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      Anxiety and depression in patients with peripheral arterial disease admitted to a tertiary hospital

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          Abstract

          Background

          Anxiety and depression are highly prevalent neuropsychiatric conditions and are associated with chronic diseases, pain, loss of autonomy, dependence on others to perform routine activities, and loneliness. Depression often has a cause-and-effect relationship with other diseases, such as: acute myocardial infarction (AMI), systemic arterial hypertension (SAH), diabetes mellitus (DM) and peripheral arterial disease (PAD).

          Objectives

          To estimate the frequency of anxiety and depression in patients of both sexes with PAD admitted to a tertiary hospital.

          Methods

          This is a descriptive, cross-sectional study, with a non-random sample selected consecutively. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression, and the ankle-brachial index (ABI) was used to assess PAD.

          Results

          The prevalence of anxiety in these patients was 24.4%, with associations between anxiety and monthly family income, smoking, and SAH. The prevalence of depression was 27.6%, with associations between depression and the female gender, being married or in a stable relationship, living on a family income of one minimum wage or less, not being an alcoholic, and having hypertension.

          Conclusions

          There are high prevalence rates of anxiety and depressive disorders among patients with PAD, which are underdiagnosed and, hence, not properly treated.

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          Most cited references35

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          Depression: A cognitive perspective

          Cognitive science has been instrumental in advancing our understanding of the onset, maintenance, and treatment of depression. Research conducted over the last 50 years supports the proposition that depression and risk for depression are characterized by the operation of negative biases, and often by a lack of positive biases, in self-referential processing, interpretation, attention, and memory, as well as the use of maladaptive cognitive emotion regulation strategies. There is also evidence to suggest that deficits in cognitive control over mood-congruent material underlie these cognitive processes. Specifically, research indicates that difficulty inhibiting and disengaging from negative material in working memory: (1) increases the use of maladaptive emotion regulation strategies (e.g., rumination), decreases the use of adaptive emotion regulation strategies (e.g., reappraisal), and potentially impedes flexible selection and implementation of emotion regulation strategies; (2) is associated with negative biases in attention; and (3) contributes to negative biases in long-term memory. Moreover, studies suggest that these cognitive processes exacerbate and sustain the negative mood that typifies depressive episodes. In this review, we present evidence in support of this conceptualization of depression and discuss implications of research findings for theory and practice. Finally, we advance directions for future research.
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            Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010.

            Depressive disorders were a leading cause of burden in the Global Burden of Disease (GBD) 1990 and 2000 studies. Here, we analyze the burden of depressive disorders in GBD 2010 and present severity proportions, burden by country, region, age, sex, and year, as well as burden of depressive disorders as a risk factor for suicide and ischemic heart disease. Burden was calculated for major depressive disorder (MDD) and dysthymia. A systematic review of epidemiological data was conducted. The data were pooled using a Bayesian meta-regression. Disability weights from population survey data quantified the severity of health loss from depressive disorders. These weights were used to calculate years lived with disability (YLDs) and disability adjusted life years (DALYs). Separate DALYs were estimated for suicide and ischemic heart disease attributable to depressive disorders. Depressive disorders were the second leading cause of YLDs in 2010. MDD accounted for 8.2% (5.9%-10.8%) of global YLDs and dysthymia for 1.4% (0.9%-2.0%). Depressive disorders were a leading cause of DALYs even though no mortality was attributed to them as the underlying cause. MDD accounted for 2.5% (1.9%-3.2%) of global DALYs and dysthymia for 0.5% (0.3%-0.6%). There was more regional variation in burden for MDD than for dysthymia; with higher estimates in females, and adults of working age. Whilst burden increased by 37.5% between 1990 and 2010, this was due to population growth and ageing. MDD explained 16 million suicide DALYs and almost 4 million ischemic heart disease DALYs. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%-3.8%) to 3.8% (3.0%-4.7%) of global DALYs. GBD 2010 identified depressive disorders as a leading cause of burden. MDD was also a contributor of burden allocated to suicide and ischemic heart disease. These findings emphasize the importance of including depressive disorders as a public-health priority and implementing cost-effective interventions to reduce its burden. Please see later in the article for the Editors' Summary.
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              Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia.

