Implantable Cardioverter Defibrillator Shocks and Psychological Distress

Kyoung Suk Lee, Jun Hyung Kim, Ki Woon Kang, Jennifer Miller, Samantha M. McEvedy, Seon Young Hwang, Debra K. Moser

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Although the implantable cardioverter defibrillator (ICD) has a survival benefit for the prevention of sudden cardiac death, ICD recipients commonly experience emotional distress as a consequence of ICD shocks. Objective: The aim of this study was to examine whether the association between ICD shocks and psychological distress (anxiety and depressive symptoms) is mediated by ICD-related concerns and perceived control among ICD recipients. Methods: This was a multinational cross-sectional observational study of 334 ICD recipients. Patients reported the number of shocks received since ICD implantation and completed questionnaires to assess anxiety, depressive symptoms, ICD-related concerns, and perceived control. A path analysis was conducted to explore the relationship of receiving ICD shocks with anxiety and depressive symptoms and the mediating effects of ICD-related concerns and perceived control. Results: Of the 334 ICD recipients, 39.2% experienced ICD shocks at least once since implantation. There was no direct effect of ICD shocks on anxiety and depressive symptoms. Experiencing ICD shocks was indirectly associated with an increased likelihood of anxiety and depressive symptoms via the pathways of ICD-related concerns and perceived control (indirect effects on anxiety = 0.060, 0.043; indirect effect on depressive symptoms = 0.025, 0.073). Conclusion: Experiencing defibrillator shocks was associated with psychological distress in ICD recipients; the relationship was fully mediated by ICD-related concerns and perceived control. These results suggest that clinicians should routinely assess ICD-related concerns and perceived control in patients with ICD. Research is needed to develop and test interventions to decrease emotional distress related to the ICD shock experience.

Original languageEnglish
Pages (from-to)66-73
Number of pages8
JournalJournal of Cardiovascular Nursing
Issue number1
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
Professor, Hanyang University, College of Nursing, Seoul, South Korea. Debra K. Moser, PhD, RN Professor and Gill Endowed Chair of Nursing, Codirector of RICH Heart Program, University of Kentucky, College of Nursing, Lexington. Source of funding: the National Research Foundation of Korea grant funded by the Korea government (MEST) (2016R1A2B4008495) and a research grant funded by the Chungnam National University (2015-1794-01). The authors have no conflicts of interest to disclose. Correspondence Kyoung Suk Lee, PhD, RN, MPH, Seoul National University, College of Nursing, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea ( DOI: 10.1097/JCN.0000000000000610

Publisher Copyright:
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.


  • anxiety
  • depressive symptoms
  • implantable cardioverter defibrillator
  • perceived control

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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