Material and Method: The population of the crosssectional and descriptive study consists of 230 patients who were hospitalized in the Coronary Intensive Care Unit of University Hospital in May-July 2019. Study data were obtained by using a sociodemographic questionnaire and Hospital Anxiety and Depression (HAD) scale. In statistical evaluations, t test, one-way analysis of variance tests were applied.

Results: The mean age of the patients included in the study was 65,55±12,73, and 42.2% of them (n =97) were female and 57.8% (n =133) were male. The mean score of the anxiety subscale was 8,20±3,56, and the mean of the depression subscale was 9,32±4,26. The mean score of anxiety (p <0,001) and depression (p <0,05) in female patients was found to be higher than male patients. It was determined that patients over 60 years of age, whose spouses died or were divorced, scored higher in the depression subscale (p <0,05).

Conclusion: One third of the patients under treatment in the coronary intensive care unit are affected by anxiety, and a very large portion of them are affected by depression. Contrary to expectations, it was found that depression affects the intensive care patient population more. More research is needed on anxiety and depression rates and affecting factors in intensive care patients.

Around the world, depression and anxiety are the two main causes of serious community health issues. Between 12% to 47% of ICU patients report having anxiety symptoms, while 28% of patients report having depressive symptoms⁴. Studies among patients in intensive care units have shown that patients are susceptible to anxiety and depression^5,6. In particular, ensuring the survival of patients in recent years is considered a successful result, but patients are known to have negative emotional consequences during their stay in intensive care units ⁷. Unaccustomed environment and people, mobility constraints, being bedridden, sleep disturbance, unable to see their relatives, factors such as the sense of dependence on vehicles or intensive care units, frequently repeated pain stimuli, and lack of sufficient knowledge of treatment and applications cause psychological symptoms^8,9. It can also increase the stress of patients because the devices used in intensive care units are not sufficiently known by patients and patient relatives ^10,11. Stressors in the intensive care unit are indicated as physical (ventilator use, needle, etc.), physiological (lack of movement, confucius, difficulty communicating, etc.), and environmental (light and noise, unpleasant images and smells, etc.). The patient's response to these stress factors depends on factors such as medical diagnosis, prognosis, culture, social support, family relations, age, gender, development level, mental state, and coping mechanisms^12,13. Cases of severe disease and difficult to treat, this rate increases further. In particular, anxiety and depression developed in these patients adversely affect patient adaptation, quality of life, response to treatment, course of disease, mortality, and morbidity^14-16.

Determining factors affecting the anxiety and depression levels of patients in the Coronary Intensive Care Unit (CICU) will enable more effective and evidence-based care. In this study, depression and anxiety levels of patients treated in the Coronary Intensive Care Unit of a university hospital were analyzed.

Data collection
Zigmond and Snaith¹⁷ created the hospital anxiety and depression scale in 1983. Aydemir¹⁸ conducted validity and reliability research from Türkiye in 1997. For the Turkish patient group, the coefficients of reliability of the anxiety (HAD-A) and depression subscales (HAD-D) of the had scale were determined as 0.85 and 0.78 respectively. Hospital Anxiety Depression Scale (HADS); It includes subscales of anxiety and depression, is a self-notification scale, and consists of a total of 14 substances, 7 of which investigate the symptoms of depression (even numbers) and 7 investigate anxiety (odd numbers). Responses are evaluated in quadruple Likert format and scored between 0-3. The rating of each item is different. The scores for articles 1, 3, 5, 6, 8, 10, 11, and 13 are 3, 2, and 1 with decreasing intensity. Ratings for articles 2, 4, 7, 9, 12, and 14 are 0, 1, 2, and 3. When collecting articles 1, 3, 5, 7, 9, 11, and 13 for the anxiety subscale; for the depression subscale; points for articles 2, 4, 6, 8, 10, 12, and 14 are collected. A minimum score of 0 and a maximum of 21 points can be obtained from each subdivision. Scale's objective is to swiftly scan anxiety and depression for people who have physical illness in order to identify the risk group rather than to make a diagnosis. There are subscales of anxiety (HAD-A) and depression (HAD-D). As a result of the Turkey research, the cutting score for the depression subscale was 7 and the cutting score for the anxiety subscale was 10.

Statistical Analysis
IBM SPSS Statistics 22.0 statistical program was used in the evaluation of the data obtained in our study. T test, one-way variance analysis (ANOVA) test was applied in statistical evaluations. The mean were given together with the standard deviation (mean±Sd), and p <0.05 was evaluated as statistical signiability.

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Table 1: Sociodemographic characteristics of patients.

Information about the hospitalization process of the patients is given in table 2.

