Davidson Depression Heart

1: Gend Med. 2007 Jun;4(2):146-56.
High frequency of anxiety and angina pectoris in depressed women with coronary
heart disease.
Sundel KL, Stain-Mahngren R, Andersson A, Berg-Wistedt A, Schenck-Gustafsson K.
Department of Psychiatry, St. Gorans Hospital, Institution for Clinical
Neuroscience, The Karolinska Institutet, Stockholm, Sweden.
Background: Depression is an unfavorable state that is difficult to recognize in
patients with coronary heart disease (CHD). Little is known about the
characteristics of depressed female CHD patients. Objective: The purpose of this
study was to investigate the occurrence of depressive symptoms in women entering
a cardiac rehabilitation program, and furthermore, to examine whether women who
have CHD and depressive symptoms display any unfavorable physical or
psychological characteristics that could be helpful in identifying female CHD
patients at increased risk of depression. Methods: In a Swedish cross-sectional
survey of Swedish women entering a randomized, female cardiac rehabilitation
trial, patients with a Beck Depression Inventory (BDI) score indicating
depression were compared with patients without depressive symptoms. Results: Of
the 121 women with CHD who participated in the study, 23.1% had BDI scores
consistent with moderate to severe depression (BDI >/=19). Scores of >/=19 were
strongly correlated to established angina pectoris (P = 0.007) and higher rates
of anxiety on the Beck Anxiety Inventory (P < 0.001). Depressed women also were
more likely to have a family history of heart disease (P = 0.036) and were less
likely to care for their health in the future (P = 0.005). Conclusions: This
study suggests a strong relationship between depression and angina pectoris in
women with CHD. The study also confirms previous findings that depressive
symptoms are common in women with CHD. Findings of more pronounced cardiac
symptoms in depressed women with CHD suggest that depressive symptoms may
present differently or alter cardiac symptoms in female CHD patients.
Consequently, the occurrence of increased cardiac symptoms indicates the need to
screen for depression, whether depressive symptoms are apparent or not. The
higher scores for anxiety in depressed women with CHD and their poorer health
care practices, in combination with their more pessimistic beliefs about
lifestyle changes, highlight the need to identify depression to enhance
adherence to treatment regimens in the cardiac rehabilitation process.
PMID: 17707848 [PubMed - in process]
2: Eur J Cardiovasc Nurs. 2007 Aug 9; [Epub ahead of print]
Determinants of depressive symptoms in hospitalised men and women with heart
failure.
Lesman-Leegte I, Jaarsma T, Sanderman R, Hillege HL, van Veldhuisen DJ.
Department of Cardiology, University Medical Center Groningen, University of
Groningen, The Netherlands.
BACKGROUND: Depressive symptoms are prominent and related to an increased risk
on cardiovascular disease outcomes and all cause mortality in HF patients. AIM:
To intervene effectively, factors related to depressive symptoms in men and
women should be identified. METHODS: Depressive symptoms of 921 hospitalised HF
patients (61% male; age 71+/-11; LVEF 33%+/-14, NYHA II-IV) were assessed by the
Center for Epidemiological Studies-Depression scale (CES-D). RESULTS: Overall
40% of the patients had depressive symptoms (CES-D >/=16), which were more
common in women than in men (47% versus 36%, p<0.001). Multivariable analysis in
men revealed that depressive symptoms were related to age (OR 0.84, 95% CI
0.71-0.98, p=0.03, per 10 years), physical health (OR 0.76, 95% CI 0.71-0.83,
p<0.001, per 10 units) and HF symptoms. In women depressive symptoms were also
related to NYHA II-III versus IV (OR 0.60, 95% CI 0.37-0.95, p<0.03) and COPD
(OR 2.33, 95% CI 1.20-4.53, p<0.012). CONCLUSION: Depressive symptoms are more
common in women than in men. In both men and women depressive symptoms are
related to age and physical health. For clinical factors: In men only HF
symptoms, but in women also NYHA and COPD were related to depressive symptoms.
PMID: 17693135 [PubMed - as supplied by publisher]
3: Thromb Res. 2007 Jul 31; [Epub ahead of print]
The platelet of the patients with ischemic cardiopathy and cardiac valve disease
showed a reduction of 8OH-DPAT binding sites.
Bellido I, Delange L, Gomez-Luque A.
Department of Pharmacology and Clinical Therapeutics, School of Medicine, Campus
de Teatinos, Boulevard Louis Pasteur, 32, 29071, University of Malaga, Spain.
Depression is prospectively associated with increased risk of coronary artery
disease in individuals initially free of clinical cardiovascular disease
probably by an increased platelet activity. The serotonergic receptors mainly
implied in depression are 5-HT(1A) and 5-HT(2) receptors. Activation of 5HT(2)
receptor induces platelet aggregation. Drugs with 5-HT(1A) receptor agonist and
5-HT(2A) receptor antagonist effects reduced the receptor-mediated platelet
aggregation. There are only indirect data about 5-HT(1A) receptors presence in
platelet membranes, thus our aims were to study the characteristics of the
platelet membranes 5-HT(1A) binding sites of both healthy volunteers and
patients with cardiac valve disease and ischemic cardiopathy. The bound of the
5-HT(1A) selective agonist (3)H-8OH-DPAT to the platelet membranes 5-HT(1A)
binding sites of patients with cardiac valve disease and ischemic cardiopathy
were compared with a control group of healthy voluntaries using radioligand
binding methods. The patients with cardiovascular disease showed a reduction (-
50.40%) (p<0.01) of the (3)H-8OH-DPAT bound to the platelet membranes 5-HT(1A)
receptors (1.652+/-0.79 fmol/mg protein) with respect to the control group
(3.331+/-0.16 fmol/mg protein). (3)H-8OH-DPAT binding to human platelet
membranes is saturable, of high affinity, and seems selective for 5-HT(1A)
receptors, and similar to that described in animal brain and in other human
cells. Patients with ischemic cardiopathy and cardiac valve disease showed a
reduction of the 8OH-DPAT bound to the platelet membranes. Taken together, these
findings suggest that the 8OH-DPAT bound to the human platelet membranes is
modulated by modifications produced by cardiovascular disease conditions.
4: Int J Nurs Stud. 2007 Jul 26; [Epub ahead of print]
Quality of life and behavioral compliance in cardiac rehabilitation patients: a
longitudinal survey.
Komorovsky R, Desideri A, Rozbowsky P, Sabbadin D, Celegon L, Gregori D.
Cardiovascular Research Foundation, S. Giacomo Hospital, Castelfranco Veneto,
Italy.
BACKGROUND: Few data regarding inter-relations between health-related quality of
life (HRQoL) and compliance are available. The aim of present study was to
assess which aspects of HRQoL might predict patients' behavioral compliance to
medical suggestions and whether questionnaires might be useful for patients
undergoing cardiac rehabilitation. METHODS: HRQoL and compliance were measured
in 52 consecutive patients undergoing cardiovascular rehabilitation. The
measurements were performed at the beginning, at the end of rehabilitation, and
after 6 months follow-up. Baseline, demographic and HRQoL characteristics were
linked to compliance by multiple regression modelling. RESULTS: Over time no
significant differences between HRQoL and compliance scores were observed. Age
(odds ratio (OR) 1.37, 95% confidence interval (CI) 1.08-2.45), number of taken
drugs (OR=1.45; 95% CI: 1.02-2.11), anxiety score (OR=0.32; 95% CI: 0.15-1.02),
depression score (OR=0.48; 95% CI: 0.06-0.78), and social health score (OR=1.09;
95% CI: 1.01-1.24), appeared to be independent predictors of compliance.
CONCLUSION: Older age, higher number of drugs, high social health score, and low
anxiety and depression scores predict better behavioral compliance in cardiac
rehabilitation patients.
5: Eur J Cardiovasc Prev Rehabil. 2007 Aug;14(4):547-554.
Symptoms of anxiety and depression in patients with stable coronary heart
disease: prognostic value and consideration of pathogenetic links.
Rothenbacher D, Hahmann H, Wusten B, Koenig W, Brenner H.
aDivision of Clinical Epidemiology and Aging Research, The German Cancer
Research Center, Heidelberg bKlinik Schwabenland, Isny-Neutrauchburg cKlinik am
Sudpark, Bad Nauheim dDepartment of Internal Medicine II-Cardiology, University
of Ulm Medical Center, Ulm, Germany.
BACKGROUND: We evaluated the association of symptoms of anxiety and depression
with fatal and non-fatal cardiovascular disease events among patients with
coronary heart disease and considered several potential underlying pathogenetic
links. DESIGN: This was a prospective cohort study. METHODS: In this study,
including coronary heart disease patients undergoing an in-patient
rehabilitation program, symptoms of anxiety and depression were evaluated with
the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal
cardiovascular disease events were determined during a 3-year follow-up.
RESULTS: Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a
manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and
manifest depressive symptoms score, respectively. During the 3-year follow-up
fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%)
patients. After adjustment for covariates, patients having manifest anxiety
symptoms had a statistically significant hazard ratio (HR) of 2.32 [95%
confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and
patients with depressive symptoms had an HR of 1.47 (95% CI 0.62-3.51) compared
to other patients. In a model considering anxiety and depressive symptom scores
simultaneously, the hazard ratio for a cardiovascular disease event associated
with anxiety symptoms increased to 3.31 (95% CI 1.32-8.27), whereas the hazard
ratio associated with depressive symptoms decreased (HR 0.62; 95% CI 0.20-1.87).
We found a positive association of increased anxiety scores with body mass index
and systolic blood pressure. CONCLUSIONS: The study suggests an important role
especially for symptoms of anxiety for long-term prognosis of patients with
known coronary heart disease. It furthermore suggests that several pathogenetic
links may partly explain the increased risk.
6: Int J Cardiol. 2007 Jul 25; [Epub ahead of print]
High impact of depression in heart failure: Early diagnosis and treatment
options.
Norra C, Skobel EC, Arndt M, Schauerte P.
Department of Psychiatry and Psychotherapy, University Hospital, Aachen,
Germany; Max-Planck-Institute of Experimental Medicine, Division of Clinical
Neuroscience, Gottingen, Germany.
Depressive syndromes in chronic heart failure (CHF) are common and are
associated with a poorer prognosis, particularly with increased morbidity and
mortality. CHF as a severe physical disorder may increase the risk of developing
depressive syndromes or vice-versa as an interaction of possible common
psycho-organic etiological aspects. Depression in CHF is associated with
impaired NYHA status and daily activities, resulting in enhanced hospitalisation
rates and medical costs with a great impact on long-term health. Only a fraction
of comorbid patients receives antidepressants. Therefore, identification of risk
factors and prevention by optimizing cardiological and psychiatric therapeutic
strategies appear essential for these patients. Early diagnosis and treatment of
both CHF and depression may prevent further pathophysiological effects on the
heart and brain. This review gives a comprehensive overview of the occurrence,
risk factors and shared pathophysiology of depression in CHF, and focuses on
improving insufficient diagnosis and therapy of depression. Special attention is
given on the cardiac effects of psychopharmacological and alternate
non-pharmacological antidepressant therapy in CHF. Recommendations are made for
treating depression in CHF patients for a better prevention of this disabling
physical and psychosocial condition.
7: J Am Geriatr Soc. 2007 Aug;55(8):1303.
Angiotensin-converting enzyme inhibitors in concomitant heart failure and
depression.
Parashar A, Varma A.
Department of Internal Medicine, Carilion Cliic, Roanoke, Virginia, USA.
8: Expert Opin Pharmacother. 2007 Jul;8(10):1529-37.
Sertraline for the treatment of depression in coronary artery disease and heart
failure.
Parissis J, Fountoulaki K, Paraskevaidis I, Kremastinos DT.
University of Athens, 17 Aftokratoros, Irakliou St 15122 Maroussi, Athens,
Greece. jparissis@yahoo.com
Depression is a common co-morbid condition in patients with cardiac disease and
has been identified as an independent risk factor for increased morbidity and
mortality. SSRIs are established agents for the treatment of depression and are
well tolerated in patients with cardiac disease. SSRIs are a heterogeneous group
of antidepressants, which apart from their common mechanism of action, differ
substantially in their chemical structure, metabolism and pharmacokinetics. This
article reviews experimental and clinical evidence on the safety and efficacy of
the most extensively studied SSRI, sertraline, in depressed patients with
coronary artery disease and heart failure. Intervention with sertraline has the
potential to provide depressed patients with cardiac disease relief from their
depressive symptoms, improvement in quality of life and a potential benefit in
their cardiovascular risk profile.
9: Eur J Heart Fail. 2007 Jul 27; [Epub ahead of print]
Depression and survival in chronic heart failure: Does gender play a role?
Faller H, Stork S, Schowalter M, Steinbuchel T, Wollner V, Ertl G, Angermann CE.
University of Wurzburg, Institute of Psychotherapy und Medical Psychology,
Wurzburg, Germany.
BACKGROUND: Data regarding the influence of depression on outcome in chronic
heart failure are conflicting and neglect possible gender differences. AIMS: To
investigate prevalence and prognostic importance of depression in a cohort of
patients with symptomatic heart failure and to compare findings in males and
females. METHODS: Depression was measured at study entry using a self-reported
9-item Patient Health Questionnaire (PHQ-9) in 231 consecutive outpatients. The
median follow-up time was 986 (IQR=664-1120) days. RESULTS: The prevalence of
suspected major depression was 13% (minor depression, 17%) and was not different
between the sexes. Major (but not minor) depression was associated with an
increased mortality risk (hazard ratio [HR]=3.3, 95% confidence
interval=1.8-6.1, p<0.001). This relationship remained significant after
adjustment for other prognostically relevant factors as age, sex, heart failure
aetiology, degree and type of left ventricular dysfunction, and New York Heart
Association functional class. However, testing the effect of the interaction
between gender and depression failed to reach significance (p=0.37). CONCLUSION:
Our data confirm a high prevalence of depression in chronic heart failure.
Further, they prove an independent prognostic impact of major, but not minor,
depression. Possible gender differences regarding the prognostic impact of
depression require further investigation in a larger patient cohort.
10: Biol Psychiatry. 2007 Jul 19; [Epub ahead of print]
Social Isolation Disrupts Autonomic Regulation of the Heart and Influences
Negative Affective Behaviors.
Grippo AJ, Lamb DG, Carter CS, Porges SW.
Department of Psychiatry and Brain-Body Center, University of Illinois at
Chicago, Chicago, Illinois.
BACKGROUND: There is a documented association between affective disorders (e.g.,
depression and anxiety) and cardiovascular disease in humans. Chronic social
stressors may play a mechanistic role in the development of behavioral and
cardiac dysregulation. The current study investigated behavioral, cardiac, and
autonomic responses to a chronic social stressor in prairie voles, a rodent
species that displays social behaviors similar to humans. METHODS: Female
prairie voles were exposed to 4 weeks of social isolation (n = 8) or pairing
(control conditions; n = 7). Electrocardiographic parameters were recorded
continuously during isolation, and behavioral tests were conducted during and
following this period. RESULTS: Isolation induced a significant increase in
resting heart rate, reduction in heart rate variability (standard deviation of
normal-to-normal intervals and amplitude of respiratory sinus arrhythmia), and
exaggerated cardiac responses during an acute resident-intruder paradigm.
Isolation led also to both depression-like and anxiety-like behaviors in
validated operational tests. These changes in response to social isolation
showed predictable interrelations and were mediated by a disruption of autonomic
balance including both sympathetic and parasympathetic (vagal) mechanisms.
CONCLUSIONS: These findings indicate that social isolation induces behavioral,
cardiac, and autonomic alterations related to those seen after other stressors
and which are relevant to cardiovascular disease and affective disorders. This
model may provide insight into the mechanisms that underlie these co-occurring
conditions.
11: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001312.
WITHDRAWN: Antidepressants for depression in medical illness.
Gill D, Hatcher S.
BACKGROUND: Depression in the physically unwell is common and an important cause
of morbidity. There are problems with diagnosing depression in the physically
ill which may lead to under-recognition and under-treatment. In clinical
practice antidepressants are available and a feasible option for treating
depressive disorders. Therefore we thought it would be a reasonable first step
in addressing this problem to describe the literature of randomised controlled
trials in this area. OBJECTIVES: To determine whether antidepressants are
clinically effective and acceptable for the treatment of depression in people
who also have a physical illness. SEARCH STRATEGY: MEDLINE, Cochrane Library
Trials Register and Cochrane Depression and Neurosis Group Trials Register were
all systematically searched, supplemented by hand searches of two journals and
reference searching. SELECTION CRITERIA: All relevant randomised trials
comparing any antidepressant drug (as defined in the British National Formulary)
with placebo or no treatment, in patients of either sex over 16, who have been
diagnosed as depressed by any criterion, and have a specified physical disorder
(for example cancer, myocardial infarction). "Functional" disorders where there
is no generally agreed physical pathology (e.g. irritable bowel syndrome) were
excluded. The main outcome measures are numbers of individuals who
recover/improve at the end of the trial and, as a proxy for treatment
acceptability, numbers who complete treatment. DATA COLLECTION AND ANALYSIS:
Data was extracted independently by the reviewers onto data collection forms and
differences settled by discussion. MAIN RESULTS: 18 studies were included,
covering 838 patients with a range of physical diseases (cancer 2, diabetes 1,
head injury 1, heart 1, HIV 5, lung 1, multiple sclerosis 1, renal 1, stroke 3,
mixed 2). Depression was diagnosed clinically in 3 studies, otherwise by
structured interview or checklist.Only 5 studies described how they performed
randomisation. 1 study compared drug with no treatment, and the rest with
placebo: all of the latter said they were double blind.6 studies used SSRIs, 3
atypical antidepressants, and the remainder tricyclics.Patients treated with
antidepressants were significantly more likely to improve than those given
placebo (13 studies, OR 0.37, 95% CI 0.27-0.51) or no treatment (1 study, OR
3.45, 95% CI 11.1-1.10). About 4 patients would need to be treated with
antidepressants to produce one recovery from depression which would not have
occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4).Most
antidepressants (tricyclics and SSRIs together, 15 trials ) produced a small but
significant increase in dropout (OR 1.66, 95% CI 1.14-2.40. NNH 9.8, 95% CI
5.4-42.9). The "atypical" antidepressant mianserin produced significantly less
dropout than placebo.Only 2 studies used numerical scales designed to measure
effects on function and quality of life; in HIV (Karnofsky scale), drug was
better than no treatment; in lung disease (Sickness Impact Profile), drug was
not significantly different from placebo.Only 7 studies reported looking for
changes in the physical disease. Antidepressants produced no change in immune
function in HIV relative to placebo (2 studies) or no treatment (1 study).
Relative to placebo, antidepressants produced no change in cardiovascular
function in heart disease, in respiratory function in lung disease, or in vital
signs or laboratory tests in cancer (1 study each). Nortriptyline produced worse
control in diabetes.Trends towards tricyclics being more effective than SSRIs,
but also more likely to produce dropout were noted, but these are based on
non-randomised comparisons between trials. AUTHORS' CONCLUSIONS: The review
provides evidence that antidepressants, significantly more frequently than
either placebo or no treatment, cause improvement in depression in patients with
a wide range of physical diseases.About 4 patients would need to be treated with
antidepressants to produce one recovery from depression which would not have
occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4).Antidepressants
seem reasonably acceptable to patients, in that about 10 patients would need to
be treated with antidepressants to produce one dropout from treatment which
would not have occurred had they been given placebo (NNH 9.8, 95% CI
5.4-42.9).The evidence is consistent across the trials, apart from 2 trials in
cancer, where the "atypical" antidepressant mianserin produced significantly
less dropout than placebo.Trends towards tricyclics being more effective than
SSRIs, but also more likely to produce dropout were noted, but these are based
on non-randomised comparisons between trials.Problems with the evidence include
most of the trials' use of observers, rather than patients, to decide on
improvement, and concentration mainly on symptoms rather than function and
quality of life. There is also a possibility of undetected negative
trials.Nevertheless, the review provides evidence that use of antidepressants
should at least be considered in those with both physical illness and
depression. Regarding diagnosis, the existence of a cheap and readily available
treatment for depression should encourage detailed assessment of persistent low
mood in the physically ill.
12: Psychosom Med. 2007 Jul;69(6):521-8. Epub 2007 Jul 16.
Coronary artery disease and depression: patients with more depressive symptoms
have lower cardiovascular reactivity during laboratory-induced mental stress.
York KM, Hassan M, Li Q, Li H, Fillingim RB, Sheps DS.
Cardiovascular Research, Department of Medicine, University of Florida,
Gainesville, FL, USA. kaki.york@medicine.ufl.edu
OBJECTIVE: To investigate the relationship between symptoms of depression and
cardiovascular reactivity during mental stress in patients with coronary artery
disease (CAD). Depressive symptoms are common in patients with CAD and are
related to an increased risk of cardiac events and death. Some researchers have
proposed that negative outcomes in depressed patients with CAD may be related to
exaggerated cardiovascular reactivity and psychological stress. However, the
data are unclear. METHODS: Patients with CAD (n = 128; mean age = 64 years) were
recruited for this study. Participants underwent psychological stress testing
and 2-day (stress/rest) radionuclide imaging. The Beck Depression Inventory
(BDI) results were collected at baseline. Cardiac function data were also
gathered and stress data were compared with baseline findings. RESULTS: The
change in systolic blood pressure (SBP) from rest to stress was 47 +/- 18 (mean
+/- standard deviation) mm Hg, diastolic blood pressure (DBP) = 30 +/- 11 mm Hg,
double product difference (DP) = 5887 +/- 3095, and heart rate (HR) = 20 +/- 13
beats/minute (p < .001 for all). The BDI score was 8.7 +/- 5.6. The BDI score
was negatively correlated with all hemodynamic variables, although only
significant with stress SBP and DP, and HR and DP changes. BDI scores also
predicted changes in HR and DP. HR remained significant in regression analyses
controlling for other sample characteristics. CONCLUSIONS: This study showed a
negative relationship between depressive symptoms and cardiovascular reactivity
to mental stress. In contrast to the mechanism proposed by earlier researchers,
this study suggests that decreased cardiovascular reactivity occurs with
increased depressive symptomology. The mechanism by which this effect occurs and
its clinical significance are still unknown.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
13: Transplantation. 2007 Jul 15;84(1):97-103.
Depressive symptoms and all-cause mortality after heart transplantation.
Havik OE, Sivertsen B, Relbo A, Hellesvik M, Grov I, Geiran O, Andreassen AK,
Simonsen S, Gullestad L.
Department of Clinical Psychology, University of Bergen, Bergen, Norway.
odd.havik@psykp.uib.no
BACKGROUND: Several studies indicate that heart transplantation (HTx) is
associated with depression and reduced quality of life. However, the impact of
depression on the prognosis for HTx-patients has not yet been sufficiently
established. The aim of the present study was to prospectively investigate the
influence of depression on mortality in patients with HTx, adjusting for other
known risk factors. METHODS: In a prospective, cross-sectional study with
minimum 5-year follow-up, symptoms of depression were assessed in 147
HTx-patients using the Beck Depression Inventory (BDI). RESULTS: Mild to severe
depressive symptoms (BDI > or =10) were observed in 36 patients (24.5%).
Depressive symptoms on inclusion increased the risk of mortality during the
follow-up period. The risk remained significant after adjusting for several
somatic and lifestyle risk factors, and the adjusted relative risk associated
with depression (risk ratio: 2.32; 95% CI: 1.13-4.79; P=0.02) was comparable to
the adjusted relative risk associated with time since HTx. CONCLUSIONS: Symptoms
of depression predict mortality independently of somatic and lifestyle risk
factors in HTx patients, and this group of patients should be screened for
depressive symptoms.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 17627244 [PubMed - indexed for MEDLINE]
14: Psychol Health Med. 2007 Jul;12(4):460-9.
The role of coping, anxiety, and stress in depression post-acute coronary
syndrome.
Benedetto MD, Lindner H, Hare DL, Kent S.
School of Behavioural and Social Sciences and Humanities, University of
Ballarat. Mt Helen. Australia.
Depressive symptoms are common and can affect prognosis following acute coronary
syndromes (ACS). This study examined the psychological factors, coping, anxiety,
and perceived stress associated with depression following ACS. Psychological
variables were assessed in 15 females and 66 males (M = 57 years, SD = 12).
Repeated measures at 2, 12, and 24 weeks post-ACS compared depression, anxiety,
perceived stress, and coping resources as determined by the Cardiac Depression
Scale, Beck Depression Inventory-II, State Trait Anxiety Inventory, Perceived
Stress Scale, and Coping Resources Inventory. Depression, anxiety, and perceived
stress remained high in the depressed group across time. Coping scores at 2
weeks post-ACS predicted depression scores at 24 weeks post-ACS. It appears that
trait anxiety and coping resources are related to depressive symptoms post-ACS.
15: Clin Psychol Rev. 2007 May 25; [Epub ahead of print]
Depression and coronary heart disease: A review of the epidemiological evidence,
explanatory mechanisms and management approaches.
Goldston K, Baillie AJ.
National Heart Foundation of Australia (NSW Division), Australia; Psychology
Department, Macquarie University, Sydney Australia.
There is compelling evidence that depression is an independent risk factor for
both the development of Coronary Heart Disease (CHD) and for worsening prognosis
once CHD is established. Given the increasing awareness of the high prevalence
of co-morbid depression in individuals with CHD, clinical psychologists are
likely to become increasingly involved in the care of cardiac patients. It is
imperative therefore, that they are aware of the complex relationship between
depression and CHD and are familiar with the pharmacological and psychological
interventions most likely to be effective in these patients. The following
review explores the epidemiological evidence for the relationship between
depression and CHD, examines the biological, behavioral and social mechanisms
that may account for this relationship, and considers the findings of the
psychological and pharmacological intervention trials seeking to improve
outcomes for depressed cardiac patients. Collaboration across a range of
disciplines is needed to establish a program of research and professional
education and to develop clinical practice guidelines and pathways which support
the implementation of best practice in the assessment and management of
co-morbid depression in people with and at risk of CHD. Clinical psychologists
are well-equipped to take a lead in this important endeavor.
16: Psychosomatics. 2007 Jul-Aug;48(4):338-47.
Recognition of depression in medical patients with heart failure.
Koenig HG.
Duke University Medical Center, Durham, NC 27710, USA. koenig@geri.duke.edu
The author examined physician and patient factors related to recognition of
depression in depressed medical patients. Medical inpatients over age 50 were
systematically identified with depressive disorder (N=1,000). Medical physicians
(N=422) treating these patients were asked whether they believed patients had
depression warranting specific treatment. Frequency of seeing and treating older
depressed patients and attitudes toward treatment effectiveness were key factors
related to physicians' recognition of depression. Patient factors were younger
age, white race, female gender, and persistence of depression after discharge.
Although physicians' intuition about depression course was often correct,
persistent depression was not recognized in nearly 40% of patients.
Publication Types:
Major depressive disorder and inflammatory markers in elderly patients with
heart failure.
Andrei AM, Fraguas R Jr, Telles RM, Alves TC, Strunz CM, Nussbacher A, Rays J,
Iosifescu DV, Wajngarten M.
Heart Institute, University of Sao Paulo School of Medicine, Sao Paulo, SP,
Brazil.
The authors evaluated levels of inflammatory markers in 34 chronic heart failure
(CHF) out-patients age 65 years and over, with (N=18) and without (N=16) major
depressive disorder (MDD), and healthy-control subjects (N=13). Patients with
CHF had left-ventricular ejection fractions <0.40 and were in the New York Heart
Association functional class II or III. The authors used the SCID DSM-IV to
diagnosis MDD. High-sensitivity C-reactive protein levels were significantly
higher in patients with CHF and MDD as compared with healthy-control subjects.
No differences regarding tumor necrosis factor(alpha) or interleukin(6) were
found among the three groups.
Publication Types:
18: Clin Res Cardiol. 2007 Jun 27; [Epub ahead of print]
The relationship between depressive symptoms and anxiety and quality of life and
functional capacity in heart transplant patients.
Karapolat H, Eyigor S, Durmaz B, Yagdi T, Nalbantgil S, Karakula S.
Ege University Medical Faculty Physical, Medicine and Rehabilitation Department,
35100, Bornova, Izmir, Turkey, haleuzum76@hotmail.com.
OBJECTIVE : To establish the relationship between depressive symptoms and
anxiety with both the quality of life and functional capacity of heart
transplant patients. METHODS : Thirty-four patients were included. Outcome
measures were the Beck Depression Inventory (BDI), the State- Trait Anxiety
Inventory (STAI), the Short Form 36 (SF36) and peak oxygen consumption (pVO(2)).
RESULTS : After the transplant there was a significant negative correlation
between the BDI and most of subgroups on the SF36 (p<0.05). There were
significant negative correlations found between the pVO(2) and both the BDI and
STAI-trait anxiety score (p<0.05). Statistically significant improvements were
noted in all subgroups on the SF36 and all BDI scores after the transplant, in
comparison to the pre-transplant period (p<0.05). CONCLUSIONS : The functional
capacity of a person affects the state of their depression and anxiety. We
recommend participation in a cardiac rehabilitation program in the early stages
of transplantation and believe that the quality of life, which has been shown to
be related to the functional capacity and psychological symptoms, would benefit
from this program.
19: Herz. 2006 Dec;31 Suppl 3:64-8.
Depression and coronary artery disease.
Frasure-Smith N, Lesperance F.
Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, Recherche
Psychiatrie, Montreal,Quebec, Canada.
Studies in patients recovering from myocardial infarction, episodes of unstable
angina, coronary bypass surgery and coronary angioplasty, show that between 12
and 20% of hospitalized cardiac patients meet psychiatric criteria for current
major depression. A similar percentage report elevated levels of depressive
symptoms on paper and pencil self-report measures. These rates of depression are
about three times higher than in the general community. On a practical basis
this means that about one in three hospitalized CAD patients has some degree of
depression. Despite its high prevalence in patients with CAD, depression is not
a normal reaction to cardiac disease. Both major depression and elevated
depressive symptoms are associated with at least a doubling in risk of
subsequent cardiac events, even when standard cardiac risk factors, including
left ventricular ejection fraction and number of blocked coronary arteries, are
taken into account. In fact, several large, longitudinal community-based studies
show that depression precedes the development of clinically evident CAD by many
years. There is substantial evidence that depression is a potentially modifiable
cardiac risk factor of as much importance as diabetes or lack of exercise.
Although the precise mechanisms explaining the link between depression and CAD
remain unknown, there is evidence that changes in autonomic regulation,
sub-chronic inflammation, endothelial dysfunction, enhanced platelet
responsiveness and reduced omega-3 free fatty acid levels may all be involved.
Intriguingly, the mechanisms that have been hypothesized to explain the link
between depression and CAD prognosis are the same as those suggested to explain
the favorable impact of omega-3 supplements in CAD patients. Additional clinical
trials to assess the impact of omega-3 supplements on depression are clearly
warranted both in CAD patients and in individuals free of heart disease.
Publication Types:
Review
20: Dialogues Clin Neurosci. 2007;9(1):71-83.
Gender differences in cardiovascular disease and comorbid depression.
Moller-Leimkuhler AM.
Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany.
