Meditation and Secondary Prevention of Depression and Anxiety in Heart Disease: a Systematic Review
Heart disease is the leading cause of global mortality, accounting for 13.7 million deaths annually. Optimising depression and anxiety symptoms in adults with heart disease is an international priority. Heart disease secondary prevention is best achieved through implementation of sustainable pharmacological and non-pharmacological interventions, including meditation. Meditation is a means of generating self-awareness and has implications for enhanced self-management of depression and anxiety symptoms. This review aims to identify high-level quantitative evidence for meditation interventions designed to improve depression and/or anxiety symptoms among adults with heart disease and ascertain the most important elements of meditation interventions that facilitate positive depression and/or anxiety outcomes. This systematic review and narrative synthesis was completed in accordance with the PRISMA Statement and has adhered to the Cochrane Risk of Bias guideline. Six databases were searched between 1975 and 2017. Statistically significant outcomes were demonstrated in over half (5/9) of phase II meditation studies for depression and/or anxiety and involved 477 participants. Meditation interventions that generated positive outcomes for depression and/or anxiety included elements such as focused attention to body parts (or body scan) (3/4 studies) and/or group meetings (4/5 studies). Meditation is a means of reframing heart disease outpatient services towards an integrated model of care. Future adequately powered phase III studies are needed to confirm which meditation elements are associated with reductions in depression and anxiety; and the differential effects between concentrative and mindfulness-based meditation types among adults with heart disease.
KeywordsMeditation Psychological Transcendental Meditation Mindfulness Mind-body therapies
AR designed and executed the study, analysed the data, and wrote the paper. MD collaborated in the writing and editing of the final manuscript. PJN collaborated with the design and writing of the study. JLP collaborated in the writing and editing of the final manuscript. LH collaborated with the design, data analysis, and writing of the study.
Compliance with Ethical Standards
The manuscript does not contain clinical studies or patient data.
Conflicts of Interest
The authors declare that there are no conflicts of interest.
- Abbott, R. A., Whear, R., Rodgers, L. R., Bethel, A., Thompson Coon, J., Kuyken, W., et al. (2014). Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: a systematic review and meta-analysis of randomised controlled trials. Journal of Psychosomatic Research, 76(5), 341–351. https://doi.org/10.1016/j.jpsychores.2014.02.012.CrossRefPubMedGoogle Scholar
- Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., et al. (2017). Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation, 135(10), e146–e603. https://doi.org/10.1161/cir.0000000000000485.CrossRefPubMedPubMedCentralGoogle Scholar
- Brook, R. D., Appel, L. J., Rubenfire, M., Ogedegbe, G., Bisognano, J. D., Elliott, W. J., … Rajagopalan, S. (2013). Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. doi: https://doi.org/10.1161/HYP.0b013e318293645f.
- Bunevicius, A., Staniute, M., Brozaitiene, J., Pop, V. J., Neverauskas, J., & Bunevicius, R. (2013). Screening for anxiety disorders in patients with coronary artery disease. Health and Quality of Life Outcomes, 11(1), 37. https://doi.org/10.1186/1477-7525-11-37.CrossRefPubMedPubMedCentralGoogle Scholar
- Casey, A., Chang, B.-H., Huddleston, J., Virani, N., Benson, H., & Dusek, J. A. (2009). A model for integrating a mind/body approach to cardiac rehabilitation: outcomes and correlators. Journal of Cardiopulmonary Rehabilitation and Prevention, 29(4), 230–238. https://doi.org/10.1097/HCR.0b013e3181a33352.CrossRefPubMedGoogle Scholar
- Delaney, C., Barrere, C., & Helming, M. (2011). The influence of a spirituality-based intervention on quality of life, depression, and anxiety in community-dwelling adults with cardiovascular disease: a pilot study. Journal of Holistic Nursing, 29(1), 21–32. https://doi.org/10.1177/0898010110378356.CrossRefPubMedGoogle Scholar
- Delui, M. H., Yari, M., Khouyinezhad, G., Amini, M., & Bayazi, M. H. (2013). Comparison of cardiac rehabilitation programs combined with relaxation and meditation techniques on reduction of depression and anxiety of cardiovascular patients. Open Cardiovascular Medicine Journal, 7(1), 99–103.CrossRefGoogle Scholar
- Gordon, N. (2007). Alternative approaches to cardiac rehabilitation: investigating thoughts and emotions. (3311285 Ph.D.), Walden University, Ann Arbor. Retrieved from http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:3311285 ProQuest Dissertations & Theses Global database.
- Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M. G. M. (2015). Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of Rcts. PLoS One, 10(4), 1–17. https://doi.org/10.1371/journal.pone.0124344.CrossRefGoogle Scholar
- Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. Journal of the American Medical Association Internal Medicine, 174(3), 357–368. https://doi.org/10.1016/j.dza.2014.07.007.CrossRefPubMedGoogle Scholar
- Hickman, L. D., Phillips, J. L., Newton, P. J., Halcomb, E. J., Al Abed, N., & Davidson, P. M. (2015). Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: a systematic review. Archives Gerontology and Geriatrics, 61(3), 322–329. https://doi.org/10.1016/j.archger.2015.06.021.CrossRefGoogle Scholar
- Hui, P. N., Wan, M., Chan, W. K., & Yung, P. M. B. (2006). An evaluation of two behavioral rehabilitation programs, qigong versus progressive relaxation, in improving the quality of life in cardiac patients. Journal of Alternative & Complementary Medicine, 12(4), 373–378. https://doi.org/10.1089/acm.2006.12.373.CrossRefGoogle Scholar
- Julian, L. J. (2011). Measures of anxiety. Arthritis Care & Research, 63(0 11), https://doi.org/10.1002/acr.20561.
