Angina is well known as chest pain caused by insufficient flow of oxygen-rich blood to the cardiac muscle [1,2]. In some cases, this pain may spread to the back, arms, shoulders, or neck . It is symptom of cardiac problems, commonly coronary heart disease (CHD) [3,4].
There are four common types of angina: stable, unstable, microvascular, and variant angina [1,3]. Stable angina always follows a specific pattern, while unstable angina does not follow a specific pattern . Microvascular angina is a common type of angina, while variant angina is a rare type .
Angina may result mainly from ischemic heart disease or spasm of the coronary arteries. However, there are several risk factors, such as smoking, hypertension, metabolic syndrome, unhealthy cholesterol levels, diabetes, obesity, and inactivity [1,4].
According to the American Heart Association report in 2016, 15.5 million American individuals had CHD in 2012, which is the main cause of angina, and 8.2% of these patients had angina. Researchers expected that by 2030, CHD prevalence would increase by 18% from 2013 .
Although depression is another health condition, the American Heart Association reported that depression worsens the condition of the heart especially in patients with CHD . To better understand the effects of depression on the heart, basic knowledge of depression is essential.
Depression is a mood disorder that affects the way of thinking and behavior and leads to constant feelings of sadness [7,8]. Moreover, it can also cause physical and mental problems, leading to a decrease in the activity and functioning ability of the patient diagnosed with this disorder [7,8].
Feelings of sadness, grief, and bereavement may develop in an individual’s life. However, it is totally different in depression because these feelings are constant . Fortunately, depression can be treated, but it may require a long time [7,8].
Thus, according to the American Heart Association, depression affects the heart in two possible ways: (1) constant feelings of stress, sadness, and anxiety usually lead patients to unhealthy choices, especially with regard to food or exercise, and (2) depression can lead the body to produce certain hormones adversely affecting cholesterol levels and blood pressure .
According to the National Institute of Mental Health, in 2016, there were approximately 16.2 million patients with depression in the United States.9 However, in 2017, the number of patients increased to approximately 17.3 million .
Several studies showed that there is a relationship between depression and angina with respect to the effects in a patient’s life. According to Szpakowski et al., depression is commonly associated with angina, leading to high morbidity and mortality rates in patients with this disorder .
A study by Thombs et al. on patients with acute myocardial infarction (AMI) showed that survivors of AMI have constant depression . Moreover, according to Kaptein et al., symptoms of depression after myocardial infarction are considered important risk factors of developing other cardiac conditions .
Although there are several studies showing the relationship among depression, angina, and patients’ quality of life, there is no specific study that showed the effect of the association between these two conditions on physical and mental health of patients. Therefore, this study aimed to investigate the influence of depression on the physical and mental health of adult patients with angina.