Anne-Maria.Moeller-Leimkuehler@med.uni-muenchen.de
Although gender is increasingly perceived as a key determinant in health and
illness, systematic gender studies in medicine are still lacking. For a long
time, cardiovascular disease (CVD) has been seen as a "male" disease, due to
men's higher absolute risk compared with women, but the relative risk in women
of CVD morbidity and mortality is actually higher. Current knowledge points to
important gender differences in age of onset, symptom presentation, management,
and outcome, as well as traditional and psychosocial risk factors. Compared with
men, CVD risk in women is increased to a greater extent by some traditional
factors (e.g., diabetes, hypertension, hypercholesterolemia, obesity), and
socioeconomic and psychosocial factors also seem to have a higher impact on CVD
in women. With respect to differences in CVD management, a gender bias in favor
of men has to be taken into account, in spite of greater age and higher
comorbidity in women, possibly contributing to a poorer outcome. Depression has
been shown to be an independent risk factor and consequence of CVD; however,
concerning gender differences, the results have been inconsistent. Current
evidence suggests that depression causes a greater increase in CVD incidence in
women, and that female CVD patients experience higher levels of depression than
men. Gender aspects should be more intensively considered, both in further
research on gender differences in comorbid depression, and in cardiac treatment
and rehabilitation, with the goal of making secondary prevention more effective.
Publication Types:
Review
Common genetic factors for depression and cardiovascular disease.
Bondy B.
Psychiatric Hospital, University of Munich, Germany.
Brigitta.Bondy@psy.med.uni-muenchen.de
There is increasing knowledge regarding the considerable comorbidity between
depression and cardiovascular disease, which are two of the most common
disorders in developed countries. The associated vulnerability is not
unidirectional, as the presence of cardiovascular disease can also influence
mood states. Although this may be the result of psychological factors, common
biological mechanisms, including genetic ones, are thought to be responsible for
this interaction; we can thus question whether variations in genes could be
predisposing factors. Regarding the multiple interactions in the mechanisms
between depression and cardiovascular system disorders, e.g., dysfunctions in
the hypothalamic-pituitary-adrenocortical and sympathoadrenal axis and the
response to stress, the importance of the serotonergic and immune systems, or
the impact on the renin-angiotensin system, several candidate genes are being
investigated. However, despite the interest in unraveling the potential
susceptibility genes for both disorders, most available studies have so far
dealt with the impact of polymorphisms in relation to either depression or
cardiovascular disease. A few recent studies have now examined the effects of
gene-gene or gene-environment interactions, and are investigating the impact of
"depression-related" variants on cardiac response to stress. The first promising
results were obtained with the serotonin transporter, and it may be hypothesized
that this polymorphism interacts via the impact of the S allele on depression
and via the effect of the L allele on platelet activation. However, the role
played by various other candidate genes remains to be determined, especially
regarding the question as to whether they are indicative of common
pathophysiological mechanisms, or for identifying a subgroup of patients with
somatic disorders that are more closely related to psychiatric symptoms.
Publication Types:
Review
Depression and cardiovascular comorbidity.
Glassman AH.
Columbia University, New York, NY, USA. ahg1@columbia.edu
Depression has long had a popular link to cardiovascular disease and death.
However, only during the last 15 years has scientific evidence supporting this
common wisdom been available. Beginning in the early 1990s, there began to
accumulate community-based epidemiological evidence that medically healthy,
depressed patients followed for long periods of time were at increased risk of
both cardiovascular disease and cardiac death. In the mid-1990s, evidence
appeared to indicate that depression following a heart attack increased the risk
of death. It is now apparent that depression aggravates the course of multiple
cardiovascular conditions. There are two major unanswered questions. One is
whether treating depression will reduce the risk of cardiovascular disease and
death. Here, preliminary, but not definitive, evidence suggests that the
serotonin reuptake inhibitors may be useful. The other unanswered question
regards the mechanisms that underlie this link between depression and
cardiovascular disease. There is strong evidence linking platelet activation,
autonomic activity and inflammatory markers to both depression and heart
disease, but why these links exist is far less clear.
Publication Types:
Review
23: Eur J Cardiovasc Nurs. 2007 Jun;6(2):89-91. Epub 2007 May 7.
Comment on:
Eur J Cardiovasc Nurs. 2006 Dec;5(4):251-2.
Eur J Cardiovasc Nurs. 2007 Jun;6(2):92-8.
Depression in cardiac patients: an evidence base for selection of brief
screening instruments by nursing staff.
Doyle F, McGee H, Conroy R.
Publication Types:
Comment
Editorial
Review
24: Cleve Clin J Med. 2007 Feb;74 Suppl 1:S67-72.
Sick at heart: the pathophysiology of negative emotions.
Kubzansky LD.
Department of Society, Human Development, and Health, Harvard School of Public
Health Boston, MA 02115, USA. lkubzans@hsph.harvard.edu
Publication Types:
Review
25: Cleve Clin J Med. 2007 Feb;74 Suppl 1:S63-6.
Depression and heart disease.
Lesperance F, Frasure-Smith N.
Centre Hospitalier de l'Universite de Montreal, Montreal Heart Institute,
Montreal, Quebec, Canada. francois.lesperance@umontreal.ca
Publication Types:
Review
26: Psychosomatics. 2007 May-Jun;48(3):185-94.
Performance characteristics of depression screening instruments in survivors of
acute myocardial infarction: review of the evidence.
Thombs BD, Magyar-Russell G, Bass EB, Stewart KJ, Tsilidis KK, Bush DE,
Fauerbach JA, McCann UD, Ziegelstein RC.
Johns Hopkins University Evidence-Based Practice Center, the Dept. of Psychiatry
and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore,
MD, USA. brett.thombs@mcgill.ca
Authors conducted a systematic review to assess performance characteristics of
depression screening instruments after acute myocardial infarction (AMI). Among
the seven studies identified, the Beck Depression Inventory (BDI) and the
depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) were
used most frequently. Studies were generally of low quality, and no screening
instrument performed notably better than others. Future research should compare
the BDI and the HADS-D with instruments such as the Patient Health Questionnaire
(PHQ-9 and PHQ-2) in post-AMI patients, should attend to important elements of
the screening process, including when, where, and how often to screen patients,
and should evaluate serial screening.
Publication Types:
Review
27: J Psychosom Res. 2007 Apr;62(4):401-10.
Comorbid depression and health-related quality of life in patients with coronary
artery disease.
Stafford L, Berk M, Reddy P, Jackson HJ.
Department of Psychology, School of Behavioural Science, Faculty of Medicine,
Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
lesley.liebowitz@bigpond.com
OBJECTIVE: This article reviews recent studies relating to the impact of
depression and its treatment on the health-related quality of life (HRQOL) of
patients with coronary artery disease (CAD). METHODS: Articles for the primary
review were identified via MEDLINE and PsycINFO (1995-2006). RESULTS: Evidence
suggests that depression has an aversive impact on the HRQOL of patients with
stable CAD as well as on patients hospitalized for acute myocardial infarction
and coronary artery bypass graft surgery. Unfortunately, there are few
depression treatment studies in patients with CAD that make use of standardized
HRQOL measures, but the limited evidence suggests that successful treatment has
positive implications for HRQOL in these patients. The mechanisms through which
depression impacts on HRQOL require further study but are likely to be
behavioral. CONCLUSIONS: Depressive symptoms significantly undermine HRQOL in
patients with CAD despite successful medical and surgical management. Although
successful treatment of depression has not been shown to reduce mortality rates
in patients with CAD, further study may find that the HRQOL benefits of such
treatment are equally valuable.
Publication Types:
Review
28: Am J Geriatr Cardiol. 2007 Mar-Apr;16(2):76-83.
Depression and nursing home admission among hospitalized older adults with
coronary artery disease: a propensity score analysis.
Ahmed A, Lefante CM, Alam N.
Division of Gerontology and Geriatric Medicine, Department of Medicine, School
of Medicine, University of Alabama at Birmingham, AL, USA. aahmed@uab.edu
Admission to a nursing home is considered a poor outcome for community-dwelling
older adults. The objective of this study was to determine whether depression
increased the risk of nursing home admission. Using the National Hospital
Discharge Survey 2001-2003 datasets, the authors identified 28,172
community-dwelling older adults, 65 years and older, discharged alive with a
primary discharge diagnosis of coronary artery disease. The objective of this
study was to determine the association between depression and subsequent nursing
home admissions in these patients. Propensity scores for depression, calculated
for each patient using a multivariable logistic regression model, were used to
match 686 depressed patients with 2058 nondepressed patients who had similar
propensity scores. Logistic regression analyses were used to determine the
association between depression and nursing home admission. Patients had a mean
age +/- SD of 77+/-8 years, and 61% were women. Compared with 9% of nondepressed
patients, 13% of depressed patients were admitted to nursing homes (relative
risk, 1.42; 95% confidence interval, 1.12-1.78). When adjusted for various
demographic, clinical, and care-related covariates, the association became
somewhat stronger (adjusted relative risk, 1.55; 95% confidence interval,
1.21-1.99). In ambulatory older adults hospitalized with coronary artery
disease, a secondary diagnosis of depression was associated with a significantly
increased risk of nursing home admission.
Publication Types:
Review
29: Prog Cardiovasc Nurs. 2006 Fall;21(4):202-11.
Consequences and predictors of depression in patients with chronic heart
failure: implications for nursing care and future research.
Johansson P, Dahlstrom U, Brostrom A.
Department of Cardiology, Faculty of Health Sciences, Linkoping University
Hospital, S-58185 Linkoping, Sweden. peterjohansson@mbox309.swipnet.se
Depression is common among patients with chronic heart failure (HF) and leads to
more symptoms of HF, decreased quality of life, and an increased risk for
premature death. Depressed HF patients also use more health care resources,
which increases the economic burden on the health care system. The assessment of
risk factors of depression such as age younger than 60-65 years, poor physical
functioning, previous depression, poor self-efficacy, living alone, and
distressful relationships, in combination with the use of depression
instruments, can be helpful in detecting depression in HF patients.
Unfortunately, interventions on how to relieve depression in patients with HF
have not been investigated thoroughly; however, depression agents as well as HF
education, social support, exercise therapy, stress management, and relaxation
have been shown to be useful interventions. Because of poor outcomes, studies
that examine the effectiveness and/or side effects of pharmacologic as well as
nonpharmacologic interventions on depressed patients with HF are needed.
Publication Types:
Review
30: Can J Psychiatry. 2006 Oct;51(12):738-45.
Coronary heart disease and depression: a review of recent mechanistic research.
Skala JA, Freedland KE, Carney RM.
Department of Psychiatry, Washington University School of Medicine, St Louis,
Missouri 63108, USA. skalaj@bmc.wustl.edu
OBJECTIVE: Both behavioural and physiological factors have been proposed as
mechanisms that may explain the negative effect of depression on coronary heart
disease (CHD). Our aim is to review some of the most important findings since
our prior review. METHOD: We searched MEDLINE, PsycINFO, and other sources for
recent studies of candidate mechanisms, with an emphasis on publications since
2002. RESULTS: Physiological pathways have received far greater attention than
behavioural ones in the emerging literature. Recent studies have identified
shared genetic determinants, inflammation, blood clotting, and vascular
mechanisms as plausible explanatory mechanisms. CONCLUSIONS: Future research
should focus on relations between behavioural and physiological mechanisms and
on the effects of pharmacologic and psychotherapeutic treatments for depression
on candidate mechanisms.
Publication Types:
Review
Recent evidence linking coronary heart disease and depression.
Department of Psychiatry and School of Nursing, McGill University, Montreal,
Quebec. nancy.frasure-smith@mcGill.ca
OBJECTIVES: To review the recent literature on the relation between depression
and coronary heart disease (CHD), including both etiologic studies (that is,
depression preceding development of CHD) and prognostic studies (that is,
depression predicting prognosis in established CHD), and to assess the degree to
which the literature supports a causal interpretation of the link between
depression and CHD. METHOD: We searched the MEDLINE, Current Contents, and
PsycINFO databases for articles published between December 15, 2003, and
December 15, 2005, containing combinations of several key words related to CHD,
prognosis, and depression. We reviewed papers for evidence of 6 rule-of-thumb
criteria for making causal inferences: objective CHD outcome measures,
prospective designs, results showing consistent and strong dose-response
relations, adequate covariate adjustment, biological plausibility, and evidence
from clinical trials that changing depression alters CHD risk. RESULTS: We found
8 recent etiologic studies, 16 prognostic studies, 2 publications with both
types of data, and 23 review papers. Although there was much methodological
variability concerning measurement of depression and assessment of cardiac
outcomes, the recent etiologic studies increase the evidence of a role for
depression. Recent prognostic data are less consistent. Small studies showing no
link between depression and CHD prognosis continue to appear, despite lack of
adequate statistical power. CONCLUSIONS: The recent literature continues to
support both an etiologic and a prognostic role for depression in CHD. Despite
this evidence, there have been few clinical trials of depression treatment in
CHD patients and no clinical trials of depression prevention. Additional trials
are needed.
Publication Types:
Review
32: Harv Rev Psychiatry. 2006 Nov-Dec;14(6):305-18.
Post-MI psychiatric syndromes: six unanswered questions.
Huffman JC, Smith FA, Quinn DK, Fricchione GL.
Harvard Medical School and Department of Psychiatry, Massachusetts General
Hospital, Boston, MA 02114, USA. Jhuffman@partners.org
Depression, anxiety, and other psychological variables following acute
myocardial infarction (MI) have been the subject of intense study over the last
two decades. Through selective literature review and editorial commentary, we
address six vital, unanswered questions concerning these psychological variables
and their impact on coronary outcome. The picture that emerges is complex.
Despite all that has been learned about the nature, consequences, and management
of post-MI depression and related disorders, there remain many open issues.
First, the prevalence, phenomenology, medical impact, and method of diagnosis of
post-MI depression and other psychiatric syndromes remain unclear. In addition,
at least four pathophysiologic mechanisms have been proposed to explain the link
between depression and cardiac disease, but evidence of causation remains
elusive. There have been increasingly well-designed treatment studies of post-MI
depression, but the optimal agents and timing of treatment have yet to be
defined. Finally, few recent studies of post-MI anxiety have been conducted. To
make further progress, large, multicenter trials that use optimized screening
tools, obtain data at several time points, consider multiple psychosocial
variables, and correct carefully for medical/cardiac severity are required.
Publication Types:
Review
33: Anadolu Kardiyol Derg. 2006 Dec;6 Suppl 2:5-8.
Emotional and psychiatric issues in hypertrophic cardiomyopathy and other
cardiac patients.
Rosenfeld JE.
Columbia University and St. Luke's - Roosevelt Hospital Center, New York, NY,
USA. jer3@columbia.edu.
Hypertrophic cardiomyopathy (HCM) exposes young patients to the risk of sudden
death. The risk of sudden death separates the young patient from his peers, but
connects him more closely to his physician. The physician may have a powerful
effect replacing uninformed fears with accurate knowledge, restoring hope, and
helping the patient shift focus from the fear of dying to engaging in life and
living with a medical illness. Depression and panic disorder are two psychiatric
illnesses that are common in cardiac practices, cause significant morbidity and
mortality, and may be overlooked and undertreated. Depression is a significant
cardiac risk factor. Panic disorder may be confused with cardiac illness and
complicate cardiac treatment. The cardiologist should recognize these illnesses
and help patients who have them receive treatment for the psychiatric as well as
the cardiac causes of their distress. There is a possibility that treating these
psychiatric illnesses may actually improve cardiac outcome. Cardiac and
psychotropic medications may have additive side effects or interact by altering
drug metabolism. Many psychotropic medications cause orthostatic hypotension
that may worsen obstructive HCM.
Publication Types:
Review
34: J Am Coll Cardiol. 2006 Dec 5;48(11):2215-7. Epub 2006 Nov 9.
Comment on:
J Am Coll Cardiol. 2006 Dec 5;48(11):2204-8.
Depression after myocardial infarction: unraveling the mystery of poor
cardiovascular prognosis and role of beta-blocker therapy.
von Kanel R, Begre S.
Publication Types:
Comment
Editorial
Review
35: Cardiovasc Hematol Agents Med Chem. 2006 Oct;4(4):361-7.
Selective serotonin re-uptake inhibitors for the treatment of depression in
coronary artery disease and chronic heart failure: evidence for pleiotropic
effects.
Paraskevaidis I, Parissis JT, Fountoulaki K, Filippatos G, Kremastinos D.
Second Department of Cardiology and Heart Failure Clinic, University of Athens,
Greece. elbee@ath.forthnet.gr
Depression is a common co-morbidity in patients with cardiovascular diseases
such as chronic coronary artery disease, acute coronary syndromes, post by-pass
surgery and chronic heart failure. There is a significant body of evidence
suggesting that the presence of depression is independently associated with a
decline in health status and an increase in the risk of hospitalization and
death for patients with coronary artery disease or congestive heart failure.
Novel treatment modalities such as selective serotonin re-uptake inhibitors
(SSRIs) may improve depressive symptoms and prognosis of post-myocardial
infarction and heart failure patients interacting with the common
pathophysiologic mechanisms of depression and cardiovascular disease. This
review summarizes current experimental and clinical evidence regarding the
pleiotropic effects of SSRIs on platelet functions, immune and neurohormonal
activation, and cardiac rhythm disturbances in patients with cardiovascular
disease. These bio-modulatory properties of SSRIs may be translated into
improvement of patient clinical outcomes beyond their anti-depressant action.
Publication Types:
Review
Depression and associated physical diseases and symptoms.
Goodwin GM.
Oxford University, Warneford Hospital, United Kingdom.
guy.goodwin@psychiatry.oxford.ac.uk
Depression can occur in association with virtually all the other psychiatric and
physical diagnoses. Physical illness increases the risk of developing severe
depressive illness. There are two broadly different mechanisms. The most obvious
has a psychological or cognitive mechanism. Thus, the illness may provide the
life event or chronic difficulty that triggers a depressive episode in a
vulnerable individual. Secondly, more specific associations appear to exist
between depression and particular physical disorders. These may turn out to be
of particular etiological interest. The best examples are probably stroke and
cardiovascular disease. Finally, major depression, but especially minor
depression, dysthymia, and depressive symptoms merge with other manifestations
of human distress with which patients present to their doctors. Such somatic
presentations test the conventional distinction between physical and mental
disorder and are a perennial source of controversy.
Publication Types:
Review
37: Am J Med. 2006 Jul;119(7):567-73.
Treatment of depression in patients with coronary heart disease.
Vieweg WV, Julius DA, Fernandez A, Wulsin LR, Mohanty PK, Beatty-Brooks M,
Hasnain M, Pandurangi AK.
Psychiatry Services, Hunter Holmes McGuire Veterans Affairs Medical Center,
Richmond, VA, USA. vvieweg@visi.net
Depression and coronary heart disease are common conditions that often occur
together. Evidence shows that the co-occurrence of these illnesses is not random
but driven by depression as a risk factor for the occurrence and progression of
coronary heart disease. This link is due, in part, to the impact that depression
has on neuroendocrine pathways leading to increased platelet activation,
cortisol and catecholamine excess, and altered autonomic nervous system function
that influence the pathogenesis and progression of coronary atherosclerosis and
subsequent heart disease. We know that treating depression in patients with
coronary heart disease improves the symptoms and signs of depression. Evidence
is less compelling that treating depression improves the morbidity and mortality
of coronary heart disease. However, early findings suggest that some
antidepressants may improve the course of coronary heart disease and improve
patient compliance with various cardiac interventions. We outline a practical
approach to the treatment of depression in patients with coronary heart disease.
This approach includes education, counseling, antidepressant drugs, and referral
when appropriate.
Publication Types:
Review
38: Int J Cardiol. 2007 Mar 20;116(2):153-60. Epub 2006 Jul 5.
Depression in coronary artery disease: novel pathophysiologic mechanisms and
therapeutic implications.
Parissis JT, Fountoulaki K, Filippatos G, Adamopoulos S, Paraskevaidis I,
Kremastinos D.
Second Department of Cardiology, Attikon University Hospital, Aftokratoros
Irakliou 17, 15122 Maroussi, Athens, Greece. jparissis@yahoo.com
Depression is a common comorbid condition in patients with coronary artery
disease and a well-documented risk factor for recurrent cardiac events and
mortality. The exact mechanisms underlying the interplay between depression and
ischemic heart disease remain poorly understood and the same is true for the
most effective depression treatment for cardiac patients. This review summarizes
current knowledge regarding the prognostic role of depression in patients with
coronary artery disease, the pathophysiologic pathways involved, and the effects
of antidepressant therapy on cardiovascular disease outcomes. With recent
evidence suggesting that selective serotonin reuptake inhibitors may improve
survival after myocardial infarction in patients with depression, diagnosis and
treatment of this co-morbidity may be essential for the clinical management of
coronary artery disease.
Publication Types:
Review
39: Psychosom Med. 2006 Mar-Apr;68(2):187-200.
Comment in:
Psychosom Med. 2006 Mar-Apr;68(2):185-6.
Common genetic vulnerability to depressive symptoms and coronary artery disease:
a review and development of candidate genes related to inflammation and
serotonin.
McCaffery JM, Frasure-Smith N, Dube MP, Theroux P, Rouleau GA, Duan Q,
Lesperance F.
Weight Control and Diabetes Research Center, Brown Medical School, Miriam
Hospital, Providence, RI, USA. Jeanne_McCaffery@brown.edu
OBJECTIVE: Although it is well established that depressive symptoms are
associated with recurrent cardiac events among cardiac patients and novel
cardiac events among participants with no known coronary artery disease (CAD),
the nature of this association remains unclear. In this regard, little attention
has been paid to the possibility that common genetic vulnerability contributes
to both depressive symptoms and CAD. In this paper, we review the existing
evidence for common genetic contributions to depression and CAD, primarily using
evidence from twin and family studies, followed by a review of two major
pathophysiological mechanisms thought to underlie covariation between depressive
symptoms and CAD: inflammation and serotonin. We conclude with an overview of
select candidate genes within these pathways. METHODS: Literature review.
RESULTS: In twin studies, both depression and CAD appear heritable. In the only
twin study to consider depression and CAD jointly, the correlation across
heritabilities was 0.42, suggesting that nearly 20% of variability in depressive
symptoms and CAD was attributable to common genetic factors. In addition,
although it is plausible that genetic variation related to inflammation and
serotonin may be associated with both depression and CAD, genetic variation
related to inflammation has been primary examined in relation to CAD, whereas
genetic variation in the serotonin system has been primarily examined in
relation to depression. CONCLUSIONS: It appears that the covariation of
depressive symptoms and CAD may be attributable, in part, to a common genetic
vulnerability. Although several pathways may be involved, genes within the
inflammation and serotonin pathways may serve as good candidates for the first
steps in identifying genetic variation important for depression, CAD or both.
Publication Types:
Review
40: Prog Cardiovasc Nurs. 2006 Winter;21(1):28-36.
Comment in:
Prog Cardiovasc Nurs. 2006 Winter;21(1):37-8.
The measurement and prevalence of depression in patients with chronic heart
failure.
Johansson P, Dahlstrom U, Brostrom A.
Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden.
peterjohansson@mbox309.swipnet.se
Chronic heart failure is a common disease accompanied by poor mental health and
depression. The diagnosis of depression is based on the presence of affective,
cognitive, and somatic symptoms assessed by categoric or dimensional
instruments. Depression is prominent and high rates are found with dimensional
instruments in hospitalized heart failure patients. Categoric instruments seem
to be more reliable but are more complex to use. Because of poor outcomes,
attention should also be paid to subthreshold depression. In screening for such
cases, dimensional instruments might be preferable because of the risk for
underestimation by categoric instruments. Dimensional instruments might also be
easier to implement in daily practice but, to reduce bias, cutoff scores might
need refinement according to the clinical setting. Therefore, studies that
evaluate different cutoff values are needed to find a critical level of burden
from a depressive symptomatology on outcomes such as mortality,
hospitalizations, and quality of life.
Publication Types:
Review
41: J Gen Intern Med. 2006 Jan;21(1):30-8.
Prevalence of depression in survivors of acute myocardial infarction.
Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, Fauerbach JA,
Bush DE, Ziegelstein RC.
Johns Hopkins University Evidence-based Practice Center, Johns Hopkins
University School of Medicine, Baltimore, Md, USA.
OBJECTIVES: To assess the prevalence and persistence of depression in patients
with acute myocardial infarction (AMI) and the relationship between assessment
modality and prevalence. DATA SOURCES: MEDLINE, Cochrane, CINAHL, PsycINFO, and
EMBASE. REVIEW METHODS: A comprehensive search was conducted in March 2004 to
identify original research studies published since 1980 that used a standardized
interview or validated questionnaire to assess depression. The search was
augmented by hand searching of selected journals from October 2003 through April
2004 and references of identified articles and reviews. Studies were excluded if
only an abstract was provided, if not in English, or if depression was not
measured by a validated method. RESULTS: Major depression was identified in
19.8% (95% confidence interval [CI] 19.1% to 20.6%) of patients using structured
interviews (N=10,785, 8 studies). The prevalence of significant depressive
symptoms based on a Beck Depression Inventory score > or =10 was 31.1% (CI 29.2%
to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale
(HADS) score > or =8%, 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a
HADS score > or =11%, 7.3% (CI 5.5% to 9.3%; N=830, 4 studies). Although a
significant proportion of patients continued to be depressed in the year after
discharge, the limited number of studies and variable follow-up times precluded
specification of prevalence rates at given time points. CONCLUSIONS: Depression
is common and persistent in AMI survivors. Prevalence varies depending on
assessment method, likely reflecting treatment of somatic symptoms.
Publication Types:
Research Support, U.S. Gov't, P.H.S.
Review
42: Am Heart J. 2005 Nov;150(5):871-81.
Antidepressant therapy in patients with ischemic heart disease.
Jiang W, Davidson JR.
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
jiang001@mc.duke.edu
Depressive disorders are common in patients with ischemic heart disease and have
serious consequences in terms of the risk of further cardiac events and cardiac
mortality. Among survivors of acute myocardial infarction, up to one fifth meet
diagnostic criteria for major depression, and the presence of major depression
carries a >5-fold increased risk for cardiac mortality within 6 months. This
article reviews clinical trial data on the cardiac safety profiles of
antidepressant agents with the aim of discussing clinical considerations in
selecting the most appropriate treatment of comorbid depression in patients with
ischemic heart disease. Tricyclic antidepressants are effective against
depression but are associated with cardiovascular side effects including
orthostatic hypotension, slowed cardiac conduction, antiarrhythmic activity, and
increased heart rate. Selective serotonin reuptake inhibitors, by contrast, have
benign cardiovascular profiles and are well tolerated in patients with cardiac
disease. The safety of dual-acting serotonin and noradrenaline reuptake
inhibitors has not been well studied. Intervention with a selective serotonin
reuptake inhibitors has the potential to provide the depressed patient with
ischemic heart disease relief from their depressive symptoms and may offer a
potential improvement in their cardiovascular risk profile.
Publication Types:
Review
43: Am J Cardiol. 2005 Oct 1;96(7):1016-21.
Role of depression and inflammation in incident coronary heart disease events.
Shimbo D, Chaplin W, Crossman D, Haas D, Davidson KW.
The Behavioral Cardiovascular Health and Hypertension Program, Columbia
University Medical Center, USA. ds2231@columbia.edu
Inflammatory biomarkers and depression have been proposed as novel coronary
heart disease (CHD) risk markers. However, prospective studies have rarely
assessed these 2 candidate CHD risk markers simultaneously in predicting
incident CHD events. Therefore, although depression and elevated inflammatory
biomarkers frequently covary, it is unclear how these risk markers relate to
each other and to CHD event onset. The elucidation of these causal pathways has
important clinical implications for patients who are depressed and/or have
elevated inflammatory biomarkers. In this review, the publications examining the
relations among depression, inflammation, and CHD events are discussed.
Publication Types:
Review
44: J Card Fail. 2005 Aug;11(6):455-63.
Depression and anxiety in heart failure.
Konstam V, Moser DK, De Jong MJ.
Department of Counseling and School Psychology, University of Massachusetts
Boston, MA 02125, USA.
BACKGROUND: Although common among patients with heart failure, depression and
anxiety have been relatively neglected by researchers and practitioners. Both
depression and anxiety have been implicated in contributing independently to the
poor outcomes seen in patients with heart failure. Emphasis in the literature is
on physical symptom recognition and management, in contrast to the patient's
perspective of the effects of heart failure on his or her daily life. METHODS
AND RESULTS: This review summarizes and integrates research findings on anxiety
and depression and translates these findings to clinical practice. Depression
and anxiety are prevalent among patients with heart failure and require
assessment and intervention. Short-term nonpharmacologic approaches, in
conjunction with drug therapy, hold promise for successful management of
patients who are depressed or anxious. CONCLUSION: Carefully designed clinical
trials that are tailored to individual needs, yet are embedded within a systemic
framework, are needed to inform clinicians regarding optimal practices for the
treatment of patients with heart failure who suffer from depression or anxiety.
Publication Types:
Review
45: Am Heart J. 2005 Jul;150(1):54-78.
Depression and ischemic heart disease: what have we learned so far and what must
we do in the future?
Jiang W, Glassman A, Krishnan R, O'Connor CM, Califf RM.
Department of Internal Medicine and Psychiatry and Behavioral Sciences, Duke
University Medical Center, Durham, NC 27710, USA.
Publication Types:
Review
46: J Clin Psychopharmacol. 2005 Aug;25(4 Suppl 1):S14-8.
Treatment of depression in the medically ill.
Krishnan KR.
Department of Psychiatry and Behavioral Sciences, Duke University Medical
Center, Rm. 4584 White Zone, Duke South, Durham, NC 27710, USA.
krish001@mc.duke.edu
Most studies on treatment methods in elderly depressive patients have included
primarily patients in good physical health, excluding medical comorbidity,
despite the fact that depression with medical comorbidity is the norm rather
than the exception. In addition, depression is known to increase disability and
mortality among the medically ill. This, therefore, becomes an extremely
important issue. Although data are limited, the available evidence suggests that
depression concomitant with medical illness can be treated. One or more of the
selective serotonin reuptake inhibitors have demonstrated potential usefulness
in depressed patients with ischemic heart disease, diabetes, dementia, and
Parkinson's disease and in patients after stroke and after myocardial
infarction. Large-scale trials are needed to assess not only the safety and
effectiveness of agents for the treatment of depression in comorbid illness, but
also the effects of depression on the course of the medical illness itself.
Publication Types:
Review
47: Can J Cardiol. 2005 Jun;21(8):689-97.
Post-traumatic stress disorder in patients with coronary artery disease:
screening and management implications.
Doerfler LA, Paraskos JA.
Department of Psychology, University of Massachusetts Medical School, Worcester,
USA. doerfler@assumption.edu
OBJECTIVES: To review the literature on anxiety, post-traumatic stress disorder
(PTSD) and depression in patients with coronary artery disease (CAD), and to
present an approach to diagnosis and treatment. METHODS: MEDLINE and PsychInfo
searches of English-language articles were performed. Search terms included
'anxiety', 'post-traumatic stress disorder' and 'depression', with various
cardiac-related subject headings. RESULTS: Research indicates that anxiety, PTSD
and depression occur frequently in patients with CAD, but these psychological
problems are rarely identified or treated in the cardiology or primary care
setting. CONCLUSIONS: The present review offers practical recommendations on how
to detect and assess anxiety, PTSD and depression in the cardiology or primary
care setting. Treatment recommendations are provided, with a focus on
pharmacotherapy for anxiety and depressive disorders in patients with CAD.