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Table 2: Distribution of patients' information about the hospitalization process.

Myocardial infarction (63.5%) is the leading cause of hospitalization. The patients expressed satisfaction with the service they received from the hospital (97.4%). The patients have previously experienced hospitalization (85.7%).

In our study, 63.5% of participants (n =146) had myocardial infarction, 18.7% had cardiac medications, 13.0% had arrhythmias, 2.6% had hypertension, and 2.2% had pulmonary embolism.

The mean HAD-A score of the patients hospitalized in the coronary intensive care unit is 8.20±3.56 (min:2.0, max:17.0). While the mean HAD-A score of 67.4% (n =155) of the patients was 6.21±2.18, the mean score of 32.6% (n =75) was 12.30±2.02.

The mean HAD-D score of the patients hospitalized in the coronary intensive care unit is 9.32±4.26 (min:0.0, max:21.0). While the mean HAD-D score of 30.4% (n =70) of the patients was 4.38±2.17, the mean score of 69.6% (n =160) was 11.48±2.96.

The sociodemographic characteristics of the participants according to the anxiety and depression subscale score means are given in table 3.

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Table 3: HAD-A and HAD-D score means according to sociodemographic characteristics of patients.

According to the results; the mean anxiety score of female patients is 9.18±3.41 and the mean of male patients is 7.48±3.5. Depression score mean; 10.32±3.91 in female patients and 8.58±4.37 in male patients, Patients over the age of 60 received a score of 9.85±4.11 points for depression and 8.21±4.39 for patients aged 60 and under.

The mean scores of the divorced or widowed patients in the depression subdimension were higher than the married ones, and it was 10.60±4.68. The mean scores of primary school graduates and illiterate patients in the anxiety subdimension were higher than those of high school graduates, and it was 8.45±3.52. The anxiety and depression mean scores of those who stated that there was a situation that would cause stress in their life were high, 8.85±3.42 and 10.28±4.03, respectively.

Patients who perceived their health status as poor (p=0.002) and were admitted with a hypertension diagnosis (p =0.036) were found to have greater rates of anxiety (Table 4).

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Table 4: Comparison of HAD-A scale scores according to some characteristics of patients.

The prevalence of depression was higher in patients who thought their health was moderate and poor (p =0.004) (Table 5).

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Table 5: Comparison of HAD-D scale scores according to some characteristics of the patients.

In terms of gender-basedmean, it was determined that the mean points of female patients for in terms of anxiety and depression were higher than those of male patients with significant levels. Sarigul’s¹⁹ study found that anxiety and depression were higher in female patients. Similarly, anxiety and depression levels were shown to be significantly greater in female patients in a study of patients in a cardiology critical care unit⁵. Similar to our study, it was shown that women experienced higher levels of anxiety in studies done in the intensive care unit^21,6. The structural characteristics, family and social position, and cultural characteristics of female patients can cause women to become more prone to depression.

The rate of depression was found higher in patients aged over 60 in our study. In other studies, similar to our study, it was observed that the predisposition to depression increased as age increased ^22,23. Increased fear of death and feelings of loneliness in later life is thought to cause depression to become more common in older age.

When examined for marital status, the rate of depression was found higher in patients whose spouses had died or were divorced. The mean anxiety score of patients whose spouses died or divorced was higher but was not statistically significant. In a similar study, single patients were found to score higher than the depression subdimension¹⁹. Similarly, in the study of Buldan et al.²⁴ single patients were found to have higher anxiety and depression scores. It is thought to be easier for those who are married to cope emotionally with their illness thanks to the familial and social support they receive.

In our study, the mean scores of primary school graduates and undergraduate patients with anxiety and depression, were significantly higher. Similar to our work, other studies found that the mean of primary school graduates and undergrads or non-literate authors was higher in anxiety and depression points^5,19.

Anxiety, and depression, score means were higher in patients who stated that any stress condition existed. Psychological stressors are known to increase susceptibility to cardiovascular diseases and need to be more sensitive about psychological support if patients have any stress. In our study, the mean anxiety score of patients with poor perceptions of health conditions was higher.

Patients admitted to the hospital with a diagnosis of hypertension were found to have a higher mean anxiety score. In the study of Kutlu et al.⁵ it was observed that the mean anxiety score was higher in patients who had myocardial infarction. Patients who expressed poor perception of health conditions had higher mean scores of depression, and anxiety.

The limitations of this study should be taken into account when interpreting the findings. The study may need to be replicated with bigger samples due to the tiny sample size employed. Questionnaires and qualitative research techniques can be utilized to better understand how patients perceive and feel anxiety and depression.

Conflict of interest: The authors declare no conflict of interest.

Funding: No funding was obtained for this study.

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