              With a rise in the aging popluation, the prevalence of peripheral arterial disease (PAD) is markedly increasing. The overall disease prevalence of PAD is in the range of 3%-10%, which increases to 15%-20% in persons older than 70 years of age. Given this upward trend in disease prevalence, the economic and societal burden of PAD would be considerable. The subgroup of patients who develop critical limb ischemia (CLI) represents the most challenging population to manage medically, surgically, and endovascularly. Patients with symptomatic PAD and CLI have an increased risk for death and cardiovascular events, especially in those with CLI who carry with them a substantial risk of limb loss. Advances in medical, surgical, and endovascular techniques have shown excellent outcomes in the treatment of these patients, however the optimal management paradigm has not been elucidated. This article reviews the classification and epidemiology, risk factors, natural history, and health care costs associated with PAD and CLI.
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                Author and article information

                Journal
                J Vasc Bras
                J Vasc Bras
                jvb
                Jornal Vascular Brasileiro
                Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)
                1677-5449
                1677-7301
                23 August 2019
                2019
                : 18
                : e20190002
                Affiliations
                [1 ] originalUniversidade Federal de Sergipe (UFS), Aracaju, SE, Brasil.
                [2 ] originalUniversidade Tiradentes (UNIT), Aracaju, SE, Brasil.
                [3 ] originalFundação Beneficência Hospital Cirurgia, Serviço de Cirurgia Vascular, Aracaju, SE, Brasil.
                [4 ] originalCentro Universitário de Volta Redonda (UNIFOA), Volta Redonda, RJ, Brasil.
                [1 ] originalUniversidade Federal de Sergipe (UFS), Aracaju, SE, Brasil.
                [2 ] originalUniversidade Tiradentes (UNIT), Aracaju, SE, Brasil.
                [3 ] originalFundação Beneficência Hospital Cirurgia, Serviço de Cirurgia Vascular, Aracaju, SE, Brasil.
                [4 ] originalCentro Universitário de Volta Redonda (UNIFOA), Volta Redonda, RJ, Brasil.
                Author notes

                Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

                Correspondence José Aderval Aragão Av. Marechal Rondon, s/n - Jd. Rosa Elze CEP 49100-000 - São Cristóvão (SE), Brazil Tel.: +55 (79) 99191-6767 E-mail: adervalufs@ 123456gmail.com

                Author informationJAA – PhD in Sciences, Universidade Federal de São Paulo (UNIFESP). LGRA – Physician, Unidade de Pronto Atendimento Nestor Piva. OMGN – MSc in Pharmaceutical Sciences; Vascular surgeon, Hospital de Urgência de Sergipe (HUSE); former resident, Serviço de Residência Médica em Cirurgia Vascular, Fundação Beneficência Hospital Cirurgia (FBHC). ICSA and FMSA – Medical students, Centro Universitário de Volta Redonda (UNIFOA). FPR – PhD in Biological Sciences, Instituto de Ciências Biológicas, Universidade de São Paulo (USP).

                Author contributionsConception and design: JAA, OMGN, FPR Analysis and interpretation: LGRA Data collection: ICSAA, FMSAA Writing the article: JAA, OMGN, FPR Critical revision of the article: JAA Final approval of the article*: JAA, LGRA, OMGN, ICSAA, FMSAA, FPR Statistical analysis: FPR, LGRA Overall responsibility: JAA *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

                Conflitos de interesse: Os autores declararam não haver conflitos de interesse que precisam ser informados.

                Correspondência José Aderval Aragão Av. Marechal Rondon, s/n, Jd. Rosa Elze CEP 49100-000 - São Cristóvão (SE), Brasil Tel.: (79) 99191-6767 E-mail: adervalufs@ 123456gmail.com

                Informações sobre os autoresJAA – Doutor em Ciências, Universidade Federal de São Paulo (UNIFESP). LGRA – Médica, Unidade de Pronto Atendimento Nestor Piva. OMGN – Mestre em Ciências Farmacêuticas, Cirurgião Vascular do Hospital de Urgência de Sergipe (HUSE); ex-residente do Serviço de Residência Médica em Cirurgia Vascular, Fundação Beneficência Hospital Cirurgia (FBHC). ICSA e FMSA – Estudantes, Medicina, Centro Universitário de Volta Redonda (UNIFOA). FPR – Doutor em Ciências Biológicas, Instituto de Ciências Biológicas, Universidade de São Paulo (USP).

                Contribuição dos autoresConcepção e desenho do estudo: JAA, OMGN, FPR Análise e interpretação dos dados: LGRA Coleta de dados: ICSAA, FMSAA Redação do artigo: JAA, OMGN, FPR Revisão crítica do texto: JAA Aprovação final do artigo*: JAA, LGRA, OMGN, ICSAA, FMSAA, FPR Análise estatística: FPR, LGRA Responsabilidade geral pelo estudo: JAA *Todos os autores leram e aprovaram a versão final submetida ao J Vasc Bras.

                Author information
                http://orcid.org/0000-0002-2300-3330/
                Article
                jvbAO20190002_PT 00311
                10.1590/1677-5449.190002
                6709972
                31488975
                a4eeb755-de0e-4291-9cea-237c53aa01e5

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 02 January 2019
                : 11 April 2019
                Page count
                Figures: 2, Tables: 6, Equations: 0, References: 40
                Categories
                Original Article

                depression,anxiety,vascular diseases,peripheral artery diseases,depressão,ansiedade,doenças vasculares,doença arterial periférica

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