Publication Types:
Review
48: Evid Rep Technol Assess (Summ). 2005 May;(123):1-8.
Post-myocardial infarction depression.
Bush DE, Ziegelstein RC, Patel UV, Thombs BD, Ford DE, Fauerbach JA, McCann UD,
Stewart KJ, Tsilidis KK, Patel AL, Feuerstein CJ, Bass EB.
Publication Types:
Review
49: Psychosom Med. 2005 May-Jun;67 Suppl 1:S63-6.
Lessons from SADHART, ENRICHD, and other trials.
Joynt KE, O'Connor CM.
Department of Medicine, Duke University Medical Center, Durham, North Carolina
27708, USA. joynt001@mc.duke.edu
Depression is highly prevalent in patients with cardiovascular disease and is
independently associated with a poor prognosis when present. A very important
aspect of continued therapeutic advances in this field will be the ability to
show a convincing connection between the treatment of depression in patients
with heart disease and a reduction in morbidity and mortality associated with
the co-occurrence of these conditions. The recent SADHART (Sertraline
AntiDepressant Heart Attack Trial) investigation demonstrated that sertraline is
safe and efficacious in depressed patients with ischemic heart disease but was
underpowered to detect a mortality difference between sertraline and placebo.
The ENRICHD (ENhancing Recovery in Coronary Heart Disease) trial showed that
cognitive-behavioral therapy is effective for treating depression but had no
impact on cardiovascular morbidity or mortality. There are a number of
methodologic complexities associated with research regarding depression and
cardiovascular disease, including difficulties in the definition and measurement
of depression, complexities in the conduction of large-scale trials, ethical
considerations surrounding the use of placebo, and interpretation of trial
results. In addition, the lack of certainty regarding the pathophysiologic link
between depression and cardiovascular disease means that there is a lack of
pharmacotherapy targeted specifically at the dysregulated physiology that might
explain the increased morbidity and mortality seen when these two conditions
occur together.
Publication Types:
Review
Nonpharmacologic treatments for depression in patients with coronary heart
disease.
Lett HS, Davidson J, Blumenthal JA.
Center, Durham, North Carolina 27710, USA. lett0002@mc.duke.edu
OBJECTIVES: We review nonpharmacologic treatments for depression in patients
with coronary heart disease (CHD), including psychological therapies such as
cognitive behavior therapy (CBT) and interpersonal therapy (IPT), aerobic
exercise, St. John's wort (SJW), essential fatty acids (EFAs),
S-Adenosylmethionine (SAMe), acupuncture, and chromium picolinate (CP). METHOD:
Medline searches and reviews of bibliographies were used to identify relevant
articles. Each treatment was reviewed with particular attention paid to
empirical support, as well as to potential mechanisms of action that might
affect not only depression but also CHD endpoints. RESULTS: Nearly all
randomized controlled trials (RCTs) of depression treatments have been conducted
with non-CHD patients. These studies have provided the most support for
psychological treatments, particularly CBT and IPT. Aerobic exercise, SJW, and
SAMe also have considerable empirical support in otherwise healthy persons, but
SJW may have undesirable side effects for CHD patients. Data for EFAs, CP, and
acupuncture are limited; however, the use of aerobic exercise shows considerable
promise for cardiac patients. CONCLUSIONS: There are few RCTs of patients with
clinical depression and CHD, and those that exist have significant
methodological limitations. Nonetheless, there is preliminary evidence that
nonpharmacologic treatments are effective for cardiac patients with depression.
In terms of reducing depression, the most evidence exists for psychological
treatments, particularly CBT and IPT. However, there is little evidence that
such treatment would also improve CHD risk factors. Aerobic exercise offers more
promise to improve both mental and physical health due to its effect on
cardiovascular risk factors and outcomes and thus warrants particular attention
in future trials.
Publication Types:
Review
Pharmacologic treatment of depression in patients with heart disease.
Roose SP, Miyazaki M.
College of Physicians and Surgeons, Columbia University, New York, New York,
USA. spr2@columbia.edu
The relationship between depression and cardiovascular disease is complex and
multifaceted. There is a growing body of evidence that depression significantly
and adversely affects cardiovascular health. Perhaps the most prominent finding
is the documented increase in mortality rate in patients with depression after
myocardial infarction. The critical questions of interest to both the clinician
and researcher are whether there are safe and effective treatments for
depression in patients with heart disease and whether treatment of depression
reduces the increased risk of cardiac morbidity and mortality. Although the data
are limited and are primarily from open or comparator trials, the tricyclics
(TCAs) and selective serotonin reuptake inhibitors (SSRI) are effective for
treatment of depression in patients with ischemic heart disease (IHD), and
response rates are comparable with those reported in depressed patients without
heart disease. In terms of safety, the TCAs are associated with documented
adverse cardiovascular effects, including increases in heart rate, orthostatic
hypotension, and conduction delays. Use of TCAs in patients with IHD carries a
proven increased risk of cardiac morbidity and perhaps of mortality as well. The
SSRI appear to be relatively safe and effective in the treatment for depression
in patients with comorbid IHD.
Publication Types:
Review
Depression and smoking in coronary heart disease.
Freedland KE, Carney RM, Skala JA.
Department of Psychiatry, Washington University School of Medicine, 4625 Lindell
Blvd., Suite 420, St. Louis, MO 63108, USA. freedlak@wustl.edu
OBJECTIVE: This review examines the relationship between depression and smoking
in coronary heart disease (CHD). It summarizes relevant findings from general
population and smoking cessation studies and discusses the few studies that have
investigated whether smoking confounds, mediates, or moderates the effect of
depression on cardiac morbidity and mortality. METHODS: Qualitative review of
research literature. RESULTS: Although many studies of the prognostic importance
of depression in CHD have adjusted for smoking, there is no convincing evidence
that smoking actually confounds the relationship between depression and CHD.
There is also no evidence that smoking moderates this relationship. There is,
however, limited evidence that smoking may partially mediate the effect of
depression on morbidity and mortality in CHD. CONCLUSION: We need more research
on the relationship between depression and smoking in CHD to develop a more
complete model of the mechanisms linking depression to cardiac morbidity and
mortality.
Publication Types:
Review
The role of immune system parameters in the relationship between depression and
Kop WJ, Gottdiener JS.
Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
WJKOP@USUHS.MIL
The relationship between depressive symptoms and coronary artery disease (CAD)
is mediated in part by immune system parameters. This review describes research
on the psychoneuroimmunological pathways accounting for the association between
depression and CAD, and addresses conceptual and methodological issues.
Relationships between central nervous system correlates of depression and immune
system parameters are bidirectional and are mediated via neurohormonal and
parasympathetic pathways. Evidence suggests that these associations can be
affected by a) the clinical characteristics of depression (e.g., typical
depression versus atypical depression and exhaustion), b) the duration and
severity of depressive symptoms, and c) the stage of underlying CAD. Depressive
symptoms are hypothesized to affect primarily the transition from stable CAD to
acute coronary syndromes via plaque activation and prothrombotic processes, and
may play an additional role in the response to injury at early stages of
coronary atherosclerosis.
Publication Types:
Review
Depression, alterations in platelet function, and ischemic heart disease.
Bruce EC, Musselman DL.
Department of Psychiatry and Behavioral Sciences, Emory University School of
Medicine, 101 Woodruff Circle, Suite 4000, Atlanta, GA 30322, USA.
Platelets, the smallest corpuscular component of human blood, are central to
various crucial biologic pathways in the human body. Diminished platelet
function is thought to contribute to the increased risk of ischemic heart
disease in patients with major depressive disorder, and to the increased
morbidity and diminished survival of depressed patients after an index
myocardial infarction. We reviewed both recent studies that evaluated platelet
function in various patient groups and recent information regarding the
potential beneficial effects of selective serotonin reuptake inhibitors on
platelet reactivity.
Publication Types:
Review
Depression, the autonomic nervous system, and coronary heart disease.
Carney RM, Freedland KE, Veith RC.
Department of Psychiatry, Washington University School of Medicine, St. Louis,
MO, USA. carneyr@bmc.wustl.edu
Depression is a risk factor for medical morbidity and mortality in patients with
coronary heart disease (CHD). Dysregulation of the autonomic nervous system
(ANS) may explain why depressed patients are at increased risk. Studies of
medically well, depressed psychiatric patients have found elevated levels of
plasma catecholamines and other markers of altered ANS function compared with
controls. Studies of depressed patients with CHD have also uncovered evidence of
ANS dysfunction, including elevated heart rate, low heart rate variability,
exaggerated heart rate responses to physical stressors, high variability in
ventricular repolarization, and low baroreceptor sensitivity. All of these
indicators of ANS dysfunction have been associated with increased risks of
mortality and cardiac morbidity in patients with CHD. Further research is needed
to determine whether ANS dysfunction mediates the effects of depression on the
course and outcome of CHD, and to develop clinical interventions that improve
cardiovascular autonomic regulation while relieving depression in patients with
CHD.
Publication Types:
Review
Reflections on depression as a cardiac risk factor.
Department of Psychiatry, McGill University, Montreal, Canada.
nancy.frasure-smith@mcgill.ca
OBJECTIVE: Major North American cardiology organizations do not currently list
depression among the officially recognized cardiac risk factors, yet many
behavioral medicine specialists believe depression to be an important risk. We
wondered what was missing from the available data. METHODS: The Medline, Current
Contents, and PsychInfo databases were used to perform a systematic review of
the literature linking depression and depressive symptoms with cardiac disease
outcomes. Because of previous reviews, we paid particular attention to
publications from 2001 to 2003. RESULTS: We identified 21 etiologic and 43
prognostic publications that had prospective designs, used recognized measures
of depression, and included objective outcome measures. We also identified 79
review articles. In addition to issues of sample size, sample characteristics,
and timing of measures, we noted heterogeneity in the definitions of depression,
frequent repeat publications from the same data sets, heterogeneity of outcome
measures, a variety of approaches for covariate selection, and a preponderance
of review articles, all factors that cannot help to convince skeptics.
CONCLUSIONS: Despite these issues, the bulk of the data from prospective studies
with recognized indices of depression and objective outcome measures is
supportive of depression as a cardiac risk factor.
Publication Types:
Review
Gender differences in the link between depression and cardiovascular disease.
Naqvi TZ, Naqvi SS, Merz CN.
Division of Cardiology, Cedars-Sinai Research Institute, Cedars-Sinai Medical
Center, University of California School of Medicine, Los Angeles, California,
USA. tasneem.naqvi@cshs.org
OBJECTIVES: Cardiovascular disease is the leading cause of mortality in women
costing more than 500,000 lives each year in the United States alone. Major
depression in healthy subjects increases cardiovascular mortality in both men
and women. The presence of major depression in patients with recent acute
myocardial infarction (AMI) or unstable angina more than doubles the risk of
cardiac death in both men and women. In the presence of depression, lack of
social integration has an additive effect on cardiac events. Depression is more
prevalent in women with coronary heart disease (CHD) than in men. Psychologic
counseling as well as cognitive behavioral treatment in women post-AMI seems to
adversely affect prognosis, whereas it has neutral effects in men. Pharmacologic
treatment of depression with serotonin reuptake inhibitors is safe in men and
women post-AMI and is particularly effective in patients with recurrent
depression. Whether effective treatment of depression lowers cardiac mortality
remains to be proven.
Publication Types:
Review
58: Expert Opin Investig Drugs. 2005 May;14(5):567-77.
Depression in chronic heart failure: novel pathophysiological mechanisms and
therapeutic approaches.
Parissis JT, Fountoulaki K, Paraskevaidis I, Kremastinos D.
Attikon University Hospital Heart Failure Clinic, Aftocratoros Irakliou 17,
15122, Maroussi, Athens, Greece. jparissis@yahoo.com
Depression is four to five times as common in chronic heart failure (CHF)
patients as in the general population, may confer a higher risk of developing
CHF in susceptible populations, and is significantly related to higher hospital
readmission rates and increased mortality in established CHF. This effect may be
mediated via the pathophysiological mechanisms that are shared between CHF and
depression, including increased hypothalamic-pituitary-adrenal function,
sympathoadrenal hyperactivity, diminished heart-rate variability and excessive
pro-inflammatory cytokine activation. Each of these pathways of linkage
represents a potential therapeutic target to improve outcome in CHF. This paper
reviews the recent investigational observations that clarify the direct effects
of antidepressants on immune functions, as well as the indirect effects of
anticytokine pharmacological agents on depressive symptoms in CHF. With recent
evidence suggesting that selective serotonin re-uptake inhibitors improve
survival after myocardial infarction in patients with depression, diagnosis and
treatment of this comorbidity may beneficially affect the functional capacity
and prognosis of CHF patients.
Publication Types:
Review
59: J Thromb Haemost. 2005 May;3(5):897-908.
Negative impact of depression on outcomes in patients with coronary artery
disease: mechanisms, treatment considerations, and future directions.
Shimbo D, Davidson KW, Haas DC, Fuster V, Badimon JJ.
Behavioral Cardiovascular Health & Hypertension Program, Columbia University
College of Physicians and Surgeons, New York, NY, USA.
Depressive symptoms are common in coronary artery disease (CAD) patients, and
are associated with increased cardiac risk. Although an important relation
exists between depression and CAD prognosis, the underlying pathophysiological
mechanisms are poorly understood. Additionally, evidence including the recently
published ENRICHD (Enhancing Recovery in Coronary Heart Disease Patients) trial
suggests that depression treatments do not lower recurrent cardiac risk. The
reason for the observed lack of benefit with depression treatment in CAD
patients is unclear. In this review, we discuss the impact of depression in CAD
patients, the possible mechanisms involved, the studies that have examined the
effects of psychological and antidepressant therapies on recurrent cardiac
events, and the direction that future research should take.
Publication Types:
Review
60: Psychother Psychosom. 2005;74(2):69-80.
Postmyocardial infarction mortality in relation to depression: a systematic
critical review.
Sorensenf C, Friis-Hasche E, Haghfelt T, Bech P.
The Medical Research Unit, Ringkobing, Denmark. chs@dadlnet.dk
The aim of this review was to survey the literature on depression in patients
with myocardial infarction to assess the methodological quality and to test
whether depression leads to an increased postmyocardial infarction mortality.
Medline, Psycinfo, and www.UMI.com were searched, and researchers were contacted
in the autumn of 2003. Thirty-one articles were reviewed. Only seven articles
scored above a predefined level of 75% for acceptable quality. The articles lack
description of non-responders, recall period for depressive symptoms, validation
of applied instrument on target population, and sample size large enough to show
differences between groups. The prevalence rates of depression ranged from 1.6
to 50%. In eight articles, a diagnostic test was applied, in the rest of the
studies, questionnaires were used. The prevalence of depression was highest in
those using patient-completed questionnaires. A significant positive association
was shown between depression and postmyocardial infarction mortality in 15
studies, a non-significant association in 14, and in two articles, this was not
reported. In articles with data collection starting after 1994, a
non-significant relation tended to be reported. The studies were generally not
of acceptable quality. They lacked sufficient power to show differences in
stated end points between groups. Application of non-validated instruments
caused large differences in prevalence rates of depression. Future studies
should include a minimum of 1,000 patients, use a validated instrument,
re-examine the patients, and describe participants and non-participants in
detail. 2005 S. Karger AG, Basel.
Publication Types:
Review
61: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003329.
Psychological interventions for depression in heart failure.
Lane DA, Chong AY, Lip GY.
University Department of Medicine, City Hospital, Sandwell and West Birmingham
Hospitals NHS Trust, Dudley Road, Birmingham, UK, B18 7QH.
deirdre.lane@swbh.nhs.uk
BACKGROUND: Heart failure is a common and growing health problem. Depression is
prevalent among these patients and is associated with an increased risk of
mortality, in some, but not all, studies. Depression may increase the risk of
recurrent cardiac events and death, either through direct pathophysiological
mechanisms such as thrombogenesis or ventricular arrhythmias, or through
behavioural mechanisms. Depressed patients are less likely to adhere to their
medication regimen and modify their lifestyle appropriately, thereby increasing
the likelihood of recurrent cardiac events and death. The effects of
psychological interventions for depression in terms of reducing depression and
improving prognosis in patients with heart failure are unknown. OBJECTIVES: To
assess the effects of psychological interventions for depression in people with
heart failure on depression and quality of life, morbidity, and mortality in
these patients. SEARCH STRATEGY: We searched the Cochrane Central Register of
Controlled Trials and The Database of Abstracts of Reviews of Effects on The
Cochrane Library (Issue 3, 2003), MEDLINE (1951 to August 2003), PsycINFO (1887
to August 2003), CINAHL (1980 to August 2003) and EMBASE (1980 to August 2003).
Searches of reference lists of retrieved papers were also made and expert advice
was sought. Abstracts from national and international cardiology, psychology,
and psychiatry conferences in 2003 and dissertation abstracts were also
searched. All relevant foreign language papers were translated. SELECTION
CRITERIA: RCTs of psychological interventions for depression in adults (18 years
or older) with heart failure. The primary outcome was a significant reduction in
depression. The secondary outcomes were the acceptability of treatment, quality
of life, cardiac morbidity (hospital re-admission for heart failure and
non-fatal cardiovascular events), reduction of cardiovascular behavioural risk
factors, health economics, and death. DATA COLLECTION AND ANALYSIS: Two
reviewers independently screened titles and abstracts of potential studies. Two
reviewers independently assessed the full papers for inclusion criteria. Further
information was sought from the authors where papers contained insufficient
information to make a decision about eligibility. MAIN RESULTS: No RCTs of
psychological interventions for depression in patients with heart failure were
identified. AUTHORS' CONCLUSIONS: Depression is common among patients with heart
failure. Randomised controlled trials of psychological interventions for
depression in heart failure patients are needed to investigate the impact of
such interventions on depression, quality of life, behavioural CVD risk factors,
cardiac morbidity, health economics and mortality, given the paucity of such
trials in this area and the increasing prevalence of heart failure.
Publication Types:
Review
62: J Cardiopulm Rehabil. 2004 Nov-Dec;24(6):414-21.
Anxiety, posttraumatic stress disorder, and depression in patients with coronary
heart disease: a practical review for cardiac rehabilitation professionals.
Doerfler LA, Paraskos JA.
University of Massachusetts Medical School, Worcester, Massachusetts, USA.
doerfler@assumption.edu
Publication Types:
Review
63: Curr Psychiatry Rep. 2004 Dec;6(6):438-45.
Quality of life in patients with coronary artery disease and the impact of
depression.
Swenson JR.
University of Ottawa, Department of Psychiatry, The Ottawa Hospital, General
Campus, Box 400, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6.
jrswenson@ottawahospital.on.ca
Depression has been shown to be a risk factor for the development of coronary
artery disease, and also is associated with greater risk of mortality in
patients with coronary disease. Treatment of depression may or may not prove to
alter depression as a risk factor, but improving the quality of life (QOL) of
patients with coronary disease also should be considered a primary outcome.
Quality of life is a difficult concept to define and measure. However, recent
investigations in patients with coronary disease have examined the relationship
of QOL to mortality risk and depression. This article will review the concept
and measurement of QOL, discuss studies of factors that predict QOL in patients
with coronary artery disease, and focus on the impact of depression on QOL.
Publication Types:
Review
64: J Cardiovasc Nurs. 2004 Nov-Dec;19(6 Suppl):S47-56.
Identifying and treating depression in patients with heart failure.
Artinian NT, Artinian CG, Saunders MM.
College of Nursing, Wayne State University, Detroit, Mich., USA.
n.artinian@wayne.edu
Depression is a common comorbid condition in patients with heart failure (HF)
that often goes undiagnosed and untreated. Unless symptoms of depression are
specifically looked for, they can be easily missed or mistaken for HF. Clinical
depression is a syndromal diagnosis based on patient history, the report of
signs and symptoms, and the exclusion of competing diagnoses. This article
describes the recommended strategies for recognizing and diagnosing depression.
General, psychotherapeutic, and pharmacological approaches to treatment of
depression in HF are also discussed. General treatment measures include
optimization of medical therapy, patient education, exercise, social support,
and family care. Although there are many types of psychotherapy,
cognitive-behavioral therapy is particularly appropriate for patients with HF
and is described in this article. Categories of antidepressant drugs, including
serotonin reuptake inhibitors, tricyclic antidepressants, and miscellaneous
antidepressants, are reviewed relative to treating depression in patients with
HF. Given the high prevalence and adverse impact of untreated depression in
patients with HF, it is essential for advanced practice nurses to develop the
requisite knowledge and skills for the identification and treatment of
depression.
Publication Types:
Review
65: Adv Mind Body Med. 2004 Fall;20(3):20-31.
Psychosocial factors in heart disease: a process model.
Dreher H.
Publication Types:
Review
66: CNS Spectr. 2004 Oct;9(10):763-72.
Cognitive deficits following coronary artery bypass grafting: prevalence,
prognosis, and therapeutic strategies.
Raja PV, Blumenthal JA, Doraiswamy PM.
Johns Hopkins School of Medicine in Baltimore, MD, USA.
There is increasing recognition that coronary artery bypass grafting (CABG) may
be a risk factor for subtle cognitive decline although the presence and pattern
of such decline has varied across studies. Cognitive deficits may present as
short-term memory loss, executive dysfunction and psychomotor slowing. Although
they are usually are not severe enough to meet criteria for mild cognitive
impairment or vascular dementia, they lower quality of life and add to
hospitalization and out-of-hospital costs. Proposed mechanisms include
surgical-related trauma, genetic susceptibility (eg, apolipoprotein E4 allele),
microembolization, other vascular or ischemic changes, and temperature during
surgery. Depression and anxiety levels predict subjective perception of these
deficits more than objective cognitive performance. Both nonpharmacologic (eg,
emboli reduction, temperature, or glucose management) and pharmacologic (eg,
dexanabinol, glypromate, nootropics) strategies to prevent post-CABG cognitive
deficits are under investigation. Given the large numbers of subjects who may
already have CABG associated cognitive deficits, clinical trials of agents being
tested for Alzheimer's disease (eg, donepezil, rivastigmine, memantine,
neramexane, ginkgo) may also be informative. The results of multicenter
long-term outcome studies (with matched control groups) as well as ongoing
treatment trials will more conclusively address some of these issues. These data
emphasize the need for clinicians to monitor cognitive function before and after
coronary bypass surgery, and to educate patients.
Publication Types:
Review
67: Harv Rev Psychiatry. 2004 Mar-Apr;12(2):79-93.
Is depression a major risk factor for coronary disease? A systematic review of
the epidemiologic evidence.
Wulsin LR.
Department of Psychiatry, University of Cincinnati College of Medicine, Ohio,
USA. lawson.wulsin@uc.edu
My objective is to examine systematically the status of the current evidence for
and against depression as an independent major risk factor for coronary disease.
From English-language reports on depression and coronary disease in MEDLINE
(1966-2002) and PsycINFO (1967-2002), and from informal searches, I selected all
studies that addressed the specific questions related to the established
criteria for risk-factor status: (1) strength of association, (2) prediction,
(3) specificity, (4) consistency, (5) dose-response effect, (6) biological
plausibility, and (7) response to treatment. I find that the evidence for
depression as a coronary disease risk factor is good for four criteria: strength
of association, prediction, consistency, and dose-response effect. The evidence
on specificity and biological plausibility is fair. Due to the lack of
definitive studies, there is currently insufficient evidence for cardiac risk
reduction in response to treatment for depression. My conclusion is that the
evidence for depression's role as an independent major risk factor for coronary
disease is good in four areas, but not yet conclusive in three, pointing to the
need for three types of studies: (1) prospective, observational studies that
address specificity questions, (2) studies of biological mechanisms linking
depression and coronary disease, and (3) clinical trials of treatments for
depression in people with coronary disease or at high risk for developing
coronary disease.
Publication Types:
Review
68: J Card Fail. 2004 Jun;10(3):258-71.
Why is depression bad for the failing heart? A review of the mechanistic
relationship between depression and heart failure.
Joynt KE, Whellan DJ, O'connor CM.
Department of Medicine, Division of Cardiology, Duke University Medical Center,
Durham, North Carolina 27710, USA.
BACKGROUND: Depression is 4 to 5 times as common in heart failure (HF) patients
as in the general population, might confer a higher risk of developing HF, and
negatively affects prognosis in established HF. METHODS AND RESULTS: A review
was undertaken via Medline (1966-2003) and PsycINFO (1872-2003) searches using
the subject headings "depressive disorder" and "heart failure, congestive." Our
findings suggest that the link between depression and HF may be due to shared
pathophysiology. Depression may augment catecholamine release, arrhythmias,
elaboration of proinflammatory cytokines, and platelet activation--processes
that may influence prognosis in HF. Depression is also associated with a higher
risk of noncompliance and lower levels of social support, which have been shown
to worsen prognosis in HF. The impact of pharmacologic or behavioral treatment
for depression on physiologic parameters or clinical outcomes in HF remains
unclear. Inherent difficulties in recognition of depression in the setting of HF
may decrease the likelihood that depressed patients receive the treatment they
need. CONCLUSIONS: Depression is common in HF, may contribute to the development
of HF in susceptible populations, and is independently predictive of poor
clinical outcomes. Pathophysiologic pathways and psychosocial issues that are
shared between the 2 conditions might explain these observations and represent
potential therapeutic targets. Vigilant attention to the recognition and
treatment of depression in HF patients is warranted.
Publication Types:
Review
69: Psychosom Med. 2004 May-Jun;66(3):305-15.
Depression as a risk factor for coronary artery disease: evidence, mechanisms,
and treatment.
Lett HS, Blumenthal JA, Babyak MA, Sherwood A, Strauman T, Robins C, Newman MF.
Center, Durham, North Carolina 27710, USA. lett0002@mc.duke.edu
OBJECTIVE: The present paper reviews the evidence that depression is a risk
factor for the development and progression of coronary artery disease (CAD).
METHODS: MEDLINE searches and reviews of bibliographies were used to identify
relevant articles. Articles were clustered by theme: depression as a risk
factor, biobehavioral mechanisms, and treatment outcome studies. RESULTS:
Depression confers a relative risk between 1.5 and 2.0 for the onset of CAD in
healthy individuals, whereas depression in patients with existing CAD confers a
relative risk between 1.5 and 2.5 for cardiac morbidity and mortality. A number
of plausible biobehavioral mechanisms linking depression and CAD have been
identified, including treatment adherence, lifestyle factors, traditional risk
factors, alterations in autonomic nervous system (ANS) and hypothalamic
pituitary adrenal (HPA) axis functioning, platelet activation, and inflammation.
CONCLUSION: There is substantial evidence for a relationship between depression
and adverse clinical outcomes. However, despite the availability of effective
therapies for depression, there is a paucity of data to support the efficacy of
these interventions to improve clinical outcomes for depressed CAD patients.
Randomized clinical trials are needed to further evaluate the value of treating
depression in CAD patients to improve survival and reduce morbidity.
Publication Types:
Review
70: Prev Cardiol. 2004 Spring;7(2):83-90; quiz 91-2.
Depression and acute myocardial infarction.
Malach M, Imperato PJ.
IPRO, Lake Success, NY 11042, USA.
A number of studies have demonstrated a relationship between depression and low
perceived social support and increased cardiac morbidity and mortality in
patients with coronary heart disease. There is also evidence that depression
increases the risk of acute myocardial infarction and morbidity and mortality
following it. This review examines those studies that have investigated these
relationships as well as those that have attempted to explain them on the basis
of various pathophysiologic mechanisms. Among the latter are studies that have
shown that selective serotonin reuptake inhibitors are beneficial in the
treatment of depression and that they appear to reverse the enhanced platelet
activity observed in depressed patients with acute myocardial infarction.
Depression increases hospital length of stay, procedures, readmission rates, and
the cost of medical care. Much remains to be elucidated concerning the roles of
depression and low perceived social support in predisposing to acute myocardial
infarction and to increased morbidity and mortality following it. However,
sufficient scientific evidence exists for physicians to make efforts to diagnose
and treat depression to reduce the concurrent risk of acute myocardial
infarction and morbidity and mortality following it.
Publication Types:
Review
Psychological theories of depression: potential application for the prevention
of acute coronary syndrome recurrence.
Davidson KW, Rieckmann N, Lesperance F.
Columbia College of Physicians and Surgeons, New York, NY 10032, USA.
kd2124@columbia.edu
OBJECTIVE: The natural course of elevated depressive symptoms or subthreshold
depression in patients with an acute coronary syndrome (ACS) is presented, as is
the prognostic impact. Safe and effective psychological treatment options are
desirable for subthreshold depression in patients with ACS, should they prove
tolerable, efficacious, and cost-effective to cardiologists and their patients.
To achieve this long-term goal, we propose focusing on 3 intermediate goals.
First, we need to understand which symptoms or patterns of symptoms (eg,
fatigue, anhedonia, guilt feelings) are specifically predictive of ACS
recurrence. Second, the prevalence of known psychosocial vulnerabilities
(proximal causes) of depressive disorders should be assessed in patients with
ACS, to understand better the etiology of these symptoms in these patients.
Third, randomized controlled trials of vulnerability-related, evidence-based
psychological depression interventions in cardiac patients are needed. The ways
in which psychological proximal cause theories are relevant--or irrelevant--for
both the treatment of depressive symptoms in post-ACS patients and the
prevention of ACS recurrence are discussed.
Publication Types:
Review
72: Eur Heart J. 2004 Jan;25(1):3-9.
Coronary artery disease and depression.
Zellweger MJ, Osterwalder RH, Langewitz W, Pfisterer ME.
Cardiology Department, University Hospital, University of Basel, Petersgraben 4,
CH-4031 Basel, Switzerland. mzellweger@uhbs.ch
Coronary artery disease (CAD) as well as depression are both highly prevalent
diseases. Both cause a significant decrease in quality of life for the patient
and impose a significant economic burden on society. There are several factors
that seem to link depression with the development of CAD and with a worse
outcome in patients with established CAD: worse adherence to prescribed
medication and life style modifications in depressive patients, as well as
higher rates in abnormal platelet function, endothelial dysfunction and lowered
heart rate variability. The evidence is growing that depression per se is an
independent risk factor for cardiac events in a patient population without known
CAD and also in patients with established diagnosis of CAD, particularly after
myocardial infarction. Treatment of depression has been shown to improve
patients' quality of life. However, it did not improve cardiovascular prognosis
in depressed patients even though there is open discussion about the trend to
better outcome in treated patients. Large scale clinical trials are needed to
answer this question. Selective serotonin reuptake inhibitors seem to be
preferable to tricyclic antidepressants for treatment of depressive patients
with comorbid CAD because of their good tolerability and absence of significant
cardiovascular side effects. Hypericum perforatum (St. John's wort), an
increasingly used herbal antidepressant drug should be used with caution due to
severe and possibly dangerous interaction with cardioactive drugs.
Publication Types:
Review
73: Eur J Cardiovasc Nurs. 2002 Oct;1(3):183-8.
Psychosocial factors and their association with clinical outcomes in patients
with heart failure: why clinicians do not seem to care.
Moser DK.