- Krisanaprakornkit, T., Krisanaprakornkit, W., Piyavhatkul, N., & Laopaiboon, M. (2006). Meditation therapy for anxiety disorders. Cochrane Database of Systematic Reviews, (1), Cd004998. doi: https://doi.org/10.1002/14651858.CD004998.pub2.
- Lavie, C. J., & Milani, R. V. (2006). Adverse psychological and coronary risk profiles in young patients with coronary artery disease and benefits of formal cardiac rehabilitation. Archives of Internal Medicine, 166(17), 1878–1883. https://doi.org/10.1001/archinte.166.17.1878.CrossRefPubMedGoogle Scholar
- Levine, G. N., Lange, R. A., Bairey-Merz, C. N., Davidson, R. J., Jamerson, K., Mehta, P. K., et al. (2017). Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. Journal of the American Heart Association, 6(10). https://doi.org/10.1161/jaha.117.002218.
- Mandel, S. E. (2007). Effects of music-assisted relaxation and imagery (Mari) on health-related outcomes in cardiac rehabilitation: follow-up study. (Ph.D.), Union Institute and University, Ohio, US.Google Scholar
- Mehta, L. S., Beckie, T. M., DeVon, H. A., Grines, C. L., Krumholz, H. M., Johnson, M. N., et al. (2016). Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation, 133(9), 916–947. https://doi.org/10.1161/cir.0000000000000351.CrossRefPubMedGoogle Scholar
- Nyklíček, I., Dijksman, S., Lenders, P., Fonteijn, W., & Koolen, J. (2014). A brief mindfulness based intervention for increase in emotional well-being and quality of life in percutaneous coronary intervention (Pci) patients: the MindfulHeart randomized controlled trial. Journal of Behavioral Medicine, 37(1), 135–144. https://doi.org/10.1007/s10865-012-9475-4.CrossRefPubMedGoogle Scholar
- Paul-Labrador, M., Polk, D., Dwyer, J. H., Velasquez, I., Nidich, S., Rainforth, M., et al. (2006). Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Archives of Internal Medicine, 166(11), 1218–1224. https://doi.org/10.1001/archinte.166.11.1218.CrossRefPubMedGoogle Scholar
- Rutledge, J. C., Hyson, D. A., Garduno, D., Cort, D. A., Paumer, L., & Kappagoda, C. T. (1999). Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. Journal of Cardiopulmonary Rehabilitation, 19(4), 226–234.CrossRefGoogle Scholar
- Salmoirago-Blotcher, E., Crawford, S. L., Carmody, J., Rosenthal, L., Yeh, G., Stanley, M., et al. (2013). Phone-delivered mindfulness training for patients with implantable cardioverter defibrillators: results of a pilot randomized controlled trial. Annals of Behavioral Medicine: a publication of the Society of Behavioral Medicine, 46(2), 243–250. https://doi.org/10.1007/s12160-013-9505-7.CrossRefGoogle Scholar
- Schlitz, M., Amorok, T., & Micozzi, M. (2005). Consciousness and healing: integral approaches to mind-body medicine. St. Louis: Elseveir Churchill.Google Scholar
- Simony, C. P., Pedersen, B. D., Dreyer, P., & Birkelund, R. (2015). Dealing with existential anxiety in exercise-based cardiac rehabilitation: a phenomenological-hermeneutic study of patients’ lived experiences. Journal of Clinical Nursing, 24(17–18), 2581–2590. https://doi.org/10.1111/jocn.12867.CrossRefPubMedGoogle Scholar
- Szekely, A., Balog, P., Benko, E., Breuer, T., Szekely, J., Kertai, M. D., et al. (2007). Anxiety predicts mortality and morbidity after coronary artery and valve surgery—a 4-year follow-up study. Psychosomatic Medicine, 69(7), 625–631. https://doi.org/10.1097/PSY.0b013e31814b8c0f.CrossRefPubMedGoogle Scholar
- Taylor, R. S., Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J. S., Dalal, H., et al. (2014). Exercise-based rehabilitation for heart failure. Cochrane Database of Systematic Reviews, 1(4), i-123.Google Scholar
- Tully, P. J., & Baker, R. A. (2012). Depression, Anxiety and Cardiac Morbidity Outcomes after Coronary Artery Bypass Surgery: A Contemporary and Practical Review. Journal of Geriatric Cardiology, 9(2), 197–208.Google Scholar
- Udell, J. A., Koh, M., Qiu, F., Austin, P. C., Wijeysundera, H. C., Bagai, A., et al. (2017). Outcomes of women and men with acute coronary syndrome treated with and without percutaneous coronary revascularization. Journal of the American Heart Association, 6(1). https://doi.org/10.1161/jaha.116.004319.
- World Health Organisation. (2014a). Non communicable diseases (NCD) country profiles 2014. Retrieved from Geneva: http://www.who.int/nmh/countries/aus_en.pdf
- World Health Organisation. (2014b). Global status report on noncommunicable diseases. Retrieved from Geneva: http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf?ua=1