Background: Although most implantable cardioverter defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not been investigated. Our objectives were to (1) describe ICD-related concerns, and (2) examine whether the relationships between receipt of defibrillating shocks and psychological distress were mediated by patients’ concerns related to their ICD.
Methods and Results: All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3,067 completing the survey (55% response). Their mean age was 66+11 years, and 80% were male. One third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression (OR 1.58 and OR 3.04, respectively). The association between receipt of shocks and psychologically distress were mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety,and 54% of the relationship between shocks and symptoms of depression, see Figure 1.
Conclusion: Having high ICD-related concerns has a bigger impact on psychological distress than receipt of an actual shock. Screening for ICD-related concerns in clinical practice may identify patients at risk of psychological distress, which could provide a specific target for intervention. Interventions tailored to individual patients’ needs can - besides addressing device-related education and anxiety about shocks - also include relaxation and stress management, cognitive restructuring, social support and/or group discussions, and exercise programs.