College of Nursing, University of Kentucky, 527 CON/HSLC Building, Lexington, KY
40536-0232, USA. dmoser@uky.edu
Poor quality of life, social isolation, depression and anxiety all have been
linked to increased risk of rehospitalization and mortality in patients with
heart failure. Yet, despite evidence of their importance to outcomes in heart
failure patients, psychosocial factors are assessed and treated infrequently in
clinical practice. Potential reasons for this include: (1) inadequate
dissemination of research about the link between psychosocial factors and
outcomes; (2) insufficient training in heart-mind interactions that precludes
clinicians from taking advantage of what is known; (3) perceived problems with
interventions or with the science of heart-mind interactions that interfere with
acceptance of what is known; (4) concerns about how to measure psychosocial
factors in clinical practice; and (5) lack of curiosity from clinicians about
the role of psychosocial factors in their patients. In this article, each of
these possible explanations is explored and recommendations suggested.
Publication Types:
Review
74: Psychosom Med. 2003 Sep-Oct;65(5):729-37.
Increased coronary events in depressed cardiovascular patients: 5-HT2A receptor
as missing link?
Schins A, Honig A, Crijns H, Baur L, Hamulyak K.
Department of Psychiatry, Academic Hospital Maastricht, Maastricht, The
Netherlands.
OBJECTIVE: Major depressive disorder and depressive symptoms have been
identified as independent risk factors for cardiac morbidity and mortality in
patients with ischemic heart disease. Increased susceptibility to platelet
activation has been proposed as one of the mechanisms by which depression acts
as a significant risk factor for thrombotic events. In this review, data on
platelet activation and platelet aggregation measures in depressed patients with
or without concomitant cardiovascular disease are given. Data on the influence
of antidepressants on parameters of platelet activation are summarized. METHODS:
A literature search was done by checking MEDLINE Advanced and PsycInfo from 1990
to 2003 and through checking the bibliographies of these sources. The following
key words were used for this search: platelet activation, platelet aggregation,
depression, depressive disorder, ischemic heart disease, calcium, and serotonin.
RESULTS: There is an indication of enhanced platelet activation and aggregation
in depressed patients. Next, patients with a depressive disorder show signs of a
hyperactive platelet 5-HT2A receptor signal transduction system as measured by
increased platelet calcium mobilization after stimulation of platelets with
serotonin. CONCLUSIONS: Depression appears to be associated with an increased
susceptibility for serotonin-mediated platelet activation. Upregulation and/or
increased sensitivity of 5-HT2A/1B receptors and downregulated 5-HT transporter
receptors in the periphery may contribute to increased risk of thromboembolic
events in patients with depression and cardiovascular disease. Increased
platelet reactivity based on a hyperreactive 5-HT2A receptor signaling system
might be influenced by antidepressive medication that antagonizes platelet
5-HT2A receptors.
Publication Types:
Review
75: Cochrane Database Syst Rev. 2003;(3):CD004394.
Psychological interventions for depression in adolescent and adult congenital
heart disease.
Lip GY, Lane DA, Millane TA, Tayebjee MH.
Haemostasis Thrombosis and Vascular Biology Unit, University Department of
Medicine, City Hospital, Dudley Road, Birmingham, UK, B18 7QH.
BACKGROUND: Adult and adolescent congenital heart disease is increasing in
prevalence as better medical care means more children are surviving to
adulthood. People with chromic disease often also experience depression. There
are several non-pharmacological treatments that might be effective in treating
depression and improving quality of life for adults and young adults with
congenital heart disease. The aim of this review was to assess the effects of
treatments such as psychotherapy, cognitive behavioural therapies and talking
therapies for treating depression in this population. OBJECTIVES: To assess the
effects (both harms and benefits) of psychological interventions for treating
depression in young adults and adults with congenital heart disease. SEARCH
STRATEGY: We searched the Cochrane Controlled Trials Register (CCTR) (on The
Cochrane Library issue 4, 2002), MEDLINE (1966 to August 2002), EMBASE (1980 to
August 2002), PsycLIT (1887 to August 2002), the Database of Abstracts of
Reviews of Effectiveness (DARE) (Issue 4, 2002 of the Cochrane Library),
Biological Abstracts (January 1980 to August 2002), and CINAHL (January 1980 to
August 2002). Abstracts from national and international cardiology and
psychology conferences and dissertation abstracts were also searched. SELECTION
CRITERIA: Randomised controlled trials comparing psychological interventions
with no intervention for people over 15 years with depression who have
congenital heart disease. DATA COLLECTION AND ANALYSIS: Two reviewers
independently screened titles and abstracts of studies that were potentially
relevant to the review. Studies that were clearly ineligible were rejected. Two
reviewers independently assessed the abstracts or full papers for inclusion
criteria. Further information was sought from the authors where papers contained
insufficient information to make a decision about eligibility. MAIN RESULTS: No
randomised controlled trials were identified. REVIEWER'S CONCLUSIONS: Depression
is common in patients with congenital heart disease and can exacerbate the
physical consequences of the illness. There are effective pharmacological and
non-pharmacological treatments for depression, but we have not been able to
identify any trials showing the effectiveness of non-pharmacological treatments.
A well designed randomised controlled trial is needed to assess the effects of
psychological interventions for depression in congenital heart disease.
Publication Types:
Review
76: Biol Psychiatry. 2003 Aug 1;54(3):262-8.
Treatment of depression in patients with heart disease.
Roose SP.
College of Physicians and Surgeons, Columbia University, New York, New York
10032, USA.
There is a growing body of evidence that depression significantly and adversely
affects cardiovascular health. Perhaps the most prominent finding is the
documented increase in mortality rate in patients with depression after
myocardial infarction. The critical questions of interest to both the clinician
and researcher are whether there are safe and effective treatments for
depression in patients with heart disease and whether treatment of depression
reduces the increased risk of cardiac morbidity and mortality. Though the data
are limited and are primarily from open or comparator trials, the tricyclic
antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and
specific psychotherapies appear to be effective for treatment of depression in
patients with ischemic heart disease (IHD), and response rates are comparable to
those reported in depressed patients without heart disease; however, there has
been only one placebo-controlled trial to date, and therefore it is premature to
come to definitive conclusions regarding the efficacy of antidepressant
therapies in this patient population. With respect to safety, the TCAs are
associated with documented adverse cardiovascular effects, including increases
in heart rate, orthostatic hypotension, and conduction delays. Use of TCAs in
patients with IHD carries a proven increased risk of cardiac morbidity and
perhaps of mortality as well. The SSRIs appear to be relatively safe and
effective treatment for depression in patients with comorbid IHD.
Publication Types:
Review
Depression, mortality, and medical morbidity in patients with coronary heart
disease.
Carney RM, Freedland KE.
Department of Psychiatry, Washington University School of Medicine, St Louis,
Missouri 63108, USA.
There is substantial evidence that depression is a risk factor for cardiac
morbidity and mortality, both for patients without clinical evidence of coronary
heart disease at index examination and for patients with established coronary
disease. The relationship is most apparent for patients with a recent acute
myocardial infarction. Many questions about the impact of depression on heart
disease remain unresolved.
Publication Types:
Review
Epidemiology of comorbid coronary artery disease and depression.
Rudisch B, Nemeroff CB.
Department of Psychiatry and Behavioral Sciences, Emory University School of
Medicine, Atlanta, Georgia 30322, USA.
This article reviews the epidemiology of comorbid coronary artery disease and
unipolar depression. Both major depression and subsyndromal depressive symptoms
will be considered; unless otherwise specified, the term depression will be used
to designate all depressive states, including major depressive disorder, minor
depression, dysthymia, and other subsyndromal forms of depression. While 17% to
27% of patients with coronary artery disease have major depression, a
significantly larger percentage has subsyndromal symptoms of depression.
Patients with coronary artery disease and depression have a twofold to threefold
increased risk of future cardiac events compared to patients without depression,
independent of baseline cardiac dysfunction. The relative risk for the
development of coronary artery disease conferred by depression in patients
initially free of clinical cardiac disease is approximately 1.5, independent of
other known risk factors for coronary disease. In the discussion, special
attention will be paid to the interactions of both gender and age with
depression and coronary artery disease risk. Scrutiny of the role of confounding
risk factors is presented, such as global burden of comorbid medical illness and
modification of traditional risk factors, which may, in part, mediate the effect
of depression on coronary artery disease.
Publication Types:
Review
79: Congest Heart Fail. 2003 May-Jun;9(3):163-9.
Depression and congestive heart failure.
Guck TP, Elsasser GN, Kavan MG, Barone EJ.
Department of Family Practice, Creighton University School of Medicine, Omaha,
NE 68102, USA. tpguck@creighton.edu
The prevalence rates of depression in congestive heart failure patients range
from 24%-42%. Depression is a graded, independent risk factor for readmission to
the hospital, functional decline, and mortality in patients with congestive
heart failure. Physicians can assess depression by using the SIG E CAPS + mood
mnemonic, or any of a number of easily administered and scored self-report
inventories. Cognitive-behavior therapy is the preferred psychological
treatment. Cognitive-behavior therapy emphasizes the reciprocal interactions
among physiology, environmental events, thoughts, and behaviors, and how these
may be altered to produce changes in mood and behavior. Pharmacologically, the
selective serotonin reuptake inhibitors are recommended, whereas the tricyclic
antidepressants are not recommended for depression in congestive heart failure
patients. The combination of a selective serotonin reuptake inhibitor with
cognitive-behavior therapy is often the most effective treatment.
Publication Types:
Review
80: Pharmacotherapy. 2003 Jun;23(6):754-71.
Safety of antidepressant drugs in the patient with cardiac disease: a review of
the literature.
Alvarez W Jr, Pickworth KK.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland
21287-6180, USA.
Patients with cardiac disease, specifically ischemic heart disease and heart
failure, have a higher frequency of major depressive disorder than patients
without cardiac disease. The pathophysiologic reason for this is not completely
understood. Previous depression, other debilitating illnesses, and type A
personality are risk factors for the development of depression in cardiac
patients. Depression has been shown to lower the threshold for ventricular
arrhythmias. Therefore, treatment of depression potentially may prolong life in
these patients. Antidepressant options that have been evaluated include several
of the tricyclic antidepressants, trazodone, bupropion, and several of the
selective serotonin reuptake inhibitors. Individual antidepressant drugs vary in
their pharmacologic activity and side-effect profiles. Although clinical data
are limited, it is important to individualize therapy in order to minimize
cardiac adverse effects. Clinicians are encouraged to evaluate patients with
cardiac disease for major depressive disorder and to consider antidepressant
drug therapy for these patients when appropriate.
Publication Types:
Review
81: Heart. 2003 May;89 Suppl 2:ii16-8; discussion ii35-7.
The psychological perspective: a professional view.
Newman S.
Centre for Behavioural and Social Sciences in Medicine, Department of Psychiatry
and Behavioural Sciences, University College London, London, UK.
S.Newman@ucl.ac.uk
Psychological issues surrounding the care of patients with cardiovascular
disease are many and diverse. This paper discusses three main areas: cognitions,
emotions, and social support. The examples given relate primarily to
post-myocardial infarction patients but the concepts discussed are relevant to
other aspects of cardiovascular disease. Patients' cognitions can influence
early help seeking for symptoms of myocardial infarction, attendance at cardiac
rehabilitation, behaviour change, and return to work. Depression and anxiety are
common following myocardial infarction and can be associated with increased
mortality. Mood changes must therefore be addressed as part of the cardiac
rehabilitation programme. Social support also plays an important part in cardiac
rehabilitation.
Publication Types:
Review
82: Curr Psychiatry Rep. 2003 May;5(1):47-54.
Depression and ischemic heart disease: overview of the evidence and treatment
implications.
Jiang W, Blumenthal JA.
Department of Psychiatry and Behavioral Science, Duke University Medical Center,
Box 3366, Durham, NC 27710, USA. jiang001@mc.duke.edu
In this article, the authors review the evidence that depression is a risk
factor for ischemic heart disease and examine the efficacy and safety of
depression treatments in patients with ischemic heart disease.
Publication Types:
Review
83: Neurosci Biobehav Rev. 2002 Dec;26(8):941-62.
Biological mechanisms in the relationship between depression and heart disease.
Grippo AJ, Johnson AK.
Department of Psychology, The University of Iowa, Iowa City 52242-1407, USA.
Psychological depression is shown to be associated with several aspects of
coronary artery disease (CAD), including arrhythmias, myocardial infarction,
heart failure and sudden death. The physiological mechanisms accounting for this
association are unclear. Hypothalamic-pituitary-adrenal dysregulation,
diminished heart rate variability, altered blood platelet function and
noncompliance with medial treatments have been proposed as mechanisms underlying
depression and cardiovascular disease. Recent evidence also suggests that
reduced baroreflex sensitivity, impaired immune function, chronic fatigue and
the co-morbidity of depression and anxiety may be involved in the relationship
between depression and cardiovascular dysregulation. An experimental strategy
using animal models for investigating underlying physiological abnormalities in
depression is presented. A key to understanding the bidirectional association
between depression and heart disease is to determine whether there are common
changes in brain systems that are associated with these conditions. Such
approaches may hold promise for advancing our understanding of the interaction
between this mood disorder and CAD.
Publication Types:
Review
Do depressive symptoms increase the risk for the onset of coronary disease? A
systematic quantitative review.
Wulsin LR, Singal BM.
Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA.
lawson.wulsin@uc.edu
OBJECTIVE: The objectives of this study were to systematically review the recent
studies of the contribution of depression to the onset of coronary disease and
to estimate the magnitude of the risk posed by depression for onset of coronary
disease. METHOD: We searched MEDLINE (1966-2000), PsychInfo (1967-2000), and
cross references and conducted informal searches for all community studies of
depression symptoms in samples with no clinically apparent heart disease at
baseline. From these studies we selected all published cohort studies of 4 years
or more follow-up that controlled for other major coronary disease risk factors
and reported relative risks (or a comparable measure) of baseline depression for
the onset of coronary disease. Following methods for the meta-analysis of
epidemiologic studies, we used a random-effects model to estimate the combined
overall relative risk. RESULTS: Ten studies met our inclusion criteria. Relative
risks ranged from 0.98 to 3.5. Nine studies reported significantly increased
risk, including two with mixed results; one study reported no increased risk.
The combined overall relative risk of depression for the onset of coronary
disease was 1.64 (95% CI = 1.41-1.90). CONCLUSIONS: This quantitative review
suggests that depressive symptoms contribute a significant independent risk for
the onset of coronary disease, a risk (1.64) that is greater than the risk
conferred by passive smoking (1.25) but less than the risk conferred by active
smoking (2.5). Future prospective community studies should examine the effect of
severity and duration of depressive symptoms and disorders on the risk for the
onset of coronary disease.
Publication Types:
Meta-Analysis
Review
85: Med J Aust. 2003 Mar 17;178(6):272-6.
Comment in:
ACP J Club. 2003 Nov-Dec;139(3):81.
"Stress" and coronary heart disease: psychosocial risk factors.
Bunker SJ, Colquhoun DM, Esler MD, Hickie IB, Hunt D, Jelinek VM, Oldenburg BF,
Peach HG, Ruth D, Tennant CC, Tonkin AM.
National Heart Foundation, 411 King Street, West Melbourne, VIC 3003, Australia.
steve.bunker@heartfoundation.com.au
An Expert Working Group of the National Heart Foundation of Australia undertook
a review of systematic reviews of the evidence relating to major psychosocial
risk factors to assess whether there are independent associations between any of
the factors and the development and progression of coronary heart disease (CHD),
or the occurrence of acute cardiac events. The expert group concluded that (i)
there is strong and consistent evidence of an independent causal association
between depression, social isolation and lack of quality social support and the
causes and prognosis of CHD; and (ii) there is no strong or consistent evidence
for a causal association between chronic life events, work-related stressors
(job control, demands and strain), Type A behaviour patterns, hostility, anxiety
disorders or panic disorders and CHD. The increased risk contributed by these
psychosocial factors is of similar order to the more conventional CHD risk
factors such as smoking, dyslipidaemia and hypertension. The identified
psychosocial risk factors should be taken into account during individual CHD
risk assessment and management, and have implications for public health policy
and research.
Publication Types:
Comparative Study
Review
86: Behav Modif. 2003 Jan;27(1):83-102.
Negative emotion and coronary heart disease. A review.
Sirois BC, Burg MM.
VA Connecticut Healthcare System, USA.
This article reviews literature regarding the influence of negative emotions,
specifically depression, anger/hostility, and anxiety on coronary heart disease
(CHD). For each domain, evidence is presented demonstrating the deleterious
effects of negative affect on health outcomes in patients with CHD. This is
followed by a discussion of the manner in which emotional factors are transduced
into cardiac health risk factors. The pathophysiological mechanisms by which
negative emotions have been found to exert an influence on CHD are highlighted.
Finally, a general overview of the outcomes of interventions designed to
ameliorate the effects of these negative emotional states on cardiovascular
health are reviewed. Several treatment studies are described in detail for the
purpose of elaborating the types of multicomponent interventions that attempt to
address negative emotions in populations with CHD.
Publication Types:
Review
87: AACN Clin Issues. 2003 Feb;14(1):3-12.
Depression in patients with heart failure: physiologic effects, incidence, and
relation to mortality.
Thomas SA, Friedmann E, Khatta M, Cook LK, Lann AL.
School of Nursing, University of Maryland, Baltomore 21201, USA.
Thomas@son.umaryland.edu
Heart failure affects 4.8 million people in the United States. Patients
depressed after myocardial infarction have increased morbidity and mortality.
Only a few studies have investigated the effects of depression in patients with
heart failure. The incidence of depression in heart failure ranges from 13% to
77.5%. Men with heart failure are more likely to become depressed than the
general population. Depression incidence is higher in hospitalized patients with
heart failure than in stabilized outpatients. In patients with heart failure,
depression is associated with mortality. Physiologic changes, which occur in
depressed patients, have been implicated as possibly contributing to the
increased mortality. Nurses have a major role in the management of patients with
heart failure and can be pivotal in the detection and treatment of depression in
these patients. Reduction in depression is likely to decrease morality in
patients with heart failure.
Publication Types:
Review
88: Am Heart J. 2007 Jul;154(1):102-8.
Relationship between depressive symptoms and long-term mortality in patients
with heart failure.
Jiang W, Kuchibhatla M, Clary GL, Cuffe MS, Christopher EJ, Alexander JD, Califf
RM, Krishnan RR, O'Connor CM.
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
jiang001@mc.duke.edu
BACKGROUND: Depression is prevalent in patients with heart failure (HF) and is
associated with short-term poor prognosis. However, the long-term effect of
depression and the use of self-administered depression evaluation on HF
prognosis remained unknown. The study sought to assess the association of
depressive symptoms and long-term mortality of patients with HF and to explore
the prognostic predictability of the Beck Depression Inventory (BDI) scale for
patients with HF. METHODS: Hospitalized patients with HF between March 1997 and
June 2003 were recruited. All participants were given the self-administered BDI
scale for depression assessment during the index admission. They were then
followed for 6 months for the collection of vital status, and annually
thereafter. RESULTS: Total study population comprises 1006 patients. The mean
BDI score was 8.3 +/- 7.1. The average days of follow-up were 971 +/- 730 and
the vital status was obtained from all participants. During this period, 42.6%
of the participants died. Depression (defined by BDI score > or = 10) was
significantly and independently associated with reduced survival (adjusted
hazard ratio 1.36, 95% CI 1.09-1.70, P < .001). Patients whose BDI scores were 5
to 9, 10 to 18, and > or = 19 were 21%, 53%, and 83% more likely to die,
respectively, than patients whose BDI score was < 5 (P < .001). CONCLUSIONS:
Self-rated depression by BDI is independently linked with higher long-term
mortality in patients with HF. Significant dose effect of depressive symptoms on
higher mortality is noted.
Publication Types:
89: J Am Coll Cardiol. 2006 Oct 17;48(8):1527-37. Epub 2006 Sep 26.
Comment in:
J Am Coll Cardiol. 2007 Apr 3;49(13):1503-4; author reply 1504.
Depression in heart failure a meta-analytic review of prevalence, intervention
effects, and associations with clinical outcomes.
Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ.
University of California, San Diego, San Diego, California, USA.
Thomas.Rutledge@va.gov
This article describes a meta-analysis of published associations between
depression and heart failure (HF) in regard to 3 questions: 1) What is the
prevalence of depression among patients with HF? 2) What is the magnitude of the
relationship between depression and clinical outcomes in the HF population? 3)
What is the evidence for treatment effectiveness in reducing depression in HF
patients? Key word searches of the Medline and PsycInfo databases, as well as
reference searches in published HF and depression articles, identified 36
publications meeting our criteria. Clinically significant depression was present
in 21.5% of HF patients, and varied by the use of questionnaires versus
diagnostic interview (33.6% and 19.3%, respectively) and New York Heart
Association-defined HF severity (11% in class I vs. 42% in class IV), among
other factors. Combined results suggested higher rates of death and secondary
events (risk ratio = 2.1, 95% confidence interval 1.7 to 2.6), trends toward
increased health care use, and higher rates of hospitalization and emergency
room visits among depressed patients. Treatment studies generally relied on
small samples, but also suggested depression symptom reductions from a variety
of interventions. In sum, clinically significant depression is present in at
least 1 in 5 patients with HF; however, depression rates can be much higher
among patients screened with questionnaires or with more advanced HF. The
relationship between depression and poorer HF outcomes is consistent and strong
across multiple end points. These findings reinforce the importance of
psychosocial research in HF populations and identify a number of areas for
future study.
Publication Types:
Meta-Analysis
Comment in:
Course of depressive symptoms and medication adherence after acute coronary
syndromes: an electronic medication monitoring study.
Rieckmann N, Gerin W, Kronish IM, Burg MM, Chaplin WF, Kong G, Lesperance F,
Davidson KW.
Department of Psychiatry, Mount Sinai School of Medicine, New York, New York,
USA.
OBJECTIVES: We tested whether improvements in depressive symptoms precede
improved adherence to aspirin in patients with acute coronary syndromes (ACS).
BACKGROUND: Depression is associated with medication nonadherence in patients
with ACS, but it is unclear whether changes in depression impact on adherence.
METHODS: Electronic medication monitoring was used to measure adherence to
aspirin during a 3-month period in a consecutive cohort of 172 patients (25 to
85 years) recruited within 1 week of hospitalization for ACS. Depressive symptom
severity was assessed using the Beck Depression Inventory (BDI) during
hospitalization and at 1 and 3 months after hospitalization. Adherence was
defined as the percentage of days aspirin was taken as prescribed. RESULTS:
Depression severity in hospital was associated with nonadherence in a gradient
fashion: 15% of non-depressed patients (BDI score 0 to 4), 29% of mildly
depressed patients (BDI score 10 to 16), and 37% of patients with
moderately-to-severely depressive symptoms (BDI score >16) took aspirin less
than 80% of the time (p = 0.03). A cross-lagged path analytic model revealed
that improvements in depressive symptoms in the first month after the ACS were
associated with improvements in adherence rates in the subsequent 2 months
(standardized direct effect -0.32, p = 0.016). CONCLUSIONS: Diagnosis and
treatment of depressive symptoms may improve medication adherence in patients
after ACS.
Publication Types:
91: J Rehabil Med. 2007 May;39(5):412-7.
Impact of depressive mood on lifestyle changes in patients with coronary artery
disease.
Soderman E, Lisspers J, Sundin O.
Department of Social Sciences, MidSweden University, Ostersund, Sweden.
eva.soderman@miun.se
OBJECTIVE: The aims of this study were to investigate the time-course of
depressive mood in patients with coronary artery disease during a secondary
prevention rehabilitation program, and to analyse how different pre-treatment
levels of depressive mood during a treatment phase were related to the degree of
lifestyle change at 36 months follow-up. SUBJECTS: The study group comprised 109
of the original 183 consecutive coronary artery disease patients (91 male and 18
female) of whom 48 recently had experienced an acute myocardial infarction, 36
had been treated with coronary bypass surgery, 13 with percutaneous transluminal
coronary angioplasty, and 12 had angina pectoris that had not been invasively
treated. The subjects were divided into 3 subgroups based on their pre-treatment
level of depressive mood. METHODS: Depressive mood was assessed at baseline,
after 4 weeks and 12 months, using the depression subscale of the Hospital
Anxiety and Depression scale. Lifestyle changes analysed included diet, smoking,
relaxation (stress management) and exercise. RESULTS: Overall depressive mood
ratings were significantly lower, both at the 4-week and 12-month assessments,
compared with baseline, with the greatest improvements in patients with higher
Hospital Anxiety and Depression measured depression. Original levels of
depressive mood were not found to influence change of lifestyle habits during a
36-month follow-up period. CONCLUSION: Depressive mood might not be an obstacle
to lifestyle changes when participating in a behaviourally oriented
rehabilitation program including exercise-training, which might be a component
important for improved depressive mood.
Publication Types:
92: J Nerv Ment Dis. 2007 May;195(5):389-95.
Religion and remission of depression in medical inpatients with heart
failure/pulmonary disease.
Koenig HG.
Department of Psychiatry and Behavioral Sciences, and Medicine, Duke University
Medical Center, GRECC VA Medical Center, Durham, North Carolina 27710, USA.
koenig@geri.duke.edu
The impact of religious involvement on time to remission of depression was
examined in older medical inpatients with heart failure and/or chronic pulmonary
disease (CHF/CPD). Inpatients older than 50 years with CHF/CPD were
systematically diagnosed with depressive disorder using a structured psychiatric
interview. Cox proportional hazards regression was used to examine the effects
of religious involvement on time to remission, controlling for covariates. Of
1000 depressed patients identified at baseline, follow-up data on depression
course were obtained on 87%. Patients involved in group-related religious
activities experienced a shorter time to remission. Although numerous religious
measures were unrelated by themselves to depression outcome, the combination of
frequent religious attendance, prayer, Bible study, and high intrinsic
religiosity, predicted a 53% increase in speed of remission (HR 1.53, 95% CI
1.20-1.94, p = 0.0005, n = 839) after controls. Patients highly religious by
multiple indicators, particularly those involved in community religious
activities, remit faster from depression.
Publication Types:
Comparative Study
93: J Am Coll Cardiol. 2007 May 8;49(18):1834-40. Epub 2007 Apr 20.
Depression is a risk factor for mortality after myocardial infarction: fact or
artifact?
Dickens C, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed F.
Psychological Medicine Research Group, Department of Psychiatry, Manchester
University, Manchester, England. chris.dickens@manchester.ac.uk
OBJECTIVES: This study sought to investigate the long-term impact of depression
on cardiac mortality after myocardial infarction (MI) and to assess whether the
timing of depression influences the findings. BACKGROUND: Previous studies have
shown that depression increases the risk of cardiac death after MI, although
some studies with robust methodology have failed to show this effect. Clinical
trials of depression treatments have failed to improve mortality. Until the
relationship between depression and post-MI mortality is understood fully,
clinical trials aimed at reducing mortality by treating depression remain
premature. METHODS: We recruited 588 subjects after MI and followed up their
cases for up to 8 years. Patients underwent detailed assessments of cardiac
status, conventional cardiac risk factors, and noncardiac illness at baseline.
Depression was assessed for the period immediately preceding MI and at 12 months
after MI, using a standardized questionnaire and a research interview. At
follow-up, the mortality status, cause, and date of death were recorded for 587
subjects using population records. RESULTS: Multivariate predictors of cardiac
death included older age (hazard ratio [HR] = 1.04, p = 0.007), previous angina
(HR = 1.8, p = 0.03), previous MIs (HR = 1.6, p = 0.004), Killip class (HR =
1.8, p = 0.005), beta-blockers (HR = 0.5, p = 0.023), and angiotensin-converting
enzyme inhibitors (HR = 0.6, p = 0.047) prescribed on discharge. Depression was
not associated with cardiac mortality, whether detected immediately before MI (p
= 0.48), 12 months after MI (p = 0.27), or at both time points (p = 0.97).
CONCLUSIONS: The association between depression and post-MI mortality is
complex, possibly being limited to depression immediately after MI. Defining the
window when intervention for depression might benefit survival is crucial for
the design of future trials.
Publication Types:
Multicenter Study
94: JAMA. 2007 May 2;297(17):1879-80; author reply 1880.
Comment on:
JAMA. 2007 Jan 24;297(4):367-79.
Treatment of depression in patients with coronary artery disease.
Dornelas EA, Burg MM.
Publication Types:
Comment
Letter
95: JAMA. 2007 May 2;297(17):1878-9; author reply 1880.
Comment on:
JAMA. 2007 Jan 24;297(4):367-79.
Treatment of depression in patients with coronary artery disease.
Ziegelstein RC.
Publication Types:
Comment
Letter
96: JAMA. 2007 May 2;297(17):1877; author reply 1878.
Comment on:
JAMA. 2007 Jan 10;297(2):177-86.
Mortality and adherence to pharmacotherapy after acute myocardial infarction.
Parakh K, Bush DE, Ziegelstein RC, Thombs BD, Fauerbach JA.
Publication Types:
Comment
Letter
97: Am Heart J. 2007 May;153(5):868-73.
A double-blind placebo-controlled pilot study of controlled-release paroxetine
on depression and quality of life in chronic heart failure.
Gottlieb SS, Kop WJ, Thomas SA, Katzen S, Vesely MR, Greenberg N, Marshall J,
Cines M, Minshall S.
University of Maryland School of Medicine and the Baltimore VAMC, Baltimore, MD,
USA. sgottlie@medicine.umaryland.edu
BACKGROUND: Depression is frequently observed in patients with heart failure and
is associated with poor quality of life and adverse prognosis. However, the
prevalence of depression in heart failure could be overestimated because
symptoms of depression overlap with those of heart failure. Similarly, the
importance of depression may be overestimated if depression merely reflects
worse heart failure. Because the response to depression treatment has not been
evaluated in this patient population, we evaluated the efficacy of
controlled-release paroxetine (paroxetine CR), a selective serotonin reuptake
inhibitor, on depression and quality of life in chronic heart failure. METHODS:
A double-blind, randomized, placebo-controlled design was used to evaluate
reductions in depression following 12 weeks of treatment with paroxetine CR (n =
14, age 62.1 +/- 12.3 years) or placebo (n = 14, age = 61.9 +/- 9.0 years).
Patients with symptomatic congestive heart failure and a score of at least 10 on
the Beck Depression Inventory (BDI) were eligible. Beck Depression Inventory was
obtained at baseline and 4, 8, and 12 weeks of follow-up. Quality of life was
assessed using the Medical Outcomes Study Short Form and the Minnesota Living
with Heart Failure Questionnaire. RESULTS: Controlled-release paroxetine
resulted in significantly more recovery from depression (BDI <10) than placebo
(69% vs 23%, P = .018) and resulted in lower continuous BDI scores throughout
the intervention (P = .024). Controlled-release paroxetine was associated with
higher general health levels compared with placebo on the Medical Outcomes Study
36-Item Short Form survey (38 +/- 10 vs 30 +/- 6, P = .016) at 12 weeks of
follow-up. Reductions in depression were correlated with improvements in
psychological aspects of quality of life (P < .05) but not with physical quality
of life measures (P > .10). CONCLUSION: Antidepressant therapy with paroxetine
CR results in significant reductions in depression among patients with heart
failure. The reductions in depression with paroxetine CR are accompanied by
improvements in psychological aspects of quality of life. Larger controlled
trials are needed to further document the effectiveness of paroxetine CR and
other selective serotonin reuptake inhibitors in patients with heart failure and
to determine patient subgroups that are most likely to benefit from
antidepressive interventions.
