Improvement of anxious but not depressive symptoms is associated with functional outcomes of psychocardiological rehabilitation

Cardiovascular and mental health conditions are closely linked, and integrative treatments increasingly target both. However, it remains unclear which psychological improvements most strongly influence functional outcomes, such as work ability and quality of life. We hypothesized that reductions in depressive symptoms, general anxiety, and heart-related anxiety would be associated with better work ability, fewer work-related impairments, and improved quality of life. We assessed 243 patients undergoing psychocardiological rehabilitation at admission and discharge. Depressive and anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), heart-related anxiety by Cardiac Anxiety Questionnaire (CAQ), work-related impairments by sociomedical evaluation and the Mini-ICF-APP Social Functioning Scale (MINI-ICF-APP-S), and quality of life with the Short Form-12 health survey (SF-12). Regression analyses revealed that reductions in general anxiety (HADS-A) and heart-related anxiety (CAQ) were linked to fewer work-related impairments (p = 0.03) and higher mental quality of life (p ≤ 0.001 and p ≤ 0.01, respectively). Reduced heart-related anxiety was also associated with higher physical quality of life (p ≤ 0.001). In contrast, higher baseline depressive symptoms (HADS-D) increased the odds of limited work ability (OR = 1.78, p = 0.01), while improvements in depression were not associated with functional outcomes. These results suggest that depressive and anxiety symptoms are similarly responsive to psychocardiological rehabilitation, but only the latter are associated with improved functional outcomes.