal of Psychiatry, 208(3), 223–231. https://doi.org/10.1192/bjp.bp.114.156554
Zhu, Y., Yu, X., Wu, Y., Shi, C., Zhang, A., Jiang, R., Li, S., Guo, G., Gao, R., & Blumenthal, J. A. (2019). Association of depression and unhealthy lifestyle behaviors in Chinese patients with acute coronary syndromes: Depression and unhealthy lifestyle behaviors in ACS patients. Journal of Cardiopulmonary Rehabilitation and Prevention, 39(6), E1. https://doi.org/10.1097/HCR.0000000000000384
Xu, L., Zhai, X., Shi, D., & Zhang, Y. (2024). Depression and coronary heart disease: Mechanisms, interventions, and treatments. Frontiers in Psychiatry, 15, 1328048. https://doi.org/10.3389/fpsyt.2024.1328048
Tully, P. J., & Baumeister, H. (2015). Collaborative care for comorbid depression and coronary heart disease: A systematic review and meta-analysis of randomised controlled trials. BMJ Open, 5(12), e009128. https://doi.org/10.1136/bmjopen-2015-009128
Varghese, T. P., Kumar, A. V., Varghese, N. M., & Chand, S. (2020). Depression related pathophysiologies relevant in heart disease: Insights into the mechanism based on pharmacological treatments. Current Cardiology Reviews, 16(2), 125. https://doi.org/10.2174/1573403x15666191127104520
Patel, D., Mc Conkey, N. D., Sohaney, R., Mc Neil, A., Jedrzejczyk, A., & Armaganijan, L. (2013). A systematic review of depression and anxiety in patients with atrial fibrillation: The mind-heart link. Cardiovascular Psychiatry and Neurology, 2013, 159850. https://doi.org/10.1155/2013/159850
Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: A meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48(8), 1527–1537. https://doi.org/10.1016/j.jacc.2006.06.055
Shear, F. el. (2020). Depression in patients with heart failure: A review article. International Journal of Medical Research & Health Sciences, 9(9), 31–39. https://www.ijmrhs.com/medical-research/depression-in-patients-with-heart-failure-a-review-article-50891.html
Storer, B., Kershaw, K. A., Braund, T. A., Chakouch, C., Coleshill, M. J., Haffar, S., Harvey, S., Newby, J. M., Sicouri, G., & Murphy, M. (2023). Global prevalence of anxiety in adult cardiology outpatients: A systematic review and meta-analysis. Current Problems in Cardiology, 48(11), 101877. https://doi.org/10.1016/j.cpcardiol.2023.101877
Glassman, A. H., O’Connor, C. M., Califf, R. M., Swedberg, K., Schwartz, P., Bigger, J. T., Krishnan, K. R. R., van Zyl, L. T., Swenson, J. R., Finkel, M. S., Landau, C., Shapiro, P. A., Pepine, C. J., Mardekian, J., & Harrison, W. M. (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA, 288(6), 701–709. https://doi.org/10.1001/jama.288.6.701
Krittanawong, C., Maitra, N. S., Qadeer, Y. K., Wang, Z., Fogg, S., Storch, E. A., Celano, C. M., Huffman, J. C., Jha, M., Charney, D. S., & Lavie, C. J. (2023). Association of depression and cardiovascular disease. American Journal of Medicine, 136(9), 881–895. https://doi.org/10.1016/j.amjmed.2023.04.036
Wu, Q., & Kling, J. M. (2016). Depression and the risk of myocardial infarction and coronary death: A meta-analysis of prospective cohort studies. Medicine, 95(6), e2815. https://doi.org/10.1097/MD.0000000000002815
Freedland, K. E., Carney, R. M., & Rich, M. W. (2011). Effect of depression on prognosis in heart failure. Heart Failure Clinics, 7(1), 11–21. https://doi.org/10.1016/j.hfc.2010.08.003
Wen, Y., Yang, Y., Shen, J., & Luo, S. (2021). Anxiety and prognosis of patients with myocardial infarction: A meta-analysis. Clinical Cardiology, 44(6), 761. https://doi.org/10.1002/clc.23605
Huang, L., Zhang, L., Liu, C., Xu, Q., & Qiu, K. (2025). Interaction and mechanisms of depression and cardiovascular disease: A mini-review. PeerJ, 13, e20148. https://doi.org/10.7717/peerj.20148
Dhar, A. K., & Barton, D. A. (2016). Depression and the link with cardiovascular disease. Frontiers in Psychiatry, 7, 33. https://doi.org/10.3389/fpsyt.2016.00033
Iob, E., Kirschbaum, C., & Steptoe, A. (2019). Persistent depressive symptoms, HPA-axis hyperactivity, and inflammation: The role of cognitive-affective and somatic symptoms. Molecular Psychiatry, 25(5), 1130–1140. https://doi.org/10.1038/s41380-019-0501-6
Grippo, A. J., & Johnson, A. K. (2009). Stress, depression, and cardiovascular dysregulation: A review of neurobiological mechanisms and the integration of research from preclinical disease models. Stress, 12(1), 1. https://doi.org/10.1080/10253890802046281