Publication Types:
Randomized Controlled Trial
98: Aust J Rural Health. 2007 Apr;15(2):137-8.
Identifying depression in patients following admission for acute coronary
syndrome.
Reddy P, Dunbar JA, Janus E, Wolff A, Bunker S, Morgan M, O'Neil A.
University Department of Rural Health, Flinders University and Deakin
University, Warrnambool, Victoria, Australia. p.reddy@unimelb.edu.au
Publication Types:
99: Am J Geriatr Psychiatry. 2007 Apr;15(4):282-91.
Religion and depression in older medical inpatients.
Koenig HG.
Departments of Psychiatry & Behavioral Sciences and Medicine, Duke University
Medical Center, GRECC VA Medical Center, Durham, NC 27710, USA.
OBJECTIVE: The objective of this study is to examine the religious
characteristics of older medical inpatients with major and minor depression,
compare them with religious characteristics of nondepressed patients, and
examine their relationship to severity and type of depression. METHODS: Medical
inpatients over age 50 at Duke University Medical Center (DUMC) and three
community hospitals were identified with depressive disorder using a structured
psychiatric interview. Detailed information was obtained on their psychiatric,
medical, and religious characteristics. Religious characteristics of these
patients were then compared with those of nondepressed patients in a concurrent
study at DUMC controlling for demographic, health, and social factors. Among
depressed patients, relationships to severity and type of depression were also
examined. RESULTS: Religious involvement among 411 patients with major and 585
with minor depression was widespread, although not as frequent as in 428
nondepressed patients. After controlling for demographic and physical health
factors, depressed patients were more likely to indicate no religious
affiliation, less likely to affiliate with neofundamentalist denominations, more
likely to indicate "spiritual but not religious," less likely to pray or read
scripture, and scored lower on intrinsic religiosity. Among depressed patients,
there was no relationship between religion and depression type, but depression
severity was associated with a lower religious attendance, prayer, scripture
reading, and lower intrinsic religiosity. Social factors only partially
explained these relationships. CONCLUSION: Older medically ill hospitalized
patients with depression are less religiously involved than nondepressed
patients or those with less severe depression. Implications for clinicians are
discussed.
Publication Types:
Heart rate variability and markers of inflammation and coagulation in depressed
patients with coronary heart disease.
Carney RM, Freedland KE, Stein PK, Miller GE, Steinmeyer B, Rich MW, Duntley SP.
BACKGROUND: Depression is associated with an increased risk for cardiac
morbidity and mortality in patients with coronary heart disease (CHD). Cardiac
autonomic nervous system (ANS) dysregulation, proinflammatory processes, and
procoagulant processes have been suggested as possible explanations. METHODS:
Heart rate variability (HRV), an indicator of cardiac autonomic regulation, and
markers of inflammation [C-reactive protein (CRP), interleukin-6 (IL-6), tumor
necrosis factor-alpha (TNF-alpha)] and coagulation (fibrinogen) were assessed in
44 depressed patients with CHD. RESULTS: Moderate, negative correlations were
found between fibrinogen and four measures of HRV. IL-6 also negatively
correlated with one measure of HRV (total power) and was marginally related to
two others (very low frequency and low frequency power). Neither CRP nor
TNF-alpha was significantly related to any measure of HRV. CONCLUSIONS: The
finding that fibrinogen and IL-6 are moderately related to HRV suggests a link
between these factors in depressed CHD patients. The relationship between ANS
function and inflammatory and coagulant processes should be investigated in
larger mechanistic studies of depression and cardiac morbidity and mortality.
Publication Types:
Cortisol awakening response is elevated in acute coronary syndrome patients with
type-D personality.
Whitehead DL, Perkins-Porras L, Strike PC, Magid K, Steptoe A.
Department of Epidemiology and Public Health, Psychobiology Group, University
College London, London, United Kingdom.
OBJECTIVE: Type-D or "distressed" personality and depression following admission
for acute coronary syndrome (ACS) have been associated with poor clinical
outcome. The biological pathways underpinning this relationship may include
disruption of the hypothalamic-pituitary-adrenocortical (HPA) axis. We therefore
assessed cortisol output in patients who had recently suffered from ACS. METHOD:
Salivary cortisol was assessed eight times over a 24-h period in 72 patients
within 5 days of admission for ACS. Depressive symptoms were measured with the
Beck Depression Inventory (BDI), and type-D personality was measured with the
Type-D Scale-16. Particular attention was given to cortisol awakening response
(CAR), which was measured as the difference in cortisol between waking and peak
responses 15-30 min later. RESULTS: Cortisol showed a typical diurnal pattern,
with low levels in the evening, high levels early in the day, and CAR averaging
7.58+/-10.0 nmol/l. Cortisol was not related to the severity of ACS or
underlying coronary artery disease or to BDI scores. The CAR was positively
associated with type-D personality independently of age, gender, and body mass
(P=.007). Linear regression showed that type-D personality accounted for 7.9% of
the variance in CAR after age, sex, body mass, BDI, cortisol level on waking,
and fatigue had been taken into account (P=.008). CONCLUSIONS: Type-D
personality may be associated with disruption of HPA axis function in survivors
of acute cardiac events and may contribute to heightened inflammatory responses
influencing future cardiac morbidity.
Publication Types:
102: J Gen Intern Med. 2007 Apr;22(4):470-7.
Erratum in:
J Gen Intern Med. 2007 Jul;22(7):1066.
Spiritual well-being and depression in patients with heart failure.
Bekelman DB, Dy SM, Becker DM, Wittstein IS, Hendricks DE, Yamashita TE,
Gottlieb SH.
Department of Medicine, Division of General Internal Medicine, University of
Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA.
David.Bekelman@UCHSC.edu
BACKGROUND: In patients with chronic heart failure, depression is common and
associated with poor quality of life, more frequent hospitalizations, and higher
mortality. Spiritual well-being is an important, modifiable coping resource in
patients with terminal cancer and is associated with less depression, but little
is known about the role of spiritual well-being in patients with heart failure.
OBJECTIVE: To identify the relationship between spiritual well-being and
depression in patients with heart failure. DESIGN: Cross-sectional study.
PARTICIPANTS: Sixty patients aged 60 years or older with New York Heart
Association class II-IV heart failure. MEASUREMENTS: Spiritual well-being was
measured using the total scale and 2 subscales (meaning/peace, faith) of the
Functional Assessment of Chronic Illness Therapy-Spiritual Well-being scale,
depression using the Geriatric Depression Scale-Short Form (GDS-SF). RESULTS:
The median age of participants was 75 years. Nineteen participants (32%) had
clinically significant depression (GDS-SF > 4). Greater spiritual well-being was
strongly inversely correlated with depression (Spearman's correlation -0.55, 95%
confidence interval -0.70 to -0.35). In particular, greater meaning/peace was
strongly associated with less depression (r = -.60, P < .0001), while faith was
only modestly associated (r = -.38, P < .01). In a regression analysis
accounting for gender, income, and other risk factors for depression (social
support, physical symptoms, and health status), greater spiritual well-being
continued to be significantly associated with less depression (P = .05). Between
the 2 spiritual well-being subscales, only meaning/peace contributed
significantly to this effect (P = .02) and accounted for 7% of the variance in
depression. CONCLUSIONS: Among outpatients with heart failure, greater spiritual
well-being, particularly meaning/peace, was strongly associated with less
depression. Enhancement of patients' sense of spiritual well-being might reduce
or prevent depression and thus improve quality of life and other outcomes in
this population.
103: Psychosomatics. 2007 Mar-Apr;48(2):112-6.
Routine screening for depression and quality of life in outpatients with
congestive heart failure.
Holzapfel N, Zugck C, Muller-Tasch T, Lowe B, Wild B, Schellberg D, Nelles M,
Remppis A, Katus H, Herzog W, Junger J.
Department of Psychosomatic and General Clinical Medicine, Medical University,
Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
Nicole_Holzapfel@med.uni-heidelberg.de
The influence of depression and perceived quality of life (QoL) on symptom
perception and prognosis in congestive heart failure is well known. The authors
therefore introduced routine questionnaire screening for these parameters in
patients attending their outpatient heart failure clinic (N=320). The authors
found QoL to be significantly reduced, and almost every third patient screened
positive for a depressive disorder. These patients got a clearly-defined
treatment offer. The present study demonstrates that screening for depression
and QoL is feasible without being too complex or time-consuming and easily
implementable in an interdisciplinary outpatient setting.
Publication Types:
104: Arch Intern Med. 2007 Feb 26;167(4):367-73.
Relationship of depression to death or hospitalization in patients with heart
failure.
Sherwood A, Blumenthal JA, Trivedi R, Johnson KS, O'Connor CM, Adams KF Jr,
Dupree CS, Waugh RA, Bensimhon DR, Gaulden L, Christenson RH, Koch GG,
Hinderliter AL.
Department of Psychiatry, Duke University Medical Center, Durham, NC, USA.
sherw002@mc.duke.edu
BACKGROUND: Depression is widely recognized as a risk factor in patients with
coronary heart disease. However, patients with heart failure (HF) have been less
frequently studied, and the effect of depression on prognosis, independent of
disease severity, is uncertain. METHODS: Two hundred four outpatients having a
diagnosis of HF, with a ventricular ejection fraction of 40% or less, underwent
baseline assessments including evaluation of depressive symptoms using the Beck
Depression Inventory and of HF severity determined by plasma N-terminal
pro-B-type natriuretic peptide. Cox proportional hazards regression analyses
were used to examine the effects of depressive symptoms on a combined primary
end point of death and hospitalizations because of cardiovascular disease
(hereafter referred to as cardiovascular hospitalization) during a median
follow-up of 3 years. RESULTS: Symptoms of depression (Beck Depression Inventory
score) were associated with risk of death or cardiovascular hospitalization
(P<.001) after controlling for established risk factors including HF disease
severity, ejection fraction, HF etiology, age, and medications. Clinically
significant symptoms of depression (Beck Depression Inventory score >/=10) were
associated with a hazard ratio of 1.56 (95% confidence interval, 1.07-2.29) for
the combined end point of death or cardiovascular hospitalization. Contrary to
our expectation, antidepressant medication use was associated with increased
likelihood of death or cardiovascular hospitalization (hazard ratio, 1.75; 95%
confidence interval,1.14-2.68, P =.01) after controlling for severity of
depressive symptoms and for established risk factors. CONCLUSIONS: Symptoms of
depression were associated with an adverse prognosis in patients with HF after
controlling for HF severity. The unexpected association of antidepressant
medications with worse clinical outcome suggests that patients with HF requiring
an antidepressant medication may need to be monitored more closely.
Publication Types:
Multicenter Study
105: J Cardiovasc Nurs. 2007 Mar-Apr;22(2):138-44.
Depression and quality of life in women after a myocardial infarction.
White ML, Groh CJ.
McAuley School of Nursing, University of Detroit-Mercy, Detroit, Mich and
Doctoral Student, Wayne State University, Detroit, MI, USA. aw4919@wayne.edu
BACKGROUND: Cardiovascular disease is the number one cause of mortality and
morbidity among women in the United States, resulting in 25,000 deaths annually.
Despite this high mortality figure, most women survive. Although evidence
suggests that depression is common after myocardial infarction (MI), there are
limited data on how depression impacts women's recovery after their first event.
The purpose of this study was to describe the relationship between depression
and quality of life in women after a first MI. METHOD: A convenience sample of
27 women (mean age = 60.7 years) with first MI completed the study. Depression
was measured using the Beck Depression Inventory, and quality of life was
measured using the Short Form-36. RESULTS: The mean (SD) depression score was
9.4 (5.5), indicating mild to moderate depression. Depression had a significant
negative correlation with the mental component summary of the Short Form-36 (r =
-0.72, P = .0005) but not the physical component summary (r = -0.191, P = .360).
In addition, subjects reported lower scores on 3 of the 8 Short Form-36
subscales when compared with national norms of persons experiencing a recent MI.
IMPLICATIONS: Many women continue to report mild to severe depression after MI,
and depression seems to be related to some aspects of quality of life. Screening
for depression and treating if symptoms are significant is one intervention for
improving quality of life after MI.
Publication Types:
Comparative Study
106: J Cardiovasc Nurs. 2007 Mar-Apr;22(2):125-30.
Coping and depressive symptoms in adults living with heart failure.
Vollman MW, Lamontagne LL, Hepworth JT.
Vanderbilt University School of Nursing, Nashville, TN 37240, USA.
michael.vollman@vanderbilt.edu
BACKGROUND AND RESEARCH OBJECTIVE: This study used process coping theory as the
basis for investigating how coping strategies are associated with depressive
symptoms in individuals living with heart failure (HF). Demographic factors also
were examined as correlates of depressive symptoms. SUBJECTS AND METHODS: The
convenience sample of adults living with HF (n = 75) who participated in this
study ranged in age from 27 to 82 years (M = 55). Sixty-nine percent of the
participants were men, 59% were married or partnered, with the majority being
Caucasian and from the middle class. Subjects were recruited from a
comprehensive HF program located within an academic health science center in the
southeastern United States. A single wave of data collection occurred. All study
questionnaires were verbally administered in a clinic room selected for privacy
during a routine HF clinic visit. RESULTS AND CONCLUSION: Individuals who used
more planful problem-solving and social support seeking coping strategies had
fewer depressive symptoms, whereas individuals who used more escape-avoidance
coping (eg, wishful thinking) had more depressive symptoms. When demographic
factors also were included in a regression analysis assessing depressive
symptoms, marital status, functional impairment, and the coping strategies of
planful problem-solving and escape-avoidance were all statistically significant
predictors of depression. Single individuals, those who used more
escape-avoidance, less planful problem-solving coping, and more functional
impairment had more depressive symptoms. These results suggest that psychosocial
factors, in addition to physical parameters, and the ways individuals cope with
the stressors of living with heart failure may be important predictors of
107: Am J Cardiol. 2007 Feb 15;99(4):519-29. Epub 2006 Dec 28.
The Editor's Roundtable: major depression in patients with coronary heart
disease.
Friedewald VE, Arnold LW, Carney RM, Jaffe AS, Sheps DS, Roberts WC.
The University of Texas Health Sciences Center at Houston, Houston, Texas, USA.
vfriedew@nd.edu
Publication Types:
108: Psychosom Med. 2007 Jan;69(1):23-9.
Cardiac-related hospitalization and/or death associated with immune
dysregulation and symptoms of depression in heart failure patients.
Redwine LS, Mills PJ, Hong S, Rutledge T, Reis V, Maisel A, Irwin MR.
Department of Medicine, University of California, San Diego, CA, USA.
lredwine@vapop.ucsd.edu
OBJECTIVE: Congestive heart failure (CHF) patients with depressive symptoms have
a greater risk of morbidity and mortality. Immune activity such as inflammation
is increasingly implicated as underlying this relationship. However, it is
unknown whether there is a broader spectrum of immune dysregulation beyond
inflammatory activity. This study examined in CHF patients the relationship of
depressive symptoms with cellular immune activity measured by Th1/Th2 ratios and
cardiac rehospitalization and/or death. METHOD: Eighteen patients with CHF (mean
age = 62, NYHA classes II-IV) were enrolled and depressive symptoms were
measured with interviewer ratings using the Hamilton Rating Scale-Depression.
For the determination of Th1/Th2 ratios, intracellular cytokine expression of
interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) CD4+ T cells were
measured by flow cytometry. Plasma interleukin-6 levels were measured to
ascertain circulating inflammatory cytokine activity. Patient records were
examined for cardiac related rehospitalization or cardiac related death over a
two-year period after baseline depression and immune measures were taken.
RESULTS: Higher depression scores were associated with a prospective increase in
incidence of cardiac related hospitalizations and/or death (p = .037). Lesser
IFN-gamma/IL-10 expressing CD4+ T cell ratios were related to higher depressive
symptom scores at baseline (p = .005) and a prospective increased incidence of
cardiac related hospitalization or death over a two-year period (p = .05).
CONCLUSIONS: A shift in the Th1/Th2 ratio may play a role in the association
between depressive symptoms and morbidity and mortality in CHF patients,
suggesting broader immune dysregulation than previously considered.
Publication Types:
109: JAMA. 2007 Jan 24;297(4):411-2.
Comment on:
JAMA. 2007 Jan 24;297(4):367-79.
Antidepressants in coronary heart disease: SSRIs reduce depression, but do they
save lives?
Glassman AH, Bigger JT Jr.
Publication Types:
Comment
Editorial
110: JAMA. 2007 Jan 24;297(4):367-79.
Erratum in:
JAMA. 2007 Jul 4;298(1):40.
Comment in:
ACP J Club. 2007 May-Jun;146(3):68.
JAMA. 2007 Jan 24;297(4):411-2.
JAMA. 2007 May 2;297(17):1878-9; author reply 1880.
JAMA. 2007 May 2;297(17):1879-80; author reply 1880.
Effects of citalopram and interpersonal psychotherapy on depression in patients
with coronary artery disease: the Canadian Cardiac Randomized Evaluation of
Antidepressant and Psychotherapy Efficacy (CREATE) trial.
Lesperance F, Frasure-Smith N, Koszycki D, Laliberte MA, van Zyl LT, Baker B,
Swenson JR, Ghatavi K, Abramson BL, Dorian P, Guertin MC; CREATE Investigators.
Department of Psychiatry, Universite de Montreal, Montreal, Quebec, Canada.
francois.lesperance@umontreal.ca
CONTEXT: Few randomized controlled trials have evaluated the efficacy of
treatments for major depression in patients with coronary artery disease (CAD).
None have simultaneously evaluated an antidepressant and short-term
psychotherapy. OBJECTIVE: To document the short-term efficacy of a selective
serotonin reuptake inhibitor (citalopram) and interpersonal psychotherapy (IPT)
in reducing depressive symptoms in patients with CAD and major depression.
DESIGN, SETTING, AND PARTICIPANTS: The Canadian Cardiac Randomized Evaluation of
Antidepressant and Psychotherapy Efficacy, a randomized, controlled, 12-week,
parallel-group, 2 x 2 factorial trial conducted May 1, 2002, to March 20, 2006,
among 284 patients with CAD from 9 Canadian academic centers. All patients met
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria
for diagnosis of major depression of 4 weeks' duration or longer and had
baseline 24-item Hamilton Depression Rating Scale (HAM-D) scores of 20 or
higher. INTERVENTIONS: Participants underwent 2 separate randomizations: (1) to
receive 12 weekly sessions of IPT plus clinical management (n = 142) or clinical
management only (n = 142) and (2) to receive 12 weeks of citalopram, 20 to 40
mg/d (n = 142), or matching placebo (n = 142). MAIN OUTCOME MEASURES: The
primary outcome measure was change between baseline and 12 weeks on the 24-item
HAM-D, administered blindly during centralized telephone interviews (tested at
alpha = .033); the secondary outcome measure was self-reported Beck Depression
Inventory II (BDI-II) score (tested at alpha = .017). RESULTS: Citalopram was
superior to placebo in reducing 12-week HAM-D scores (mean difference, 3.3
points; 96.7% confidence interval [CI], 0.80-5.85; P = .005), with a small to
medium effect size of 0.33. Mean HAM-D response (52.8% vs 40.1%; P = .03) and
remission rates (35.9% vs 22.5%; P = .01) and the reduction in BDI-II scores
(difference, 3.6 points; 98.3% CI, 0.58-6.64; P = .005; effect size = 0.33) also
favored citalopram. There was no evidence of a benefit of IPT over clinical
management, with the mean HAM-D difference favoring clinical management (-2.26
points; 96.7% CI, -4.78 to 0.27; P = .06; effect size, 0.23). The difference on
the BDI-II did not favor clinical management (1.13 points; 98.3% CI, -1.90 to
4.16; P = .37; effect size = 0.11). CONCLUSIONS: This trial documents the
efficacy of citalopram administered in conjunction with weekly clinical
management for major depression among patients with CAD and found no evidence of
added value of IPT over clinical management. Based on these results and those of
previous trials, citalopram or sertraline plus clinical management should be
considered as a first-step treatment for patients with CAD and major depression.
TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN15858091.
Publication Types:
Multicenter Study
111: Prev Cardiol. 2007 Winter;10(1):15-21.
Depressive symptoms and sex affect completion rates and clinical outcomes in
cardiac rehabilitation.
Caulin-Glaser T, Maciejewski PK, Snow R, LaLonde M, Mazure C.
McConnell Heart Health Center, Riverside Methodist Hospital, Columbus, OH
43214-3646, USA. tcauling@ohiohealth.com
Symptoms of depression are often seen in patients with coronary heart disease.
Symptoms appear more commonly in women and are negatively associated with
measures of cardiovascular health. Using multiple logistic regression analyses,
the authors evaluated the independent effects of depression (as measured by the
Beck Depression Inventory [BDI-II]) and sex on cardiac rehabilitation (CR)
completion. In addition, in those who completed CR, the authors evaluated
whether depressive symptoms and sex affected clinical outcomes. Women as well as
participants with enrollment BDI-II scores > or =14 had significantly higher
rates of CR noncompletion. Patients with BDI-II scores > or =14 who completed CR
achieved significant improvements in lipid profile, body mass index, and
exercise capacity regardless of sex. Women and individuals with BDI-II scores >
or =14 are at risk for CR noncompletion and should be encouraged to complete CR,
because cardiovascular benefits comparable to those seen in men and individuals
with low BDI-II scores were achieved when these patients completed the CR
program.
112: Psychosomatics. 2007 Jan-Feb;48(1):22-30.
Effects of antidepressant treatment on cognitive performance in elderly subjects
with heart failure and comorbid major depression: an exploratory study.
Alves TC, Rays J, Telles RM, Junior RF, Wajngarten M, Romano BW, Watanabe C,
Busatto GF.
Department of Psychiatry, University of Sao Paulo Medical School, Sao Paulo,
Brazil. tania_alves@hotmail.com
Cognitive deficits are common in association with heart failure (HF), and it is
possible that their severity is magnified by the concomitant presence of major
depressive disorder (MDD). Using the Cambridge Mental Disorders of the Elderly
Examination battery, the authors compared the cognitive performance of MDD-HF
subjects (N=20), nondepressed HF subjects (N=23), and healthy control subjects
(N=18). Scores were lower in both HF groups relative to control subjects. In the
MDD-HF group, there were significant cognitive improvements after antidepressant
treatment. Cognitive impairment is, therefore, significant in HF subjects with
or without comorbid MDD, and it is important to recognize and treat MDD symptoms
associated with HF.
Publication Types:
Controlled Clinical Trial
113: Prog Cardiovasc Nurs. 2006 Fall;21(4):182-9.
Somatic symptoms explain differences in psychological distress in heart failure
patients vs a comparison group.
Redeker NS.
University of Medicine & Dentistry of New Jersey, School of Nursing, Newark, NJ
07101-1709, USA. redekena@umdnj.edu
Psychological distress is common among patients with heart failure (HF);
however, somatic symptoms are also common and may confound its assessment.
Understanding the contributions of symptoms to psychological distress may assist
in focusing treatment. The purpose of this study was to evaluate differences
between HF patients and a non-HF comparison group on psychological distress
(anxiety and depression); the association of anxiety and depression with common
somatic symptoms of HF (fatigue, sleep disturbance, dyspnea, and excessive
daytime sleepiness); and the extent to which somatic symptoms and HF diagnosis
explain psychological distress. In this cross-sectional study, 61 stable
systolic HF outpatients and a comparison group of 57 persons recruited from the
community completed the Centers for the Epidemiological Studies of Depression
Scale, Profile of Mood States-Short Form, Hospital Anxiety and Depression Scale,
Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Multidimensional
Assessment of Fatigue Scale, and the Multidimensional Assessment of Dyspnea
Scale. The HF patients scored higher on depression, as measured by the Centers
for the Epidemiological Studies of Depression Scale, but not on the other
depression or anxiety scales. Group-related differences in depression were
explained by sleep disturbance, fatigue, and excessive daytime sleepiness, after
accounting for the effects of age, sex, minority status, comorbidity, and
physical function.
Coronary heart disease and depression: the next steps.
Publication Types:
Editorial
115: Psychosom Med. 2007 Jan;69(1):4-9. Epub 2006 Dec 13.
Heart rate turbulence, depression, and survival after acute myocardial
infarction.
Carney RM, Howells WB, Blumenthal JA, Freedland KE, Stein PK, Berkman LF,
Watkins LL, Czajkowski SM, Steinmeyer B, Hayano J, Domitrovich PP, Burg MM,
Jaffe AS.
OBJECTIVE: Depression is a risk factor for mortality after acute myocardial
infarction (AMI), possibly as a result of altered autonomic nervous system (ANS)
modulation of heart rate (HR) and rhythm. The purposes of this study were to
determine: a) whether depressed patients are more likely to have an abnormal HR
response (i.e., abnormal turbulence) to premature ventricular contractions
(VPCs), and b) whether abnormal HR turbulence accounts for the effect of
depression on increased mortality after AMI. METHODS: Ambulatory
electrocardiographic data were obtained from 666 (316 depressed, 350
nondepressed) patients with a recent AMI; 498 had VPCs with measurable HR
turbulence. Of these, 260 had normal, 152 had equivocal, and 86 had abnormal HR
turbulence. Patients were followed for up to 30 (median = 24) months. RESULTS:
Depressed patients were more likely to have abnormal HR turbulence (risk factor
adjusted odds ratio = 1.8; 95% confidence interval [CI] = 1.0-3.0; p = .03) and
have worse survival (odds ratio = 2.4; 95% CI = 1.2-4.6; p = .02) than
nondepressed patients. When HR turbulence was added to the model, the adjusted
hazard ratio for depression decreased to 1.9 (95% CI = 0.9-3.8; p = .08), and to
1.6 (95% CI = 0.8-3.4; p = .18) when a measure of HR variability (LnVLF) was
added. The hazard was found to differ over time with depression posing little
risk for mortality in year 1 but greater risk in years 2 and 3 of the follow up.
CONCLUSION: ANS dysregulation may partially mediate the increased risk for
mortality in depressed patients with frequent VPCs after an AMI.
Publication Types:
116: J Nerv Ment Dis. 2006 Dec;194(12):909-16.
Major depression and physical illness trajectories in heart failure and
pulmonary disease.
Koenig HG, Johnson JL, Peterson BL.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
and GRECC VA Medical Center, Durham, North Carolina 27710, USA.
The purpose of this study was to examine conjoint trajectories of
depression-physical illness in elderly medical inpatients with heart failure
and/or chronic pulmonary disease and major depression (MDD), and to identify
baseline predictors of trajectory. Consecutive medically hospitalized patients
over age 50 with heart failure and/or chronic pulmonary disease were screened
for MDD using the Structured Clinical Interview for Depression. Patients were
re-evaluated at 6, 12, 18, and 24 weeks. Four depression-physical illness
conjoint trajectories were examined: depression better, illness better;
depression better, illness same; depression same, illness better; and depression
same, illness same. Baseline predictors of trajectory were examined. MDD was
identified in 413 patients; 352 had at least one follow-up. By 6 weeks, 22.3%
improved on both depression and illness and 38.1% improved on neither. By 24
weeks, 45.0% had improved on both and 24.8% on neither. Short-term baseline
predictors of trajectory (6 weeks) differed from long-term (12-24 weeks); past
psychiatric history, overall medical illness severity, and education were
short-term predictors, whereas past psychiatric history, depression treatments,
and physical functioning were long-term. Improvements in MDD and physical
illness track closely together. Characteristics during baseline hospitalization
predict outcome trajectory after discharge, and may be useful in understanding
etiology and directing treatment.
Publication Types:
Comparative Study
Depression vulnerabilities in patients with different levels of depressive
symptoms after acute coronary syndromes.
Rieckmann N, Burg MM, Gerin W, Chaplin WF, Clemow L, Davidson KW.
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
BACKGROUND: Cognitive, behavioral, and interpersonal vulnerabilities have been
studied in patients fulfilling diagnostic criteria for major depression and
dysthymia. The extent to which these vulnerabilities are present in cardiac
patients with mild to moderate depressive symptoms--a risk factor for
mortality--is unknown. Moreover, few studies have examined interrelations among
depression vulnerabilities. METHODS: A consecutive cohort of 314 patients with
acute coronary syndrome completed the Beck Depression Inventory (BDI) and
measures of cognitive, behavioral, and interpersonal vulnerabilities
(Dysfunctional Attitudes Scale, Pleasant Events Schedule for the Elderly, Dyadic
Adjustment Scale, and an inventory of role transitions) within 1 week of
hospital admission. Of the patients, 166 were classified as nondepressed (BDI
score, 0-4), 91 as mildly depressed (BDI score, 10-16), and 57 as moderately to
severely depressed (BDI score, >16). RESULTS: Compared with nondepressed
patients, both mildly depressed and moderately to severely depressed patients
exhibited higher mean levels of all vulnerabilities as well as a higher
prevalence of more than one elevated vulnerability, defined by threshold scores.
Vulnerabilities were only minimally interrelated (r = 0.01-0.25), and they were
independently associated with mild and moderate depressive symptom status.
CONCLUSIONS: This is the first study to show that cognitive, behavioral, and
interpersonal depression vulnerabilities are uniquelyassociated with concurrent
depressive symptoms. There appeared to be only modest overlap between
vulnerabilities, supporting the idea that depression in medically ill patients
is a multifaceted phenomenon, even in the presence of minimally elevated
depressive symptoms. Longitudinal studies are required before causality and
treatment implications can be addressed.
Publication Types:
118: Ann Pharmacother. 2005 Nov;39(11):1792-7. Epub 2005 Oct 4.
Adherence to medications by patients after acute coronary syndromes.
Sud A, Kline-Rogers EM, Eagle KA, Fang J, Armstrong DF, Rangarajan K, Otten RF,
Stafkey-Mailey DR, Taylor SD, Erickson SR.
College of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
BACKGROUND: Nonadherence to medication may lead to poor medical outcomes.
OBJECTIVE: To describe medication-taking behavior of patients with a history of
acute coronary syndromes (ACS) for 4 classes of drugs and determine the
relationship between self-reported adherence and patient characteristics.
METHODS: Consenting patients with the diagnosis of ACS were interviewed by
telephone approximately 10 months after discharge. The survey elicited data
characterizing the patient, current medication regimens, beliefs about drug
therapy, reasons for discontinuing medications, and adherence. The survey
included the Beliefs About Medicine Questionnaire providing 4 scales: Specific
Necessity, Specific Concerns, General Harm, and General Overuse, and the
Medication Adherence Scale (MAS). Multivariate regression was used to determine
the independent variables with the strongest association to the MAS. A p value <
or = 0.05 was considered significant for all analyses. RESULTS: Two hundred
eight patients were interviewed. Mean +/- SD age was 64.9 +/- 13.0 years, with
60.6% male, 95.7% white, 57.3% with a college education, 87.9% living with > or
=1 other person, and 42% indicating excellent or very good health. The
percentage of patients continuing on medication at the time of the survey
category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme
inhibitors). Reasons for stopping medication included physician discontinuation
or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 +/-
0.4, with 53.8% indicating nonadherence (score >1). The final regression model
showed R(2) = 0.132 and included heart-related health status and Specific
Necessity as significant predictor variables. CONCLUSIONS: After ACS, not all
patients continue their drugs or take them exactly as prescribed. Determining
beliefs about illness and medication may be helpful in developing interventions
aimed at improving adherence.
