Thought Paper for Frasure-Smith (2008)
Frasure-Smith et al. studied patients with stable CAD for characteristics of GAD and MDD to determine some possible courses of action for more effective intervention and treatment. Although their study is innovative in that it includes patients with both GAD and MDD, there are some flaws in their methods that raise questions about the legitimacy of their findings. For example, it seems that there are significant flaws in determining GAD and MDD using self-reports as well as DSM-IV diagnoses. Self-reports are inherently biased and largely subjective while the DSM-IV is widely acknowledged to have flaws due to its rigid adherence to pre-determined criteria that does not always appropriately account for situational factors that may have influenced diagnosis.
Additionally, this study looks at GAD and MDD 2 months after patients experienced adverse coronary incidents that initially caused them to be hospitalized. This fails to take into account patients who died prior to that 2 month period as well as patients who were not hospitalized and the article even goes as far as to admit that this is a major flaw. Furthermore, emotional states are subject to change over time so being categorized as having GAD and/or MDD after the incident took place does not necessarily indicate that there is a direct connection between CAD and GAD and/or MDD.
Some further studies that could promote more understanding of this issue with an eye towards prevention and/or more effective treatment would be studies of causes of stress, depression, and anxiety as well as genetic factors that may contribute to the inhibited functioning of the serotonin system. A comprehensive study of how patients came to be in a situation that would cause them to experience GAD and MDD would be more helpful for prevention now that there has been an established relationship between GAD, MDD, and CAD.