Goldstein, C. M., Gathright, E. C., & Garcia, S. (2017). Relationship between depression and medication adherence in cardiovascular disease: The perfect challenge for the integrated care team. Patient Preference and Adherence, 11, 547. https://doi.org/10.2147/PPA.S127277
Zhou, Y., Huo, Q., Du, S., Shi, X., Shi, Q., Cui, S., Feng, C., Du, X., & Wang, Y. (2022). Social support and self-efficacy as mediating factors affecting the association between depression and medication adherence in older patients with coronary heart disease: A multiple mediator model with a cross-sectional study. Patient Preference and Adherence, 16, 285–295. https://doi.org/10.2147/PPA.S337634
Nakada, S., Celis-Morales, C., Pell, J. P., & Ho, F. K. (2025). Shared and distinct pathways from anxiety disorder and depression to cardiovascular disease: A UK Biobank prospective cohort study. European Journal of Preventive Cardiology. https://doi.org/10.1093/eurjpc/zwaf110
Jupe, T., Provi, K., Zenelaj, B., Myslimi, E., & Giannopoulos, I. (2023). Depression and anxiety in cardiac disease, diagnosing and screening. European Psychiatry, 66(Suppl. 1), S775. https://doi.org/10.1192/j.eurpsy.2023.1634
Musey, P. I., Lee, J. A., Hall, C. A., & Kline, J. A. (2018). Anxiety about anxiety: A survey of emergency department provider beliefs and practices regarding anxiety-associated low risk chest pain. BMC Emergency Medicine, 18(1), 10. https://doi.org/10.1186/s12873-018-0161-x
Lomper, K., Ross, C., & Uchmanowicz, I. (2023). Anxiety and depressive symptoms, frailty and quality of life in atrial fibrillation. International Journal of Environmental Research and Public Health, 20(2), 1066. https://doi.org/10.3390/ijerph20021066
Gorini, A., Giuliani, M., Raggio, L., Barbieri, S., & Tremoli, E. (2020). Depressive and anxiety symptoms screening in cardiac inpatients: A virtuous Italian approach to psychocardiology. International Journal of Environmental Research and Public Health, 17(14), 5007. https://doi.org/10.3390/ijerph17145007
Jha, M. K., Qamar, A., Vaduganathan, M., Charney, D. S., & Murrough, J. W. (2019). Screening and management of depression in patients with cardiovascular disease. Journal of the American College of Cardiology, 73(14), 1827. https://doi.org/10.1016/j.jacc.2019.01.041
Berge, T., Bull-Hansen, B., Solberg, E. E., Heyerdahl, E. R., Jørgensen, K. N., Vinge, L. E., Aarønæs, M., Øie, E., & Hyldmo, I. (2019). Screening for symptoms of depression and anxiety in a cardiology department. Tidsskrift for Den Norske Legeforening, 139(14). https://doi.org/10.4045/tidsskr.18.0570
Li, Y.-N., Buys, N., Ferguson, S., Li, Z.-J., & Sun, J. (2021). Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis. World Journal of Psychiatry, 11(11), 1147. https://doi.org/10.5498/wjp.v11.i11.1147
Rajasree Katta, M., Prasad, S., Tiwari, A., Abdelgawad Abouzid, M. R., & Mitra, S. (2023). The effectiveness of cognitive-behavioral therapy for heart failure patients: A narrative review. Journal of International Medical Research, 51(9). https://doi.org/10.1177/03000605231198371
García-Sánchez, E., Santamaría-Peláez, M., González-Bernal, J. J., González-Santos, J., Sedano García, M. A., de Juana Velasco, I., Sánchez Hernández, J., García Pardo, H., & Fernández-Solana, J. (2025). Impact of cardiac rehabilitation on anxiety, depression, and health-related quality of life in cardiovascular patients. The Egyptian Heart Journal, 77(1), 64. https://doi.org/10.1186/s43044-025-00658-8
Seifouri, K., Kahdemi, R., Hajikolaei, F. A., Rasekh, F., Azadikhah, F., Mehraban, I., Alikhani, R., Mirjalili, A., Alipour, M., Sadat-Madani, S.-F., Chichagi, F., Lashkajani, S. Z., Abdi, A., Belbasi, M., Kohnehshahri, A. A., Deravi, N., Naziri, M., Pishkari, Y., Bafrani, M. A., ... Habibi, A. F. (2024). Sertraline in depressed patients with or at risk for coronary heart disese: A systemic review. American Journal of Cardiovascular Disease, 14(6), 318. https://doi.org/10.62347/axzc9187
Berkman, L. F., Blumenthal, J., Burg, M., Carney, R. M., Catellier, D., Cowan, M. J., Czajkowski, S. M., de Busk, R., Hosking, J., Jaffe, A., Kaufmann, P. G., Mitchell, P., Norman, J., Powell, L. H., Raczynski, J. M., Schneiderman, N., & Raczynski. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) randomized trial. JAMA, 289(23), 3106–3116. https://doi.org/10.1001/jama.289.23.3106
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Copyright (c) 2026 Natalia Sitko, Paulina Makowska, Joanna Gontarczyk, Alicja Laske, Martyna Sowa, Antoni Majda, Julia Pająk, Kacper Kucharski, Anna Kamosińska, Adam Kowal, Julia Sokołowska, Marcel Dawidowicz
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