119: Rev Port Cardiol. 2005 Apr;24(4):507-16.
Acute coronary syndrome and depression.
[Article in English, Portuguese]
Dias CC, Mateus PS, Mateus C, Bettencourt N, Santos L, Adao L, Sampaio F,
Fonseca C, Simoes L, Coelho R, Ribeiro VG.
Servico de Cardiologia-Centro Hospitalar de Vila Nova de Gaia, Vila Nova de
Gaia, Portugal. carlacostadias@netcabo.pt
INTRODUCTION: Clinical depression is associated with poor compliance in risk
reduction recommendations and has been suggested as an independent risk factor
for increased postmyocardial infarction morbidity and mortality. AIM: To
determine the prevalence of depressive symptoms, their main determinants and
their influence on clinical evolution in acute coronary syndromes (ACS)
patients. METHODS: We studied depressive symptoms, sociodemographic variables,
cardiovascular status and therapeutic procedures in 240 consecutive patients
admitted for ACS. Depressive symptoms were assessed using the Beck Depression
Inventory (BDI) after clinical stabilization, in patients with more than 4
years' education. RESULTS: The majority of the patients were male (203); their
average age was 59.4 +/- 13 yrs; 31.8% were admitted for unstable angina, 33.1%
for acute myocardial infarction with ST elevation and 31.8% without ST
elevation. Depressive symptoms (BDI > or =10) were present in 100 patients
(41.6%). Depressed patients were older (61.1 vs. 58.2 years, p = 0.06) and had a
history of previous cardiovascular events /47.5 vs. (34.8% p = 0.05). The
proportion of female was higher in the group of patients with BDI > or =10 (24%
vs. 9.3%, p = 0.02). Traditional cardiovascular risk factors were not associated
with depressive symptoms. There were no statistically significant differences
between the depressed and non-depressed patients in admission diagnosis,
in-hospital clinical evolution and treatment. There were 35 patients (14.6%)
with moderate/severe depression (BDI > or =19), 12 of whom were women (OR = 3.8,
p = 0.001); no relation was established between age and previous cardiac events.
These scores were less frequent in patients with a higher level of education (OR
= 0.28, p = 0.09) and married (OR = 0.31 vs. not married, p = 0.03). Clinical
follow-up of 158 patients was achieved (16 +/- 4 months), in patients with BDI >
or =19, the presence of cardiovascular symptoms (angina, congestive heart
failure) was higher (46% vs. 23%, OR = 2.8, p = 0.03), even after adjustment for
age (OR = 2.5; p = 0.06). However, there was no association between the presence
of depressive symptoms and readmission and/or fatal events. CONCLUSION:
Depression is a common finding after hospital admission for ACS, particularly in
women, and is mainly associated with prehospital factors. In our group of
patients, the presence of depressive symptoms was closely related to clinical
status during follow-up.
120: Health Psychol. 1995 Jan;14(1):88-90.
Major depression and medication adherence in elderly patients with coronary
artery disease.
Carney RM, Freedland KE, Eisen SA, Rich MW, Jaffe AS.
Missouri 633110, USA.
Little is known about the effects of depression on adherence to medical
treatment regimens in older patients with chronic medical illnesses. Poor
adherence may explain the increased risk of medical morbidity and mortality
found in depressed medical patients. Ten of 55 patients over the age of 64 with
coronary artery disease met the criteria for major depression from the
Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American
Psychiatric Association, 1987). All patients were prescribed a twice-per-day
regimen of low dose aspirin to reduce their risk for myocardial infarction.
Medication adherence was assessed for 3 weeks by an unobtrusive electronic
monitoring device. Depressed patients adhered to the regimen on 45% of days, but
nondepressed patients, on 69% (p < .02). Thus, major depression is associated
with poor adherence to a regimen of prophylactic aspirin after the diagnosis of
Publication Types:
121: Am J Cardiol. 2005 Nov 1;96(9):1179-85. Epub 2005 Sep 1.
Effect of depression on five-year mortality after an acute coronary syndrome.
Grace SL, Abbey SE, Kapral MK, Fang J, Nolan RP, Stewart DE.
York University, Toronto, Ontario, Canada. sgrace@yorku.ca
Previous research has established a relation between depression at the time of
cardiac hospitalization and patient mortality. The objective of this study was
to examine the role of depressive history and symptomatology during
hospitalization on 5-year all-cause mortality after admission for an acute
coronary syndrome. We recruited 750 patients who had unstable angina pectoris
and myocardial infarction from 12 coronary care units between 1997 and 1999.
Measurements included sociodemographic and clinic data and the Beck Depression
Inventory (BDI). Data were linked to an administrative database to determine
5-year all-cause mortality. Survival data were adjusted using a Cox's
proportional hazards model. One hundred seventy-four participants (23.2%)
self-reported a history of depressed mood for >2 weeks, 235 (31.3%) had elevated
BDI scores at index hospitalization, with 105 (14.0%) reporting persistent
depressive symptomatology. One hundred fifteen participants (15.3%) died by 5
years after hospitalization. After adjusting for prognostic indicators, such as
cardiac disease severity, medical history, and smoking, depressive
symptomatology during hospitalization was significantly predictive of mortality,
but depressive history was not. Hazard ratios associated with BDI scores <10
versus those > or =10 at hospitalization ranged from 1.90 (95% confidence
interval 1.12 to 3.24) at 2 years to 1.53 (95% confidence interval 1.04 to 2.24)
at 5 years. In conclusion, the significance of depressive symptomatology at the
time of, but not before, hospitalization underlines the need for early
identification of increased distress and renews calls to identify treatments
that not only improve quality of life but also decrease the risk of mortality.
Publication Types:
Comparative Study
122: J Psychosom Res. 2006 Jan;60(1):13-20.
Depression following acute coronary syndromes: a comparison between the Cardiac
Depression Scale and the Beck Depression Inventory II.
Di Benedetto M, Lindner H, Hare DL, Kent S.
School of Psychological Science, La Trobe University, Melbourne, Australia.
OBJECTIVE: This study compared the Cardiac Depression Scale (CDS) and the Beck
Depression Inventory II (BDI-II). METHOD: Depression was assessed in 81
participants, 2 weeks post-ACS, using the BDI-II and the Composite International
Diagnostic Interview. RESULTS: The CDS had a strong concurrent validity with the
BDI-II (r=.69). Cross-validation of the BDI-II and the CDS with the structured
interview demonstrated the ability of both measures to detect severe symptoms.
More patients were classified as depressed using the CDS. The CDS also had a
significantly higher correlation with a trait anxiety measure than the BDI-II
did. CONCLUSION: The CDS is a more suitable scale for assessing the less severe
depressive symptoms typically seen in a cardiac population.
Publication Types:
Comparative Study
Validation Studies
123: Arch Gen Psychiatry. 2006 Mar;63(3):283-8.
Onset of major depression associated with acute coronary syndromes: relationship
of onset, major depressive disorder history, and episode severity to sertraline
benefit.
Glassman AH, Bigger JT, Gaffney M, Shapiro PA, Swenson JR.
Department of Psychiatry, College of Physicians and Surgeons, Columbia
University, New York, NY, USA. ahg1@columbia.edu
CONTEXT: Depression observed following acute coronary syndrome (ACS) is common
and associated with an increased risk of death. The Sertraline Antidepressant
Heart Attack Trial (SADHART) tested the safety and efficacy of a selective
serotonin reuptake inhibitor in this population. No evidence of harm was seen,
and sertraline hydrochloride had an overall beneficial effect on mood that
occurred primarily in patients with a history of episodes of major depressive
disorder (MDD). OBJECTIVES: To determine how frequently the MDD began before ACS
and whether onset of the current MDD episode before or after the ACS event
influenced response to sertraline. DESIGN, SETTINGS, AND PARTICIPANTS: A
randomized, double-blind, placebo-controlled treatment of 369 patients with ACS
and MDD was conducted in 40 outpatient clinics in 10 countries between April 1,
1997, and April 30, 2001. MAIN OUTCOME MEASURES: Diagnosis of MDD, number of
previous episodes of depression, and episode onset before or after
hospitalization were established using the Diagnostic Interview Schedule.
Treatment response was measured with the Clinical Global Impression-Improvement
scale. RESULTS: Fifty-three percent of MDD episodes began before hospitalization
for the index episode of ACS (for 197 of 369 patients), and 94% of the MDD
episodes began more than 30 days before the index ACS episode. Episodes of MDD
that began prior to ACS responded more frequently to sertraline than to placebo
(63% vs 46%, respectively; odds ratio, 2.0; 95% confidence interval, 1.13-3.55)
whereas depression with onset beginning after hospitalization showed a high
placebo response rate (69% vs 60%, respectively) and low sertraline-placebo
response ratio (1.15). Multivariate analysis indicated that time of onset of the
current episode, history of MDD, and baseline severity independently predicted
the sertraline-placebo response ratio. CONCLUSIONS: Half of the episodes of
major depression associated with ACS began long before ACS and therefore were
not caused by ACS. Patients whose current episodes of MDD begin before ACS,
those with a history of MDD, and those whose episodes are severe should be
treated because they will benefit considerably from sertraline. Since these 3
predictors of sertraline response are independent, having more than 1 of them
substantially increases the benefit of sertraline while reducing the chance of
spontaneous recovery.
Publication Types:
Comparative Study
Multicenter Study
124: Circulation. 1995 Feb 15;91(4):999-1005.
Erratum in:
Circulation 1998 Feb 24;97(7):708.
Comment in:
Circulation. 1995 Dec 1;92(11):3361-2.
Circulation. 1995 Sep 15;92(6):1668-9.
Circulation. 1998 Feb 24;97(7):708.
Depression and 18-month prognosis after myocardial infarction.
Frasure-Smith N, Lesperance F, Talajic M.
Research Center, Montreal Heart Institute, Quebec, Canada.
BACKGROUND: We previously reported that major depression in patients in the
hospital after a myocardial infarction (MI) substantially increases the risk of
mortality during the first 6 months. We examined the impact of depression over
18 months and present additional evidence concerning potential mechanisms
linking depression and mortality. METHODS AND RESULTS: Two-hundred twenty-two
patients responded to a modified version of the National Institute of Mental
Health Diagnostic Interview Schedule (DIS) for a major depressive episode at
approximately 7 days after MI. The Beck Depression Inventory (BDI), which
measures depressive symptomatology, was also completed by 218 of the patients.
All patients and/or families were contacted at 18 months to determine survival
status. Thirty-five patients met the modified DIS criteria for major in-hospital
depression after the MI. Sixty-eight had BDI scores > or = 10, indicative of
mild to moderate symptoms of depression. There were 21 deaths during the
follow-up period, including 19 from cardiac causes. Seven of these deaths
occurred among patients who met DIS criteria for depression, and 12 occurred
among patients with elevated BDI scores. Multiple logistic regression analyses
showed that both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32
to 10.05; P = .012) and elevated BDI scores (odds ratio, 7.82; 95% CI, 2.42 to
25.26; P = .0002) were significantly related to 18-month cardiac mortality.
After we controlled for the other significant multivariate predictors of
mortality in the data set (previous MI, Killip class, premature ventricular
contractions [PVCs] of > or = 10 per hour), the impact of the BDI score remained
significant (adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09; P = .0026). In
addition, the interaction of PVCs and BDI score marginally improved the model (P
= .094). The interaction showed that deaths were concentrated among depressed
patients with PVCs of > or = 10 per hour (odds ratio, 29.1; 95% CI, 6.97 to
122.07; P < .00001). CONCLUSIONS: Depression while in the hospital after an MI
is a significant predictor of 18-month post-MI cardiac mortality. Depression
also significantly improves a risk-stratification model based on traditional
post-MI risks, including previous MI, Killip class, and PVCs. Furthermore, the
risk associated with depression is greatest among patients with > or = 10 PVCs
per hour. This result is compatible with the literature suggesting an arrhythmic
mechanism as the link between psychological factors and sudden cardiac death and
underscores the importance of developing screening and treatment programs for
post-MI depression.
Publication Types:
Comparative Study
125: BMC Health Serv Res. 2006 Feb 13;6:9.
Impact of briefly-assessed depression on secondary prevention outcomes after
acute coronary syndrome: a one-year longitudinal survey.
McGee HM, Doyle F, Conroy RM, De La Harpe D, Shelley E.
Health Services Research Centre, Department of Psychology, Royal College of
Surgeons in Ireland, Dublin 2, Ireland. hmcgee@rcsi.ie
BACKGROUND: Patients with acute coronary syndromes (ACS) are at increased risk
of further acute cardiac events. Secondary prevention aims to decrease morbidity
and mortality post-ACS. Depression is related to increased risk in this
population, and to poorer secondary prevention activities. However, lengthy
depression assessment techniques preclude depression assessment in routine care.
The present study investigated the relationship of briefly-assessed depression
with secondary prevention outcomes one year post-ACS. METHODS: Following ethics
committee approval, hospitals recruited patients for a national survey of ACS.
Consenting patients with ACS completed a brief depression scale during
hospitalisation. The predictive validity of two brief scales was independently
assessed, with groups combined for the overall sample. Participants then
completed a one-year longitudinal follow-up postal survey of secondary
prevention activities. RESULTS: The response rate for follow-up was 86% (n =
681). Proportions taking anti-platelet (88% v 87%; p = 0.334) and lipid-lowering
(83% v 84%; p = 0.437) therapies remained unchanged. Prevalence of smoking (40%
v 22%; p < 0.001), and median number of cigarettes smoked (20 v 10; p < 0.001)
were significantly reduced at one year. Fifty-six per cent of patients reported
attending cardiac rehabilitation programmes. Of those aged < 65 years at
baseline, 54% had returned to work at one year. A majority (56%) reported
feeling physically better. Prevalence of depression was unchanged in those who
completed a depression scale at both time points (15% v 17%; p = 0.434).
Baseline depression did not predict taking anti-platelet, blood pressure or
cholesterol medications (all p > 0.05), but did predict continuation of smoking
(OR = 2.3, 95% CI 1.3-4.0, p = 0.003), a higher (above median) number of general
practitioner visits (OR = 2.1, 95% CI 1.3-3.4, p = 0.005), failure to return to
work (OR = 0.4, 95% CI 0.2-0.8, p = 0.015), and not feeling better (OR = 0.6,
95% CI 0.3-1.0, p = 0.05) at one year. CONCLUSION: Rapid depression assessment
can be used to help identify patients with ACS at risk of a range of poorer
secondary prevention outcomes. The results provide support for the routine
screening of depression in acute settings. Strategies to increase rates of
smoking cessation, return to work, general well-being and decrease health
service use by depressed patients may need to incorporate some element of
treatment for depression.
Publication Types:
126: J Am Coll Cardiol. 2007 Apr 3;49(13):1503-4; author reply 1504. Epub 2007
Mar 21.
Comment on:
J Am Coll Cardiol. 2006 Oct 17;48(8):1527-37.
Depression and heart failure: why the link continues to elude us.
Persaud R.
Publication Types:
Comment
Letter
127: Harv Heart Lett. 2007 Apr;17(8):6.
Different shades of gray for post-heart attack depression. Depression that
develops for the very first time during recuperation from a heart attack affects
recovery more than depression that started before the attack.
[No authors listed]
Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical
events following percutaneous coronary intervention with paclitaxel-eluting
stents.
Pedersen SS, Denollet J, Daemen J, van de Sande M, de Jaegere PT, Serruys PW,
Erdman RA, van Domburg RT.
CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University,
Tilburg, The Netherlands. s.s.pedersen@uvt.nl
OBJECTIVE: We investigated the relative effects of fatigue, depressive symptoms,
and hopelessness on prognosis at 2-year follow-up in percutaneous coronary
intervention (PCI) patients. METHODS: Consecutively admitted PCI patients
(n=534) treated with paclitaxel-eluting stent as the default strategy completed
the Maastricht Questionnaire (MQ) at baseline. Apart from an overall vital
exhaustion score, the MQ also assesses fatigue (seven items; Cronbach's
alpha=.87) and depressive symptoms (seven items; Cronbach's alpha=.83), with
hopelessness (one item) comprised in the depressive symptom items. Patients were
followed up for adverse clinical events (mortality and nonfatal myocardial
infarction) at 2 years. RESULTS: At 2-year follow-up, there were 31 clinical
events. In univariable analyses, overall vital exhaustion and depressive
symptoms, but not fatigue, were associated with adverse prognosis; in
multivariable analysis, depressive symptoms [hazard ratio (HR)=2.69; 95%
confidence interval (95% CI)=1.31-5.55] remained the only predictor of clinical
outcome. Among the depressive symptoms, hopelessness (HR=3.44; 95% CI=1.65-7.19)
was the most cardiotoxic symptom. The incidence of clinical events was higher in
the high-hopelessness patients (11% vs. 3%; P=.001) than in the low-hopelessness
patients. Hopelessness (HR=3.36; 95% CI=1.58-7.14; P=.002) remained an
independent predictor of clinical outcome at 2 years in adjusted analysis.
CONCLUSION: Symptoms of depression, but not fatigue, predicted adverse clinical
events. Hopelessness was the most cardiotoxic symptom, associated with a more
than three-fold risk of clinical events 2 years post-PCI. Screening for
hopelessness may lead to the identification of high-risk patients.
Publication Types:
129: Br J Psychiatry. 2007 Mar;190:272-3; author reply 273.
Comment on:
Br J Psychiatry. 2006 Oct;189:367-72.
Depression and anxiety after myocardial infarction.
de Jonge P, Ormel J.
Publication Types:
Comment
Letter
130: Heart Advis. 2006 Dec;9(12):2.
Severity of depression linked to degree of heart failure.
[No authors listed]
Publication Types:
News
131: J Cardiovasc Nurs. 2007 Jan-Feb;22(1):76-83.
Psychological factors and treatment adherence behavior in patients with chronic
heart failure.
Schweitzer RD, Head K, Dwyer JW.
School of Psychology and Counselling, Queensland University of Technology,
Brisbane, QLD 4034, Australia. r.schweitzer@qut.edu.au
BACKGROUND: Chronic heart failure adversely affects 300,000 Australians. Symptom
stabilization and prognosis are partially determined by patients following
medical and lifestyle recommendations. METHODS: To test the hypothesis that
depression, anxiety, and self-efficacy are independent predictors of such
adherence, 115 predominantly male (70.6%) volunteers with a mean age of 63 years
were recruited from a major teaching hospital in Australia. RESULTS: Depression
(Beck Depression Inventory score >10, 33.3%) failed to predict adherence. Trait
anxiety (State-Trait Anxiety Inventory score >40, 31%) explained minimal
variability regarding smoking and alcohol adherence. Self-efficacy strongly
predicted adherence behavior. CONCLUSIONS: Findings will assist cardiac nurses
to prepare strategies to optimize adherence and quality of life while minimizing
public health costs.
132: J Aging Health. 2007 Feb;19(1):22-38.
Relationship of coping styles with quality of life and depressive symptoms in
older heart failure patients.
Klein DM, Turvey CL, Pies CJ.
University of Iowa, Iowa City, USA.
This study examines the relationship between coping styles, quality of life, and
depressive symptoms in older heart failure patients. Eighty heart failure
patients seeking treatment in an outpatient heart failure or family practice
clinic participated in a study examining depression, disability, and heart
failure. Patients completed a clinical interview and questionnaires about mood,
functional impairment, comorbid illness, quality of life, and coping. Heart
failure severity and maladaptive coping styles, including denial,
self-distraction, and self-blame, negatively affected quality of life and
depressive symptoms. The use of maladaptive coping strategies involves efforts
that divert attention from the illness and suggests the need to provide heart
failure patients the skills to directly address the stress associated with their
illness. Interventions that target these coping strategies may help patients
take a more active role in their heart failure management and may improve
psychological and cardiac outcomes.
Publication Types:
Comment in:
Beta-blockers and depression after myocardial infarction: a multicenter
prospective study.
van Melle JP, Verbeek DE, van den Berg MP, Ormel J, van der Linde MR, de Jonge
P.
Department of Cardiology, Thoraxcenter, University Medical Center Groningen,
Groningen, The Netherlands. j.p.van.melle@med.umcg.nl
OBJECTIVES: The purpose of this research was to explore the prospective
relationship between the use of beta-blockers and depression in myocardial
infarction (MI) patients. BACKGROUND: Beta-blocker use has been reported to be
associated with the development of depression, but the methodological quality of
studies in this field is weak. METHODS: In a multicenter study, MI patients (n =
127 non-beta-blocker users and n = 254 beta-blocker users) were assessed for
depressive symptoms (using the Beck Depression Inventory [BDI] at baseline and t
= 3, 6, and 12 months post-MI) and International Classification of Diseases-10
depressive disorder (Composite International Diagnostic Interview). Patients
were matched using the frequency matching procedure according to age, gender,
hospital of admission, presence of baseline depressive symptoms, and left
ventricular function. RESULTS: No significant differences were found between
non-beta-blocker users and beta-blocker users on the presence of depressive
symptoms (p > 0.10 at any of the time points) or depressive disorder (p = 0.86).
Controlling for confounders did not alter these findings. A trend toward
increasing BDI scores was seen in patients with long-term use of beta-blockers
and patients with higher beta-blocker dose. CONCLUSIONS: In post-MI patients,
prescription of beta-blockers is not associated with an increase in depressive
symptoms or depressive disorders in the first year after MI. However, long-term
and high-dosage effects cannot be ruled out.
Publication Types:
Multicenter Study
134: Biol Psychiatry. 2007 Jul 1;62(1):25-32. Epub 2006 Dec 8.
Hospitalization for depression is associated with an increased risk for
myocardial infarction not explained by lifestyle, lipids, coagulation, and
inflammation: the SHEEP Study.
Janszky I, Ahlbom A, Hallqvist J, Ahnve S.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
imre.janszky@ki.se
BACKGROUND: Depression is considered a risk factor for coronary heart disease
(CHD) in initially CHD-free populations. Subclinical CHD or other somatic causes
of depressive symptoms might account for the association, however. METHODS: In
this case-control study, patients had had their first acute myocardial
infarction (AMI). The study included 1799 cases, aged 45-70 years, and 2339,
age-, gender-, and hospital-catchment-area-matched control subjects. We
calculated odds ratios (OR) with 95% confidence intervals (CI) by multivariate
logistic regressions to assess the AMI risk associated with a hospitalization
for depression. RESULTS: Forty-seven cases and 22 control subjects had been
hospitalized for depression. After adjustment for matching criteria and
socioeconomic status, the OR for AMI was 2.9 (1.8-4.9) for ever hospitalized for
depression. Patients hospitalized for depression before or after the median
time, 15 years and 2 months, between the first hospitalization for depression
and AMI, were at similar risk. Adjustment for lifestyle, lipid profile,
coagulation, inflammation, prior cardiovascular events, and comorbidity only
partly decreased the observed association. CONCLUSIONS: Depression was
associated with increased risk for AMI. Subclinical CHD or other somatic causes
are unlikely to account for our findings, which also appear not to be explained
by established risk factors for AMI.
Publication Types:
Comparative Study
135: Health Serv Res. 2006 Dec;41(6):2182-200.
Erratum in:
Health Serv Res. 2006 Dec;41(6):2303. Lutfey, Karen [added].
How do doctors in different countries manage the same patient? Results of a
factorial experiment.
McKinlay J, Link C, Marceau L, O'Donnell A, Arber S, Adams A, Lutfey K.
New England Research Institutes, Watertown, MA 02472, USA.
OBJECTIVE: To determine the relative contributions of: (1) patient attributes;
(2) provider characteristics; and (3) health care systems to health care
disparities in the management of coronary heart disease (CHD) and depression.
DATA SOURCES/STUDY SETTING: Primary experimental data were collected in 2001-2
from 256 randomly sampled primary care providers in the U.S. (Massachusetts) and
the U.K. (Surrey, Southeast London, and the West Midlands). STUDY DESIGN: Two
factorial experiments were conducted in which physicians were shown, in random
order, two clinically authentic videotapes of "patients" presenting with
symptoms strongly suggestive of CHD and depression. "Patient" characteristics
(age, gender, race, and socioeconomic status [SES]) were systematically varied,
permitting estimation of unconfounded main effects and the interaction of
patient, provider, and system-level influences. DATA COLLECTION/DATA EXTRACTION
METHODS: Analysis of variance was used to measure provider decision-making
outcomes, including diagnosis, information seeking, test ordering, prescribing
behavior, lifestyle recommendations, and referrals/follow-ups. PRINCIPAL
FINDINGS: There is a high level of consistency in decision making for CHD and
depression between the U.S. and the U.K. Most physicians in both countries
correctly identified conditions depicted in the vignettes, although U.S. doctors
engage in more information seeking, are more likely to prescribe medications,
and are more certain of their diagnoses than their U.K. counterparts. The
absence of any national differences in test ordering is consistent for both of
the medical conditions depicted. U.K. physicians, however, were more likely than
U.S. physicians to make lifestyle recommendations for CHD and to refer those
patients to other providers. CONCLUSIONS: Substantively, these findings point to
the importance of patient and provider characteristics in understanding
between-country differences in clinical decision making. Methodologically, our
use of a factorial experiment highlights the potential of these methods for
health services research-especially the estimation of the influence of patient
attributes, provider characteristics, and between-country differences in the
quality of medical care.
Publication Types:
Comparative Study
136: Drugs. 2006;66(16):2095-107.
Treatment of depression in acute coronary syndromes with selective serotonin
reuptake inhibitors.
van Melle JP, de Jonge P, van den Berg MP, Pot HJ, van Veldhuisen DJ.
Department of Cardiology, Thoraxcenter, University Medical Center Groningen,
University of Groningen, 9700 RB Groningen, The Netherlands.
j.p.van.melle@med.umcg.nl
Depression in patients with acute coronary syndromes (ACS) is common and
associated with impaired cardiovascular prognosis in terms of cardiac mortality
and new cardiovascular events. It remains unclear whether antidepressant
treatment may reverse these effects. In this review, the literature is evaluated
on (i) the antidepressant efficacy of selective serotonin reuptake inhibitors
(SSRIs) for depression in patients with ACS; (ii) the pleiomorphic effects of
SSRIs that may be associated with cardiovascular prognosis; and (iii) the
effects of SSRIs on cardiovascular prognosis.SSRIs provide modest relief of
depressive symptoms in selected subgroups of depressed patients with ACS. With
respect to the pleiomorphic effects of SSRIs, three mechanisms of how SSRIs may
improve cardiovascular prognosis are discussed: via platelet function, via the
autonomic nervous system (ANS) and via vasomotor tone. Some studies show that
SSRIs may reduce platelet activity and sympathetic nervous system activation,
but results are inconclusive. SSRIs are associated with vasodilation but this
needs to be confirmed with in vivo experiments.Some non-experimental studies
describe favourable effects of SSRIs on cardiovascular prognosis. Despite recent
developments, much of the effect of SSRIs on cardiovascular prognosis remains
unclear. Although some studies suggest effects of SSRIs on platelet function,
ANS and vasomotor tone, which may lead to improved cardiovascular prognosis,
results are largely inconclusive. More well designed studies addressing these
questions are needed. Moreover, since the effects of SSRIs on depression itself
are limited, efforts should be dedicated to study the diagnostic validity and
homogeneity of depression in the context of ACS and the presence of clinically
relevant subtypes.
137: Eur Heart J. 2006 Dec;27(23):2763-74. Epub 2006 Nov 2.
Depression as an aetiologic and prognostic factor in coronary heart disease: a
meta-analysis of 6362 events among 146 538 participants in 54 observational
studies.
Nicholson A, Kuper H, Hemingway H.
Department of Epidemiology and Public Health, University College London Medical
School, 1-19 Torrington Place, London WC1E 6BT, UK. amanda.nicholson@ucl.ac.uk
AIMS: With negative treatment trials, the role of depression as an aetiological
or prognostic factor in coronary heart disease (CHD) remains controversial. We
quantified the effect of depression on CHD, assessing the extent of confounding
by coronary risk factors and disease severity. METHODS AND RESULTS:
Meta-analysis of cohort studies measuring depression with follow-up for fatal
CHD/incident myocardial infarction (aetiological) or all-cause mortality/fatal
CHD (prognostic). We searched MEDLINE and Science Citation Index until December
2003. In 21 aetiological studies, the pooled relative risk of future CHD
associated with depression was 1.81 (95% CI 1.53-2.15). Adjusted results were
included for 11 studies, with adjustment reducing the crude effect marginally
from 2.08 (1.69-2.55) to 1.90 (1.49-2.42). In 34 prognostic studies, the pooled
relative risk was 1.80 (1.50-2.15). Results adjusted for left ventricular
function result were available in only eight studies; and this attenuated the
relative risk from 2.18 to 1.53 (1.11-2.10), a 48% reduction. Both aetiological
and prognostic studies without adjusted results had lower unadjusted effect
sizes than studies from which adjusted results were included (P<0.01).
CONCLUSION: Depression has yet to be established as an independent risk factor
for CHD because of incomplete and biased availability of adjustment for
conventional risk factors and severity of coronary disease.
Publication Types:
Meta-Analysis
138: Eur J Cardiovasc Nurs. 2006 Dec;5(4):251-2.
Comment in:
Depression in cardiac patients: what can nurses do about it?
Thompson DR, Froelicher ES.
Publication Types:
Editorial
139: Am Heart J. 2006 Nov;152(5):940.e1-8.
Relationship of depression, anxiety, and social isolation to chronic heart
failure outpatient mortality.
Friedmann E, Thomas SA, Liu F, Morton PG, Chapa D, Gottlieb SS; Sudden Cardiac
Death in Heart Failure Trial Investigators.
School of Nursing, University of Maryland, Baltimore, MD 21201, USA.
OBJECTIVES: The Psychosocial Factors Outcome Study (PFOS) investigated the
prevalence of depression and anxiety and the relationship of psychosocial
factors to mortality in outpatients with heart failure (HF). BACKGROUND:
Considerable evidence links psychosocial factors to coronary heart disease
mortality and sudden cardiac death (SCD). The contribution of psychosocial
factors independent of disease severity to HF outpatient mortality is not well
elucidated. METHODS: Patients (N = 153) from 20 Sudden Cardiac Death in Heart
Failure Trial (SCD-HeFT) sites participated in the PFOS. SCD-HeFT provided
demographic, medical history, and cardiac data. Participants completed
questionnaires to assess psychosocial status at PFOS entry. RESULTS: Depression
and anxiety were common in HF outpatients (36% Beck Depression Inventory-II > or
= 13; 45% State Trait Anxiety Inventory > or = 40). Depression, anxiety, and
social support amount did not differ in the SCD-HeFT treatment groups:
implantable cardioverter defibrillator, amiodarone, and placebo medication.
Fifteen (9.8%) patients died during mean follow-up at 23.6 months (SD = 8.2). In
Cox regression controlling for treatment, depression, anxiety, and social
isolation separately predicted mortality; perceived HF-specific functional
status did not. Depression (ln) [P = .04, hazard ratio (HR) = 1.81] and social
isolation (P = .04, HR = 2.25), but not anxiety, predicted mortality independent
of demographics, clinical predictors, and treatment. When simultaneously
including significant demographic, clinical, and psychosocial predictors and
treatment groups, depression (ln) (P = .022, HR = 2.2) and social isolation (P =
.094, HR = 1.75) predicted mortality. All-cause mortality was 12% for depressed
patients and 9% for others. CONCLUSION: This study finds a high prevalence of
anxiety and confirms the high prevalence of depression in the HF outpatient
population. Depression and social isolation predicted mortality independent of
demographic and clinical status in HF outpatients.
Publication Types:
140: Am Heart J. 2006 Nov;152(5):928-34.
The prevalence of unrecognized depression in patients with acute coronary
syndrome.
Amin AA, Jones AM, Nugent K, Rumsfeld JS, Spertus JA.
Mid America Heart Institute of Saint Luke's Hospital, Kansas City, MO, USA.
BACKGROUND: Depression in patients with acute coronary syndrome (ACS) is common
and independently prognostic of a higher mortality and worse health status.
Despite great attention to its prevalence and prognostic import, little is known
about how often hospitalized patients with ACS who have significant depressive
symptoms are recognized while receiving routine cardiovascular care. METHODS: We
performed a cross-sectional study of 1181 consecutive patients with confirmed
ACS. Detailed reviews of hospital records were performed for the documentation
that depressive symptoms were recognized. Multivariable regression analysis was
used to identify factors associated with unrecognized depressive symptoms.
RESULTS: The prevalence of moderate/severe depressive symptoms was 17.6%. Only
24.5% had documentation that their depressive symptoms were recognized. In
multivariable regression analysis, characteristics associated with unrecognized
depressive symptoms were race (minorities vs whites; odds ratio [OR] = 6.73, 95%
confidence interval [CI] 2.62-19.33), ejection fraction (EF < 0.40 vs EF > or =
0.40; OR = 3.45, 95% CI 1.06-11.23), and education level (no college vs some
college; OR = 2.77, 95% CI 1.38-5.69). CONCLUSIONS: Despite its prognostic
importance and prevalence, moderate to severe depressive symptoms are poorly
recognized in hospitalized patients with ACS. Better interventions are warranted
to increase the recognition and improve the management of depressive symptoms in
patients with ACS.
Publication Types:
141: Am Heart J. 2006 Nov;152(5):921.e1-7.
Self-rated health among women with coronary disease: depression is as important
as recent cardiovascular events.
Ruo B, Bertenthal D, Sen S, Bittner V, Ireland CC, Hlatky MA.
Division of General Internal Medicine, Department of Internal Medicine, Feinberg
School of Medicine, Northwestern University, Chicago, IL 60611-2927, USA.
BACKGROUND: Prior studies have shown an association between depression and
self-rated health among patients with coronary disease. However, the magnitude
of the effect of depression on self-rated health compared with that of major
clinical events is unknown. Our main objective was to clarify the association
between depression and self-rated health using longitudinal data. METHODS: We
performed a prospective cohort study of 2675 postmenopausal women with coronary
disease. The primary predictor variable was a 4-state categorical depression
variable based on the Burnam depression screen assessed at sequential visits.
The outcome variable was self-rated overall health (excellent, very good, or
good vs fair or poor). RESULTS: After adjustment for age, comorbidities, prior
self-rated health, and interim events, women with depression at both current and
prior annual visits had a >5-fold increased odds of fair/poor self-rated health
(odds ratio [OR] 5.1, 95% CI 3.8-6.8). New depression was associated with a
>2-fold increased odds of fair/poor self-rated health (OR 2.6, 95% CI 2.0-3.4).
Having a history of depression at the preceding annual visit but not at the
current visit was associated with a slight increased odds of fair/poor
self-rated health (OR 1.3, 95% CI 1.0-1.7). The magnitude of the impact of
persistent or new depression was comparable to that of recent angina, myocardial
infarction, angioplasty, heart failure, or bypass surgery. CONCLUSIONS: Women
with persistent or new depression are more likely to report fair/poor self-rated
health. The magnitude of the impact of persistent or new depression is
comparable to that of major cardiac events.
Publication Types:
142: Aust N Z J Psychiatry. 2006 Nov-Dec;40(11-12):1025-30.
Predictors of depression 12 months after cardiac hospitalization: the
Identifying Depression as a Comorbid Condition study.
Schrader G, Cheok F, Hordacre AL, Marker J.
Department of Psychiatry, University of Adelaide, Queen Elizabeth Hospital,
Woodville, South Australia, Australia. geoffrey.schrader@adelaide.edu.au
OBJECTIVE: To determine characteristics which predict depression at 12 months
after cardiac hospitalization, and track the natural history of depression.
METHOD: Depressive symptoms were monitored at baseline, 3 and 12 months in a
cohort of 785 patients, using the self-report Center for Epidemiological Studies
Depression Scale. Multinomial regression analyses of baseline clinical and
demographic variables identified characteristics associated with depression at
12 months. RESULTS: Three baseline variables predicted moderate to severe
depression at 12 months: depression during index admission, past history of
emotional health problems and current smoking. For those who were depressed
during cardiac hospitalization, 51% remained depressed at both 3 and 12 months.
Persistence was more evident in patients who had moderate to severe depressive
symptoms when hospitalized. Mild depression was as likely to persist as to
remit. CONCLUSIONS: Three clinically accessible characteristics at the time of
cardiac hospitalization can assist in predicting depression at 12 months and may
aid treatment decisions. Depressive symptoms persist in a substantial proportion
of cardiac patients up to 12 months after hospitalization.
Recognizing increased risk of depressive comorbidity after myocardial
infarction: looking for 4 symptoms of anxiety-depression.
Denollet J, Strik JJ, Lousberg R, Honig A.
Department of Psychology and Health, Tilburg University, Tilburg, The
Netherlands. denollet@uvt.nl
BACKGROUND: Screening for depression in myocardial infarction (MI) patients must
be improved: (1) depression often goes unrecognized and (2) anxiety has been
largely overlooked as an essential feature of depression in these patients. We
therefore examined the co-occurrence of anxiety and depression after MI, and the
validity of a brief mixed anxiety-depression index as a simple way to identify
post-MI patients at increased risk of comorbid depression. METHODS: One month
after MI, 176 patients underwent a psychiatric interview and completed the Beck
Depression Inventory (BDI) and the Symptoms of Anxiety-Depression index (SAD(4))
containing four symptoms of anxiety (tension, restlessness) and depression
(feeling blue, hopelessness). RESULTS: Thirty-one MI patients (18%) had comorbid
depression and 37 (21%) depressive or anxiety disorder. High factor loadings and
item-total correlations (SAD(4), alpha = 0.86) confirmed that symptoms of
anxiety and depression co-occurred after MI. Mixed anxiety-depression
(SAD(4)>or=3) was present in 90% of depressed MI patients and in 100% of
severely depressed patients. After adjustment for standard depression symptoms
(BDI; OR = 4.4, 95% CI 1.6-12.1, p = 0.004), left ventricular ejection fraction,
age and sex, mixed anxiety-depression symptomatology was associated with an
increased risk of depressive comorbidity (OR = 11.2, 95% CI 3.0-42.5, p <
0.0001). Mixed anxiety-depression was also independently associated with
depressive or anxiety disorder (OR = 9.2, 95% CI 3.0-27.6, p < 0.0001).
CONCLUSIONS: Anxiety is underrecognized in post-MI patients; however, the
present findings suggest that anxiety symptomatology should not be overlooked in
these patients. Depressive comorbidity after MI is characterized by symptoms of
mixed anxiety-depression, after controlling for standard depression symptoms.
The SAD(4) represents an easy way to recognize the increased risk of post-MI
depression.
Publication Types:
144: Arch Intern Med. 2006 Oct 9;166(18):2035-43.
Time course of depression and outcome of myocardial infarction.
Parashar S, Rumsfeld JS, Spertus JA, Reid KJ, Wenger NK, Krumholz HM, Amin A,
Weintraub WS, Lichtman J, Dawood N, Vaccarino V.
Divisions of General Medicine, Department of Medicine, Emory University School
of Medicine, Atlanta, GA 30303, USA. smallik@emory.edu
BACKGROUND: Depression predicts worse outcomes after myocardial infarction (MI),
but whether its time course in the month following MI has prognostic importance
is unknown. Our objective was to evaluate the prognostic importance of
transient, new, or persistent depression on outcomes at 6 months after MI.
METHODS: In a prospective registry of acute MI (Prospective Registry Evaluating
outcomes after Myocardial Infarction: Events and Recovery [PREMIER]), depressive
symptoms were measured in 1873 patients with the Patient Health Questionnaire
(PHQ) during hospitalization and 1 month after discharge and were classified as
transient (only at baseline), new (only at 1 month), or persistent (at both
times). Outcomes at 6 months included (1) all-cause rehospitalization or
mortality and (2) health status (angina, physical limitation, and quality of
life using the Seattle Angina Questionnaire). RESULTS: Compared with
nondepressed patients, all categories of depression were associated with higher
rehospitalization or mortality rates, more frequent angina, more physical
limitations, and worse quality of life. The adjusted hazard ratios for
rehospitalization or mortality were 1.34, 1.71, and 1.42 for transient, new, and
persistent depression, respectively (all P<.05). Corresponding odds ratios were
1.62, 2.73, and 2.64 (all P<.01) for angina and 1.69, 2.25, and 3.27 (all P<.05)
for physical limitation. Depressive symptoms showed a stronger association with
health status compared with traditional measures of disease severity.
CONCLUSION: Depressive symptoms after MI, irrespective of whether they persist,
subside, or newly develop in the first month after hospitalization, are
associated with worse outcomes after MI.
Publication Types:
Multicenter Study
145: Br J Psychiatry. 2006 Oct;189:367-72.
Comment in:
Br J Psychiatry. 2007 Mar;190:272-3; author reply 273.
Contribution of depression and anxiety to impaired health-related quality of
life following first myocardial infarction.
Dickens CM, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A, Creed FH.
Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford
Road, Manchester M13 9WL, UK. chris.dickens@manchester.ac.uk
BACKGROUND: The extent to which depression impairs health-related quality of
life (HRQoL) in the physically ill has not been clearly established. AIMS: To
quantify the adverse influence of depression and anxiety, assessed at the time
of first myocardial infarction and 6 months later, on the physical aspect of
HRQoL 12 months after the infarction. METHOD: In all, 260 in-patients, admitted
following first myocardial infarction, completed the Hospital Anxiety and
Depression Scale and the Medical Outcomes Study SF-36 assessment before
discharge and at 6- and 12-month follow-up. RESULTS: Depression and anxiety 6
months after myocardial infarction predicted subsequent impairment in the
physical aspects of HRQoL (attributable adjusted R(2)=9%, P<0.0005). These
negative effects of depression and anxiety on outcome were mediated by feelings
of fatigue. Depression and anxiety present before myocardial infarction did not
predict HRQoL 12 months after myocardial infarction. CONCLUSIONS: Detection and
treatment of depression and anxiety following myocardial infarction improve the
patient's health-related quality of life.
Publication Types:
Resource loss predicts depression and anxiety among patients treated with an
implantable cardioverter defibrillator.
Luyster FS, Hughes JW, Waechter D, Josephson R.
Department of Psychology, Kent State University, Kent, OH 44242, USA.
OBJECTIVE: Many patients treated with an implantable cardioverter defibrillator
(ICD) experience clinically significant depression and anxiety after ICD
implantation. As ICD use continues to evolve, it is important to understand the
correlates of depression and anxiety to identify patients at greatest risk of
poor psychological functioning. Conservation of resources theory, a general
theory of stress, states that people experience greater stress if they perceive
that they are losing personal, social, and material resources. We hypothesized
that perceptions of resource loss would be related to symptoms of depression and
anxiety after controlling for other known predictors. METHODS: One hundred
patients treated with an ICD completed standardized depression and anxiety
questionnaires along with questionnaires assessing social support, physical
functioning, and resource loss. Clinical variables for patients were obtained
from prospectively obtained medical records. RESULTS: Over 20% of the sample
exhibited elevated symptoms of depression and anxiety. Patients' depression
levels were associated with poor social support, poor physical functioning, a
history of depression, and a greater length of time since ICD implantation.
Having experienced one or more clinical ICD shocks was related to depression but
not anxiety. Higher levels of perceived resource loss were associated with
higher levels of both depression and anxiety after controlling for all other
predictors. CONCLUSIONS: Resource loss may help to determine psychological
distress after ICD implantation. Understanding how resource loss contributes to
depression and anxiety may help to identify patients at greatest risk of poor
psychological functioning and may suggest treatment strategies.
Publication Types:
Comment in:
Evid Based Ment Health. 2007 May;10(2):43.
Phobic anxiety, depression, and risk of ventricular arrhythmias in patients with
coronary heart disease.
Watkins LL, Blumenthal JA, Davidson JR, Babyak MA, McCants CB Jr, Sketch MH Jr.
Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
27710, USA. watki017@mc.duke.edu
OBJECTIVE: Findings of an association between phobic anxiety and elevated risks
of sudden cardiac death suggest that phobic anxiety may be related to increased
risk of ventricular arrhythmias. The purpose of this study was to examine
whether phobic anxiety is associated with ventricular arrhythmias in patients
with documented coronary artery disease (CAD). METHODS: Phobic anxiety level was
measured using the Crown-Crisp phobic anxiety scale in 940 patients (660 men,
280 women) hospitalized for diagnostic cardiac catheterization between April
1999 and June 2002. Depressive symptomatology was assessed using the Beck
Depression Inventory. Patients were followed for a median follow-up period of 3
years, and the occurrence of ventricular arrhythmias was determined through
review of medical records. RESULTS: Ventricular arrhythmias occurred in 97
patients and were significantly related to higher phobic anxiety after
statistical adjustment for established medical and demographic determinants of
arrhythmias (odds ratio = 1.40; p = .012). Depressive symptomatology was
significantly correlated with phobic anxiety (r = 0.44, p < .001) and was also
related to ventricular arrhythmias (odds ratio = 1.40; p = .006). The composite
of depression and phobic anxiety predicted ventricular arrhythmias with a larger
effect size than either depression or phobic anxiety score alone (odds ratio =
1.6, 95% confidence interval, 1.2-2.1, p = .002). CONCLUSIONS: Both phobic
anxiety and depressive symptomatology predict ventricular arrhythmias in
patients with CAD and may share a common factor predictive of ventricular
arrhythmias.
Publication Types:
148: Psychosom Med. 2006 Sep-Oct;68(5):662-8. Epub 2006 Sep 20.
Comment in:
Evid Based Ment Health. 2007 May;10(2):42.
Course of depressive symptoms after myocardial infarction and cardiac prognosis:
a latent class analysis.
Kaptein KI, de Jonge P, van den Brink RH, Korf J.
Department of Psychiatry, University Medical Center Groningen, University of
Groningen, The Netherlands.
OBJECTIVE: The presence of depressive symptoms after myocardial infarction (MI)
is a risk factor for new cardiovascular events. The importance of the course of
post-MI depressive symptoms for cardiac prognosis is not clear. We therefore set
out to investigate whether different courses of post-MI depressive symptoms can
be identified and determine their associations with cardiac events. METHODS:
Data were derived from the Depression after Myocardial Infarction (DepreMI)
study, a naturalistic follow-up study of patients admitted for an MI in four
hospitals in The Netherlands (N = 475). Scores on the Beck Depression Inventory
(BDI) during hospitalization and at 3, 6, and 12 months post-MI were analyzed.
Using latent class analysis (LCA), we identified classes characterized by
distinctive courses of depressive symptoms and then examined their link to
cardiac prognosis. RESULTS: The prevalence of significant depressive symptoms
ranged from 22.7% to 25.5% throughout the post-MI year. Five distinct courses
were found: no depressive symptoms (56.4%), mild depressive symptoms (25.7%),
moderate and increasing depressive symptoms (9.3%), significant but decreasing
depressive symptoms (4.6%), and significant and increasing depressive symptoms
(4.0%). Subjects in this last class had, statistically, a significantly higher
risk for a new cardiovascular event compared with subjects without depressive
symptoms (hazard ratio (HR) = 2.73; p = .01). Controlling for baseline cardiac
status and sociodemographic data did not alter the association (HR = 2.46; p =
.03). CONCLUSIONS: Post-MI depressed subjects with significant and increasing
depressive symptoms are at particular risk of new cardiac events. This subgroup
may be most suited for evaluation of the effects of antidepressant treatment on
cardiac prognosis.
Publication Types:
Comparative Study
Multicenter Study
149: Ann Behav Med. 2006 Oct;32(2):121-6.
Assessment and treatment of depression in patients with cardiovascular disease:
National Heart, Lung, and Blood Institute working group report.
Davidson KW, Kupfer DJ, Bigger JT, Califf RM, Carney RM, Coyne JC, Czajkowski
SM, Frank E, Frasure-Smith N, Freedland KE, Froelicher ES, Glassman AH, Katon
WJ, Kaufmann PG, Kessler RC, Kraemer HC, Krishnan KR, Lesperance F, Rieckmann N,
Sheps DS, Suls JM.
Department of Medicine, Columbia University College of Physicians and Surgeons,
New York, NY 10032, USA, and Centre Hospitalier de l'Universite de Montreal
Research Center, Quebec, Canada. kd2124@columbia.edu
Publication Types:
Congresses
Practice Guideline
150: J Cardiovasc Nurs. 2006 Sep-Oct;21(5):407-11.
Associations between depression, fatigue, and life orientation in myocardial
infarction patients.
Brink E, Grankvist G.
Department of Nursing, Health and Culture, University West, Trollhattan, Sweden.
eva.brink@hv.se
BACKGROUND: The possible preventive and treatment measures for post-myocardial
infarction fatigue may rely on gaining insight into the psychosocial factors
associated with fatigue. One such factor may be life orientation, that is,
having an optimistic versus pessimistic view of life. Optimists expect things to
turn out for the good, whereas pessimists generally expect that bad things will
happen to them. OBJECTIVE: The aim of this study was to explore the relations
among life orientation (optimism-pessimism), depression, and fatigue after a
first-time myocardial infarction. METHODS: The sample included 98 patients in
total, 33 women and 65 men, who had suffered a first-time myocardial infarction
1 year before the testing. Linear and curvilinear regression analysis models
were used to describe and explore the associations between the variables.
RESULTS: A nonlinear relationship between postmyocardial fatigue and life
orientation was found. The interpretation was that a pessimistic view of life
could have more negative consequences for postmyocardial fatigue than an
optimistic view of life could have positive consequences. The association
between depression and fatigue was weak, supporting the notion that fatigue may
be experienced by myocardial infarction patients without coexisting depression.
CONCLUSION: Post-myocardial infarction fatigue must be investigated further and
explicitly focused upon. One way to decrease postmyocardial fatigue could be to
focus on steps that cause the most pessimistic individuals to feel less
pessimistic.
151: Arch Gen Psychiatry. 2006 Sep;63(9):1052; author reply 1052.
Comment in:
Arch Gen Psychiatry. 2007 May;64(5):611-2.
Comment on:
Arch Gen Psychiatry. 2005 Jun;62(6):661-6.
Heart rate variability and depression.
Birkhofer A, Schmidt G, Forstl H.
Publication Types:
Comment
Comparative Study
Letter
152: Heart. 2006 Sep;92(9):1316-8.
Relation between C reactive protein and depression remission status in patients
presenting with acute coronary syndrome.
Shimbo D, Rieckmann N, Paulino R, Davidson KW.
Publication Types:
Letter
Multicenter Study
153: J Gen Intern Med. 2006 Nov;21(11):1178-83. Epub 2006 Aug 9.
Persistent depression affects adherence to secondary prevention behaviors after
acute coronary syndromes.
Kronish IM, Rieckmann N, Halm EA, Shimbo D, Vorchheimer D, Haas DC, Davidson KW.
Division of General Internal Medicine, Mount Sinai School of Medicine, New York,
NY, USA.
BACKGROUND: The persistence of depressive symptoms after hospitalization is a
strong risk factor for mortality after acute coronary syndromes (ACS). Poor
adherence to secondary prevention behaviors may be a mediator of the
relationship between depression and increased mortality. OBJECTIVE: To determine
whether rates of adherence to risk reducing behaviors were affected by
depressive status during hospitalization and 3 months later. DESIGN: Prospective
observational cohort study. SETTING: Three university hospitals. PARTICIPANTS:
Five hundred and sixty patients were enrolled within 7 days after ACS. Of these,
492 (88%) patients completed 3-month follow-up. MEASUREMENTS: We used the Beck
Depression Inventory (BDI) to assess depressive symptoms in the hospital and 3
months after discharge. We assessed adherence to 5 risk-reducing behaviors by
patient self-report at 3 months. We used chi2 analysis to compare differences in
adherence among 3 groups: persistently nondepressed (BDI < 10 at hospitalization
and 3 months); remittent depressed (BDI > or = 10 at hospitalization; < 10 at 3
months); and persistently depressed patients (BDI > or = 10 at hospitalization
and 3 months). RESULTS: Compared with persistently nondepressed, persistently
depressed patients reported lower rates of adherence to quitting smoking
(adjusted odds ratio [OR] 0.23, 95% confidence interval [95% CI] 0.05 to 0.97),
taking medications (adjusted OR 0.50, 95% CI 0.27 to 0.95), exercising (adjusted
OR 0.57, 95% CI 0.34 to 0.95), and attending cardiac rehabilitation (adjusted OR
0.5, 95% CI 0.27 to 0.91). There were no significant differences between
remittent depressed and persistently nondepressed patients. CONCLUSIONS:
Persistently depressed patients were less likely to adhere to behaviors that
reduce the risk of recurrent ACS. Differences in adherence to these behaviors
may explain in part why depression predicts mortality after ACS.
Publication Types:
Comparative Study
Multicenter Study
154: Arch Gen Psychiatry. 2006 Aug;63(8):874-80.
Depression symptom severity and reported treatment history in the prediction of
cardiac risk in women with suspected myocardial ischemia: The NHLBI-sponsored
WISE study.
Rutledge T, Reis SE, Olson MB, Owens J, Kelsey SF, Pepine CJ, Mankad S, Rogers
WJ, Merz CN, Sopko G, Cornell CE, Sharaf B, Matthews KA, Vaccarino V.
Department of Psychiatry, VA San Diego Healthcare System and University of
California, San Diego, CA 92161, USA. Thomas.Rutledge@med.va.gov
BACKGROUND: Depression is associated with clinical events and premature
mortality among patients with established coronary artery disease (CAD).
Typically, however, studies in this area focus only on baseline symptom severity
and lack any data concerning symptom duration or symptom history. OBJECTIVES: To
describe and compare the relationships between 2 measures of depression-assessed
in the form of depression symptom severity and reported treatment history-with
atherosclerosis risk factors and major clinical events in a sample of women with
suspected myocardial ischemia. DESIGN: Follow-up study of women who completed a
diagnostic CAD protocol, including cardiac symptoms, coronary angiography,
ischemic testing, and assessments of depression symptom severity and reported
treatment history. SETTING: The Women's Ischemia Syndrome Evaluation (WISE), a
National Heart, Lung, and Blood Institute (NHLBI)-sponsored multicenter study
assessing cardiovascular function using state-of-the-art techniques in women
referred for coronary angiography to evaluate chest pain or suspected myocardial
ischemia. PARTICIPANTS: Five hundred five women (mean age, 53.4 years) enrolled
in WISE and followed up for a mean of 4.9 years. MAIN OUTCOME MEASURES:
Incidence of cardiac events, including myocardial infarction, stroke, and heart
failure, and total mortality. RESULTS: Relative to those with no or less stable
depression symptoms, women with elevated depression symptoms and a reported
treatment history showed higher rates of smoking, hypertension, and poorer
education and an increased incidence of death and cardiac events
(multivariate-adjusted risk ratio, 3.1; 95% confidence interval, 1.5-6.3; P =
.001). CONCLUSIONS: Among women with suspected myocardial ischemia, a
combination of depressive symptom severity and treatment history was a strong
predictor of an elevated CAD risk profile and increased risk of cardiac events
compared with those without depression or with only 1 of the 2 measured
depression markers. These findings reinforce the importance of assessing mental
health factors in women at elevated CAD risk. Focusing only on baseline
depression symptom severity may provide an incomplete picture of CAD risk.
Publication Types:
Multicenter Study
155: Diabetes Res Clin Pract. 2007 Feb;75(2):220-8. Epub 2006 Aug 1.
An examination of the moderating effect of treatment with anti-depressants on
the association of heart disease with depression in males with type 2 diabetes
attending a Veterans Affairs Medical Center.
Higgins TS Jr, Ritchie CS, Stetson BA, Burke JD, Looney SW.
School of Medicine, University of Louisville, Louisville, KY, USA.
OBJECTIVE: To examine the association of heart disease with depression and the
impact of treatment with anti-depressants on this association in older males
with type 2 diabetes. RESEARCH DESIGN AND METHODS: In this cross-sectional
study, data were collected from the electronic medical record system of the
Veterans Affairs Medical Center (VAMC) in a large mid-western city in the United
States. Subjects were 8185 males older than 40, with a history of type 2
diabetes, who had visited the VAMC within the previous 6 years. Odds ratios were
used to measure bivariate associations; multivariate logistic regression was
used to adjust for potential confounding factors. RESULTS: After adjustments for
confounding variables, significant associations were found between depression
and any adverse heart event (OR=1.34, p=0.001), coronary artery disease
(OR=1.23, p=0.039), myocardial infarction (MI; OR=1.77, p<0.001), and
angioplasty (OR=1.36, p=0.034). Examination of the interaction between
depression and anti-depressant prescription status indicated that, except for
MI, these associations were no longer significant among those who had been
prescribed anti-depressants, but remained significant and were increased in
magnitude among those who had not been prescribed anti-depressants. CONCLUSIONS:
These findings support the premise that co-morbid depression in diabetics is
associated with the occurrence of adverse heart events, and further suggest that
treatment of depression with anti-depressants moderates this association.
156: Am J Cardiol. 2006 Aug 1;98(3):319-24. Epub 2006 Jun 12.
Recognition and treatment of depression and anxiety in patients with acute
myocardial infarction.
Huffman JC, Smith FA, Blais MA, Beiser ME, Januzzi JL, Fricchione GL.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts,
USA. jhuffman@partners.org
The objective of this study was to determine the ability of providers (medical
residents and nurse practitioners) on inpatient cardiac units to recognize and
appropriately treat patients with clinically significant depression and anxiety
among a cohort admitted with acute myocardial infarction. Patients within 72
hours of acute myocardial infarction underwent screening with the Standardized
Clinical Instrument for Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition module for major depressive disorder (MDD), the Beck Depression
Inventory (BDI-II), and the Beck Anxiety Inventory (BAI). In addition, the study
psychiatrist and a treatment team clinician independently assessed whether they
believed that patients had clinically significant depression or anxiety.
Prescription of antidepressants and benzodiazepines during hospitalization was
recorded by chart review. Assessments were completed for 74 patients. Providers
identified < 15% of patients with current MDD or with a BDI score > or = 10; 11%
of patients with current MDD had appropriate treatment with antidepressants.
There was no significant correlation of providers' assessment of depression with
current MDD, BDI scores, or psychiatrists' clinical assessment of depression. In
contrast, providers identified 31% of patients with a BAI score > or = 10 and
50% of patients who were assessed by psychiatrists as anxious; > 80% of patients
with high anxiety received benzodiazepines. Providers' assessments of anxiety
were significantly correlated with BAI scores and with psychiatrists' clinical
assessments. In conclusion, medical residents and nurse practitioners routinely
under-recognize and undertreat depression among patients with acute myocardial
infarction on inpatient cardiac units. Recognition and treatment of anxiety is
substantially better, up to 50% of patients who are found to be anxious by
psychiatrists after acute myocardial infarction remain unrecognized.
Publication Types:
Comparative Study
Comparison of major and minor depression in older medical inpatients with
chronic heart and pulmonary disease.
Koenig HG, Vandermeer J, Chambers A, Burr-Crutchfield L, Johnson JL.
Duke Univ. Medical Center and the GRECC VA Medical Center, Durham, NC 27710,
USA. koenig@geri.duke.edu
Depressed medical inpatients with congestive heart failure (CHF) and/or chronic
pulmonary disease (CPD) were examined to determine characteristics
distinguishing major depression (N=413) from minor depression (N=587).
Consecutively admitted patients age 50 or over were screened for depressive
disorder with the Structured Clinical Interview for Depression (SCID-IV).
CHF/CPD patients with major depression differed from those with minor depression
not only on number and severity of depressive symptoms but also on
race/ethnicity, comorbid psychiatric illnesses, dyspnea, life stressors, social
support, and previous antidepressant therapy. CHF/CPD patients with major and
minor depression have distinct psychosocial and physical characteristics that
distinguish one from another.
Publication Types:
Comparative Study
158: Eur J Cardiovasc Nurs. 2007 Jun;6(2):92-8. Epub 2006 Jul 14.
Comment in:
Depression symptoms have a greater impact on the 1-year health-related quality
of life outcomes of women post-myocardial infarction compared to men.
Norris CM, Hegadoren K, Pilote L.
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
colleen.norris@ualberta.ca
OBJECTIVE: Several studies report that women with CAD have a poorer prognosis
than men and suggest that depressive symptoms may be a contributing factor. The
purpose of this study was to examine gender differences in depressive symptoms,
as they relate to health-related quality of life outcomes following an AMI.
METHODS: Patients with documented AMI completed a questionnaire including the
Short Form 36 physical (PCS), and mental component summary (MCS) scores, and
Beck Depression Inventory at baseline and at 1 year after AMI admission.
RESULTS: 486 (82%) patients completed the follow-up questionnaire. Females had
significantly worse PCS and MCS scores at baseline and 1-year follow-up compared
to males The mean 1-year Beck scores were significantly higher (p=0.01) for
females (10.02+/-8.23) compared to males (7.78+/-8.01) indicating more reported
depressive symptomatology. Multivariate analyses showed significant
gender-related differences in the PCS scores at 1 year, but no gender-related
differences in the 1-year MCS scores. CONCLUSIONS: These results suggest that
gender differences in mental health at 1 year relate to gender-related
differences at 1-year depression levels. The higher level of depression in women
may be a consequence of gender differences in recovery patterns from an AMI and
requires further investigation.
Publication Types:
Comparative Study
159: Am Heart J. 2006 Jul;152(1):126-35.
Prediction of medical morbidity and mortality after acute myocardial infarction
in patients at increased psychosocial risk in the Enhancing Recovery in Coronary
Heart Disease Patients (ENRICHD) study.
Jaffe AS, Krumholz HM, Catellier DJ, Freedland KE, Bittner V, Blumenthal JA,
Calvin JE, Norman J, Sequeira R, O'Connor C, Rich MW, Sheps D, Wu C; Enhancing
Recovery in Coronary Heart Disease Patients (ENRICHD) Trial Investigators.
Cardiovascular Division, Mayo Clinic, Rochester, MN 55905, USA.
jaffe.allan@mayo.edu
BACKGROUND: Patients with myocardial infarction (MI) are at further increased
risk for untoward events when patients also exhibit low social support and/or
depression. The ENRICHD study was the largest controlled trial in post-MI
patients attempting to treat these psychological comorbidities and provides an
opportunity to examine the medical and psychological characteristics that may
affect risk in this population. METHODS: We analyzed the baseline
characteristics and their relationship to the primary end point of long-term
mortality and recurrent infarction and to the secondary end points of overall
mortality and cardiovascular mortality in 2481 post-MI patients. Cox
proportional hazards models were used to predict the risk of these outcomes over
a mean of 2.5 years of follow-up. RESULTS: Death or nonfatal MI occurred in
24.1%, all-cause mortality in 13.7%, and cardiovascular mortality in 8.4% of the
sample (62% of the total). Age, heart failure, pulmonary disease, Killip class,
ejection fraction, an elevated creatinine, the use of non-angiotensin-coverting
enzyme asodilators, prior MI, diabetes, depression, and bypass surgery after
acute MI were all significant multivariable predictors. CONCLUSIONS: The medical
predictors of adverse events in post-MI patients with low social support and/or
depression were similar to those of patients with MI in other clinical trials.
Publication Types:
160: Am J Psychiatry. 2006 Jul;163(7):1295-6; author reply 1296.
Comment on:
Am J Psychiatry. 2006 Jan;163(1):138-44.
Do symptom dimensions of depression following myocardial infarction relate
differently to physical health indicators and cardiac prognosis?
Thombs BD, Grace SL, Ziegelstein RC.
Publication Types:
Comment
Letter
161: J Psychosom Res. 2006 Jul;61(1):19-23.
Comment in:
J Psychosom Res. 2006 Dec;61(6):847; author reply 849.
QT interval duration in apparently healthy men is associated with
depression-related personality trait neuroticism.
Minoretti P, Politi P, Martinelli V, Emanuele E, Bertona M, Falcone C, Geroldi
D.
Interdepartmental Center for Research in Molecular Medicine (CIRMC), University
of Pavia, Viale Taramelli, 24, I-27100 Pavia, Italy.
OBJECTIVE: High levels of neuroticism and low self-esteem are markers for
vulnerability to depression, a condition associated with a higher risk of
arrhythmias. The question as to whether these depression-related personality
domains are related to cardiac repolarization (duration of QT interval) in
apparently healthy men has been addressed in this study. METHODS: Participants
were 658 clinically healthy males who underwent a health screening programme. QT
interval duration was determined in the resting 12-lead electrocardiogram using
an automated analysis program. Neuroticism was assessed by the short-scale
Eysenck Personality Questionnaire and self-esteem by the Rosenberg self-esteem
scale. RESULTS: Heart-rate corrected QT interval {QTc, formula of Bazett [Bazett
HC. An analysis of time relations of electrocardiograms. Heart 1920;7:353-370]}
progressively increased across quartiles of neuroticism ratings. By contrast, no
differences in QTc were observed across different degrees of self-esteem. A
multivariate regression analysis showed that neuroticism was a statistically
significant, independent predictor of QTc duration. CONCLUSION: After adjustment
for potential confounders, neuroticism scores independently predicted QT
interval duration in apparently healthy men. These findings highlight the
possibility that higher arrhythmic risk could be present not only in patients
with clinical depression but also in depression-prone, otherwise healthy
individuals.
Depressive symptoms, social isolation, and progression of coronary artery
atherosclerosis: the Stockholm Female Coronary Angiography Study.
Wang HX, Mittleman MA, Leineweber C, Orth-Gomer K.
Division of Preventive Medicine, Department of Public Health Sciences,
Karolinska Institute, Stockholm, Sweden.
BACKGROUND: Although both depressive symptoms and social isolation in relation
to coronary heart disease have been studied previously, few have examined their
joint effects on coronary atherosclerosis progression in women. METHOD: Among
the women enrolled in the Stockholm Female Coronary Angiography Study, Sweden,
between 1991 and 1994, 102 were evaluated for coronary atherosclerosis
progression using a computer-assisted standardized assessment, repeated
quantitative coronary angiographic documentation, of the mean luminal diameter
change over 3 years in 10 predefined coronary segments. Depressive symptoms and
social isolation were assessed by standard questionnaires. RESULTS:
Multivariable controlled mixed model ANOVAs revealed that women who were both
depressed and socially isolated had the greatest disease progression: their
absolute mean luminal diameter decreased by 0.18 mm [95% confidence interval
(CI) = 0.11-0.24] and their percent narrowing was 5.5% (95% CI = 3.6-7.4),
whereas in women who lacked both psychological risk factors, the mean luminal
diameter decrease was 0.04 mm and their percent narrowing was 0.9%. These
associations were independent of the baseline luminal diameter and standard risk
factors, including age, smoking history, hypertension, and high-density
lipoproteins. CONCLUSIONS: In women with coronary disease, depressive symptoms
and social isolation in combination accelerated disease progression, suggesting
a direct psychosocial effect on the atherosclerotic process. These findings
provide an additional opportunity for therapeutic and preventive efforts against
progression of coronary disease in women. Copyright 2006 S. Karger AG, Basel
Publication Types:
163: Psychosomatics. 2006 Mar-Apr;47(2):129-35.
A validation study of two brief measures of depression in the cardiac
population: the DMI-10 and DMI-18.
Hilton TM, Parker G, McDonald S, Heruc GA, Olley A, Brotchie H, Friend C, Walsh
WF.
Black Dog Institute, Prince of Wales Hospital, Sydney, Australia.
t.hilton@unsw.edu.au
The authors report on the psychometric characteristics and clinical efficacy of
two versions of a recently developed screening measure of depression (the DMI-18
and DMI-10) in the cardiac population. Patients with acute coronary syndrome or
heart failure (N = 322) completed the DMI measures, psychosocial questionnaires,
and a semistructured clinical interview during the hospital stay. The DMI-18 and
DMI-10 measures have adequate psychometric properties, demonstrating high
sensitivity and specificity when evaluated against clinical judgment based on a
semistructured interview. The DMI-18 and DMI-10 are appropriate for use as
screening instruments in cardiac patients.
Publication Types:
Validation Studies
164: Eur J Heart Fail. 2006 Oct;8(6):634-40. Epub 2006 Feb 28.
Depressive symptoms are prominent among elderly hospitalised heart failure
patients.
Lesman-Leegte I, Jaarsma T, Sanderman R, Linssen G, van Veldhuisen DJ.
Department of Cardiology, University Medical Center Groningen, University of
Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
g.a.t.lesman-leegte@thorax.umcg.nl
BACKGROUND: There are limited data on the prevalence of depressive symptoms in
hospitalised elderly HF patients and demographic and clinical characteristics
associated with depressive symptoms are not known. METHODS: A sample of 572 HF
patients (61% male; age 71+/-12 years; LVEF 34%+/-15) was recruited from 17
Dutch hospitals during HF admission. Depressive symptoms were assessed by the
CES-D. Demographic, clinical variables and HF symptoms were collected from
patient chart and interview. RESULTS: Forty one percent of the patients had
symptoms of depression with women significantly more often reporting depressive
symptoms than men 48% vs. 36% (chi(2)=8.1, p<0.005). HF patients with depressive
symptoms reported more clinical HF symptoms than patients without depressive
symptoms. Even after deleting HF related symptoms (sleep disturbances and loss
of appetite) from the CES-D scale, 36% of patients were still found to have
symptoms of depression. Multivariable logistic regression analyses revealed that
depressive symptoms were associated with female gender (odds 1.68, 95% CI
1.14-2.48), COPD (odds 2.11, 95% CI 1.35-3.30), sleep disturbance (odds 3.45,
95% CI 2.03-5.85) and loss of appetite (odds 2.61, 95% CI 1.58-4.33).
CONCLUSIONS: Depressive symptoms are prominent in elderly hospitalised HF
patients especially in women. Depressive symptoms are associated with more
pronounced symptomatology, despite the fact that other indices of severity of
left ventricular dysfunction are similar.
Publication Types:
Multicenter Study
165: J Card Fail. 2006 Feb;12(1):54-60.
Difficulty taking medications, depression, and health status in heart failure
patients.
Morgan AL, Masoudi FA, Havranek EP, Jones PG, Peterson PN, Krumholz HM, Spertus
JA, Rumsfeld JS; for the Cardiovascular Outcomes Research Consortium (CORC).
University of Colorado Health Sciences Center, Denver, USA.
BACKGROUND: Little is known about medication nonadherence in heart failure
populations. We evaluated the association between 1 aspect of medication
nonadherence, patient-reported difficulty taking medications as directed, and
health status among heart failure outpatients, and then examined whether this
association was explained by depression. METHODS AND RESULTS: A total of 522
outpatients with left ventricular ejection fraction <0.40 completed clinical
evaluation, Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes
Study-Depression questionnaire, and categorized their difficulty taking
medications (5-level Likert-scale question). Multivariable regression was used
to evaluate the cross-sectional association between difficulty taking
medications and health status, with incremental adjustment for medical history
and depressive symptoms. Patients with difficulty taking medications (n = 64;
12.2%) had worse health status (8.2 +/- 2.7 point lower mean KCCQ summary
scores; P = .008) and more depressive symptoms (43.8% versus 27.1%; P = .006).
Adjusting for demographic and clinical factors had little effect on the
association between difficulty taking medications and health status (8.0 +/- 3.2
point lower KCCQ scores; P = .01); however, the relationship was attenuated with
adjustment for depressive symptoms (4.7 +/- 2.9 point lower KCCQ scores; P =
.11). CONCLUSIONS: Among heart failure outpatients, difficulty taking
medications is associated with worse health status. This association appears to
be explained, in part, by coexistent depression. Future studies should evaluate
interventions such as depression treatment to improve medication adherence and
health status.
Publication Types:
Multicenter Study
166: Aust N Z J Psychiatry. 2006 Mar;40(3):245-52.
Explicating links between acute coronary syndrome and depression: study design
and methods.
Parker G, Heruc G, Hilton T, Olley A, Brotchie H, Hadzi-Pavlovic D, Owen C,
Friend C, Walsh WF.
School of Psychiatry, University of New South Wales, and Black Dog Institute,
Prince of Wales Hospital, Randwick, Sydney, Australia. g.parker@unsw.edu.au
OBJECTIVE: To describe a regional study seeking to replicate the suggested
strong links whereby lifetime and post-coronary infarction depression are
associated with a significant increase in mortality and cardiac morbidity, and
consider the comparative influence of both depression and anxiety. METHOD: We
detail relevant international studies and describe both the methodology as well
as baseline and 1-month data from our study. RESULTS: Over a 3-year period we
recruited 489 subjects admitted to a Sydney cardiac unit with an Acute Coronary
Syndrome (ACS), and assessed by a range of cardiac variables and measures of
current and lifetime depression. Ninety-eight per cent of the sample were
assessed one month after baseline recruitment to establish depression rates.
Long-term outcome reviews of mortality and morbidity and hospitalization rates
are proceeding. For those subjects who were depressed in the post-ACS period
and, even more so for those who had experienced lifetime depression, distinctly
higher scores on anxiety variables (and lifetime caseness for anxiety disorders)
were established. CONCLUSIONS: The strong interdependence between anxiety and
depression in this sample of patients admitted with an ACS will allow
examination of the comparative extent to which expressions of 'depression' and
'anxiety' contribute to post-ACS morbidity.
Publication Types:
167: Ann Behav Med. 2006 Feb;31(1):21-9.
Shared and unique contributions of anger, anxiety, and depression to coronary
heart disease: a prospective study in the normative aging study.
Kubzansky LD, Cole SR, Kawachi I, Vokonas P, Sparrow D.
Harvard School of Public Health.
BACKGROUND: Anger, anxiety, and depression have each been identified as risk
factors for coronary heart disease (CHD). Whether the apparent risk is a
function of unique aspects of each emotion or due to a shared underlying
dimension of negative affectivity is unclear. Purpose: The goal of this study
was to assess shared and unique contributions of anger, anxiety, and depression
to incident CHD. METHODS: Data are from the Veterans Administration Normative
Aging Study, an ongoing cohort of older men. Measures of anger, anxiety, and
depression were obtained from 1,306 men completing the revised Minnesota
Multiphasic Personality Inventory in 1986. From these measures we derived three
near-orthogonal scales termed iso(lated)-anger, iso-anxiety, and iso-depression
and a fourth scale measuring general distress. RESULTS: During an average of
10.9 years of follow-up, 161 cases of incident CHD occurred. When considered
individually, iso-anxiety, iso-anger, and shared general distress were each
associated with CHD risk. When all emotions were considered simultaneously, only
iso-anxiety and shared general distress were associated with incident CHD.
CONCLUSIONS: Considering shared versus unique aspects of negative emotions may
clarify the nature of their apparent toxicity in relation to CHD risk. General
distress shared across negative emotions is an important component in the
emotion-CHD relation. Aspects of anxiety may also independently increase CHD
risk.
Publication Types:
168: Eur Heart J. 2006 Mar;27(6):757; author reply 757-8. Epub 2006 Feb 7.
Comment on:
Eur Heart J. 2005 Dec;26(24):2607-8.
The heart, the brain, and the Kounis syndrome.
Kounis NG, Kounis GN, Kouni SN, Soufras GD.
Publication Types:
Comment
Letter
169: Psychosom Med. 2006 Jan-Feb;68(1):87-93.
Erratum in:
Psychosom Med. 2007 Mar-Apr;69(2):216.
Design and rationale for a randomized, controlled trial of interpersonal
psychotherapy and citalopram for depression in coronary artery disease (CREATE).
Frasure-Smith N, Koszycki D, Swenson JR, Baker B, van Zyl LT, Laliberte MA,
Abramson BL, Lambert J, Gravel G, Lesperance F.
Department of Psychiatry, McGill University, Montreal Canada.
nancy.frasure-Smith@mcgill.ca
OBJECTIVE: Recognition that depression is associated with increased morbidity
and mortality in coronary artery disease (CAD) patients has augmented the need
for evidence-based treatment guidelines. This article presents the design of a
multisite, Canadian trial of the efficacy, safety, and tolerability of
interpersonal psychotherapy (IPT), an empirically supported, depression-focused
therapy, and the selective serotonin reuptake inhibitor citalopram, alone or in
combination, in the treatment of major depression in CAD patients. METHODS: Two
hundred eighty stable CAD patients with a current major depressive episode of at
least 4 weeks' duration, based on the Structured Clinical Interview for
Depression (SCID), and who have a baseline score >19 on a centralized,
telephone-administered, 24-item Hamilton Depression Rating Scale (HAM-D) will be
randomly assigned to receive 12 weekly IPT sessions or 12 weekly sessions of
standardized clinical management (CM). Patients are also randomly assigned to
receive 20 to 40 mg per day of citalopram or pill-placebo. This results in a
2-by-2 factorial design with four groups: IPT plus pill-placebo, IPT plus
citalopram, CM plus pill-placebo, and CM plus citalopram. This permits the
evaluation of both IPT and citalopram. Blinded, centralized, 24-item, HAM-D
telephone ratings constitute the primary outcome variable. The self-report Beck
Depression Inventory-II is the secondary outcome. Analyses will involve the
intent-to-treat principle with last observation carried forward for incomplete
assessments. RESULTS: Not applicable. CONCLUSIONS: The results of this trial
will contribute to the development of evidence-based clinical guidelines for
managing depression in the context of CAD.
Publication Types:
Depression and prehospital delay in the context of myocardial infarction.
Bunde J, Martin R.
Department of Psychology, University of Iowa, Iowa City, IA 52242, USA.
OBJECTIVE: The purpose of this study was to evaluate how depression might
influence treatment-seeking behaviors in the context of evolving symptoms of
myocardial infarction (MI). METHODS: Post-MI patients (n = 433) completed a
retrospective self-report measure of depressive symptoms with regard to the 2
weeks preceding the MI and a semistructured interview regarding their
treatment-seeking behaviors. RESULTS: Survival analyses found that delay in
seeking treatment for acute MI symptoms was observed among participants who (1)
attributed their symptoms to noncardiac causes, (2) perceived their symptoms to
be relatively mild, (3) experienced gastrointestinal distress, (4) did not
experience sweating, and (5) reported being depressed during the 2 weeks before
hospitalization. Subsidiary analyses indicated that, among depressive symptoms,
sleep disturbance and fatigue predicted delay. CONCLUSION: Depression warrants
further attention as a variable that may influence treatment seeking for MI
symptoms. Results highlight the need to adequately screen for and treat
depression among persons at risk for MI.
Publication Types:
171: Health News. 2006 Jan;12(1):7.
Depression may hasten heart failure.
[No authors listed]
Publication Types:
News
172: J Psychosom Res. 2006 Feb;60(2):177-83.
Validation of the Cardiac Depression Scale in a cardiac rehabilitation
population.
Wise FM, Harris DW, Carter LM.
Caulfield General Medical Centre, Melbourne, Australia. f.wise@cgmc.org.au
OBJECTIVE: The current study was undertaken to provide further evidence
supporting the reliability and validity of the Cardiac Depression Scale (CDS) in
a population of cardiovascular patients. METHODS: The CDS was administered to
627 consecutive ambulatory adult cardiac patients attending an outpatient
Cardiac Rehabilitation program, and a subgroup also completed the Geriatric
Depression Scale--Short Form (GDS-SF). RESULTS: Factor analysis revealed six
subscales accounting for 62% of scale variance. The CDS demonstrated high
internal consistency (Cronbach's alpha=.92) and correlation coefficient with the
GDS-SF of .77. Receiver operating characteristic curves suggested a CDS cutoff
score of 100 to detect more severe depression, and 90 to detect mild to moderate
depression. CONCLUSION: These findings encourage the continued use and
evaluation of the CDS for measuring symptoms of depressive affect in cardiac
patients.
173: Health Qual Life Outcomes. 2006 Jan 26;4:6.
Structural ambiguity of the Chinese version of the Hospital Anxiety and
Depression Scale in patients with coronary heart disease.
Wang W, Lopez V, Martin CR.
School of Medicine, Xi'an Jiaotong University, Xi'an, Shannxi, Peoples Republic
of China. s034726@mailserv.cuhk.edu.hk
BACKGROUND: The Hospital Anxiety and Depression Scale (HADS) is a widely used
screening tool designed as a case detector for clinically relevant anxiety and
depression. Recent studies of the HADS in coronary heart disease (CHD) patients
in European countries suggest it comprises three, rather than two, underlying
sub-scale dimensions. The factor structure of the Chinese version of the HADS
was evaluated in patients with CHD in mainland China. METHODS: Confirmatory
factor analysis (CFA) was conducted on self-report HADS forms from 154 Chinese
CHD patients. RESULTS: Little difference was observed in model fit between best
performing three-factor and two-factor models. CONCLUSION: The current
observations are inconsistent with recent studies highlighting a dominant
underlying tri-dimensional structure to the HADS in CHD patients. The Chinese
version of the HADS may perform differently to European language versions of the
instrument in patients with CHD.
Publication Types:
Validation Studies
174: Arch Intern Med. 2006 Jan 23;166(2):195-200.
Clinical depression and risk of out-of-hospital cardiac arrest.
Empana JP, Jouven X, Lemaitre RN, Sotoodehnia N, Rea T, Raghunathan TE, Simon G,
Siscovick DS.
Sudden Death Epidemiology Unit, INSERM Avenir-U258, Hopital Paul Brousse,
Villejuif, France. empana@vjf.inserm.fr
BACKGROUND: The association of depression with coronary heart disease-related
mortality has been widely recognized. This finding may partly reflect an
association between depression and sudden death, in part because the imbalance
between sympathetic and parasympathetic tone is altered in depressed subjects.
We, thus, investigated whether the presence and severity of clinical depression
was associated with a higher risk of sudden cardiac death. METHODS: We used data
from a population-based case-control study of risk factors for incident
out-of-hospital cardiac arrest (CA) conducted among enrollees of a health
maintenance organization in western Washington State. Cases (n = 2228) were aged
40 to 79 years and experienced CA between January 1, 1980, and December 31,
1994. Controls (n = 4164) were a stratified random sample of enrollees defined
by calendar year, age, sex, and prior heart disease. Clinical depression was
defined as physician diagnosis of depression or use of antidepressant treatment
within the year before the event. Referral to mental health clinics or
hospitalization for depression defined severe depression. RESULTS: Clinically
depressed patients had a higher odds ratio (OR) of CA (1.88; 95% confidence
interval [CI], 1.59-2.23), which persisted after adjustment for confounders (OR,
1.43; 95% CI, 1.18-1.73). The association was observed in both sexes, in various
age groups, and in subjects with prior physician-diagnosed heart disease (OR,
1.27; 95% CI, 1.01-1.60) and without prior physician-diagnosed heart disease
(OR, 1.71; 95% CI, 1.22-2.41) (P = .13 for the interaction). Compared with
nondepressed subjects, the risk of CA was increased in less severely depressed
subjects (OR, 1.30; 95% CI, 1.04-1.63) and further increased in severely
depressed subjects (OR, 1.77; 95% CI, 1.28-2.45) (P<.001 for trend). CONCLUSION:
Clinical depression may be associated with a higher risk of CA independently of
established coronary heart disease risk factors.
Publication Types:
Comparative Study
175: Heart. 2006 Sep;92(9):1225-9. Epub 2006 Jan 19.
Post-traumatic stress disorder in patients with cardiac disease: predicting
vulnerability from emotional responses during admission for acute coronary
syndromes.
Whitehead DL, Perkins-Porras L, Strike PC, Steptoe A.
Department of Epidemiology and Public Health, University College London, 1-19
Torrington Place, London WC1E 6BT, UK. daisy.whitehead@ucl.ac.uk
OBJECTIVES: To assess frequency and predictors of post-traumatic stress disorder
(PTSD), measured by the Post Traumatic Stress-self report version, at three
months after admission for acute coronary syndromes (ACS). DESIGN: Two-phase
prospective study. SETTING: Four coronary care units. PATIENTS: 135 patients
admitted to hospital with ACS confirmed by ECG and cardiac enzyme changes.
RESULTS: 20 patients (14.8%) showed a symptom pattern characteristic of PTSD at
three months assessed by a conservative scoring criterion. Severity of chest
pain and psychological factors during admission were predictive of PTSD
severity. Acute stress symptoms, depression, negative affect, hostility, and
pain scores were independent predictors of three-month PTSD symptoms (R(2) =
0.495, p < 0.001). In contrast, demographic factors (age, sex, education level
and income) were unrelated to post-traumatic symptoms, as were markers of
clinical disease severity. CONCLUSIONS: Patient vulnerability to PTSD three
months after ACS is predictable on the basis of psychological state and chest
pain at the time of admission. This may be valuable to the clinician, as PTSD
after myocardial infarction is associated with poorer quality of life, reduced
adherence to drug treatment and increased likelihood of cardiovascular
morbidity.
Publication Types:
Multicenter Study
176: Mayo Clin Womens Healthsource. 2006 Feb;10(2):1-2.
Depression and heart disease. The connection between two common conditions.
[No authors listed]
177: Am J Psychiatry. 2006 Jan;163(1):138-44.
Comment in:
Am J Psychiatry. 2006 Jul;163(7):1295-6; author reply 1296.
Symptom dimensions of depression following myocardial infarction and their
relationship with somatic health status and cardiovascular prognosis.
de Jonge P, Ormel J, van den Brink RH, van Melle JP, Spijkerman TA, Kuijper A,
van Veldhuisen DJ, van den Berg MP, Honig A, Crijns HJ, Schene AH.
University of Groningen Department of Psychiatry, the Netherlands.
p.de.jonge@med.rug.nl
OBJECTIVE: The reporting of depressive symptoms following myocardial infarction
may be confounded by complaints originating from the myocardial infarction.
Therefore, it is difficult to estimate the effects of post-myocardial infarction
depression and its treatment on cardiovascular prognosis. The authors' goal was
to study the relationship between depressive symptom dimensions following
myocardial infarction and both somatic health status and prospective
cardiovascular prognosis. METHOD: In two studies of myocardial infarction
patients (N=494 and 1,972), the Beck Depression Inventory was used to determine
the dimensional structure of depressive symptoms following myocardial
infarction. Three symptom dimensions-somatic/affective, cognitive/affective, and
appetitive-were compared with baseline left ventricular ejection fraction,
Charlson comorbidity index, Killip class, and previous myocardial infarction.
The relationship between depressive symptom dimensions and prospective
cardiovascular mortality and cardiac-related readmissions was also examined
(mean follow-up duration=2.5 years). RESULTS: Somatic/affective symptoms were
associated with poor health status (left ventricular ejection fraction, Charlson
comorbidity index, Killip class, and previous myocardial infarction) and
predicted cardiovascular mortality and cardiac events. Cognitive/affective
symptoms were only marginally associated with somatic health status and not with
cardiovascular death and cardiac events. Appetitive symptoms were related to
somatic health status but did not predict cardiovascular death or cardiac
events. CONCLUSIONS: Somatic/affective depressive symptoms following myocardial
infarction were confounded by somatic health status yet were prospectively
associated with cardiac prognosis even after somatic health status was
controlled. Cognitive/affective depressive symptoms were only marginally related
to health status and not to cardiac prognosis. These findings suggest that
treatment of depression following myocardial infarction might improve
cardiovascular prognosis when it reduces somatic/affective symptoms.
Publication Types:
Multicenter Study
178: Soc Sci Med. 2006 Jun;62(12):3109-20. Epub 2006 Jan 4.
Physical activity and depressive symptoms in cardiac rehabilitation: long-term
effects of a self-management intervention.
Scholz U, Knoll N, Sniehotta FF, Schwarzer R.
University of Zurich, Switzerland. urte.scholz@psychologie.unizh.ch
Long-term effects of a self-management intervention on physical activity and
depressive symptoms were studied in 198 men and women after cardiac
rehabilitation in Germany. Participants were randomly assigned to either an
intervention group or a standard-care control group. The intervention group
received brief self-regulatory skills training that focused on exercise planning
strategies. Four and 12 months later, physical exercise levels were half a
standard deviation higher in the intervention group. Depressive symptoms 12
months after discharge were almost half a standard deviation lower in the
intervention group than in the control group. Mediation analyses were performed
to study the potential mechanism that accounted for the reduction in depression.
Perceived attainment of exercise goals, but not physical exercise itself,
emerged as a mediator between the intervention and the reduction of depressive
symptoms. As such attainment of personal goals appears to be of particular
importance for lowering depressive symptoms during health-behavior change. Thus,
self-management strategies to help patients attain their goals should be part of
rehabilitation programs.
Publication Types:
"Major" Depressive Disorder, coronary heart disease, and the DSM-IV threshold
problem.
Ketterer MW, Wulsin L, Cao JJ, Schairer J, Hakim A, Hudson M, Keteyian SJ,
Khanal S, Clark V, Weaver WD.
Heart and Vascular Institute, Henry Ford Hospital & Wayne State University,
Detroit MI 48202, USA. MarkWKetterer@cs.com
Seventy-seven patients with documented coronary heart disease (CHD) were
evaluated for demographic/risk factor characteristics, Major Depressive Disorder
(MDD) according to the Patient's Health Questionnaire (PHQ - Diagnostic and
Statistical Manual IV criteria), and emotional distress by the Symptom Checklist
90-Revised (SCL-90-R). Early age at initial diagnosis for coronary heart disease
(AAID) was used as a proxy for disease malignancy because early AAID is a known
predictor of early mortality. MDD was unrelated to early AAID despite being
strongly associated with all the scales of the SCL-90-R. Several of the SCL-90-R
scales were significantly associated with early AAID in the sample as a whole
(Depression, Interpersonal Sensitivity, Anxiety, Paranoia, and Psychoticism) and
after removal of the patients meeting criteria for MDD (residual N = 54). Our
results suggest a new criterion for determining whether depression, or any
mental disorder, is "major": onset or aggravation of serious medical illness.
Depressive symptoms in elderly patients after a somatic illness event:
prevalence, persistence, and risk factors.
de Jonge P, Kempen GI, Sanderman R, Ranchor AV, van Jaarsveld CH, van Sonderen
E, Scaf-Klomp W, Weening A, Slaets JP, Ormel J.
Dept. of Psychiatry, Univ. of Groningen, The Netherlands. p.de.jonge@med.rug.nl
Elderly patients with somatic illness are at increased risk of depression. The
authors studied the prevalence and persistence of depressive symptoms during the
first year after the events of myocardial infarction, congestive heart failure,
fall-related injury, and the diagnosis of cancer and their putative pre-event
risk factors. The GLAS study contains data from 614 patients who experienced
post-baseline myocardial infarction, cancer, heart failure, or fall-related
injury of the extremities within 5 years after the baseline assessment.
Follow-up was conducted 8 weeks, 6 months, and 1 year after the somatic event.
The authors studied the relative importance of 21 baseline risk factors for
experiencing significant depressive symptoms during follow-up and the
persistence of depression. Depressive symptoms were prevalent in 38.3% of the
subjects during the post-event year; in about 19.1%, symptoms were mild. For a
majority of patients (67.5%), symptoms persisted until the next assessment.
Significant pre-event risk factors were depressive symptoms at baseline, age,
smoking, poor general health, poor well-being, and neuroticism. Within the
depressed group, only neuroticism was related to the persistence of symptoms.
Neuroticism increases the risk of experiencing post-event depressive symptoms
and is related to their persistence, which suggests the existence of a
depression-prone personality.
Publication Types:
181: J Psychosom Res. 2006 Jan;60(1):3-11.
Psychosocial predictors of cardiac rehabilitation quality-of-life outcomes.
Shen BJ, Myers HF, McCreary CP.
Department of Psychology, University of Miami, Coral Gables, FL 33124-0751,
United States. bshen@miami.edu
OBJECTIVE: This study investigated hostility, social support, coping,
depression, and their contributions to concurrent and posttreatment quality of
life (QoL) among a group of patients participating in a 6-week cardiac
rehabilitation program. METHOD: Both direct and mediational relationships among
psychosocial factors, QoL baseline, and QoL outcome were examined using
structural equation modeling analysis, while age, education, and severity of
illness (risk for future event) were controlled. RESULTS: The final model was
well supported (chi(2)=64.88, df=56, P>.05; CFI=.99, RMSEA=.04). Results
indicated that baseline QoL, hostility, and depressive symptom severity directly
and independently predicted QoL outcome, while depression and hostility were
also associated with baseline QoL. Hostility, social support, and maladaptive
coping also contributed to baseline and follow-up QoL by their associations with
depression. CONCLUSION: Psychosocial characteristics were interrelated, and they
predicted postrehabilitation QoL outcome directly or indirectly through
depression symptom severity.
182: Gen Hosp Psychiatry. 2006 Jan-Feb;28(1):55-8.
Validity and reliability of the Hospital Anxiety and Depression Scale in a
hypertrophic cardiomyopathy clinic: the HADS in a cardiomyopathy population.
Poole NA, Morgan JF.
Liaison Psychiatry, Clare House, St. George's Hospital and Medical School,
Tooting Broadway, SW17 0QT, London, UK. npoole@sghms.ac.uk
OBJECTIVE: The purpose of this study is the validation of the Hospital Anxiety
and Depression Scale (HADS) in patients suffering from hypertrophic
cardiomyopathy in an inner city teaching hospital. The secondary objective was
to establish whether the use of the total HADS score to detect "caseness" is
justified. METHODS: One hundred fifteen patients in a cardiac outpatient clinic
completed the HADS, which was compared against the gold standard Structured
Clinical Interview for DSM-III-R nonpatient version (SCID-np). Receiver
operating characteristic (ROC) curves were created for the anxiety and
depression subscales, as well as the total score, then sensitivity, specificity,
likelihood ratios and positive and negative predictive values were calculated.
Retest correlation was assessed at 2 weeks in 31 patients. RESULTS: The
depression subscale was highly sensitive (100%) when the cutoff score 8 was
used; however, the corresponding specificity was poor (79%). Raising the cutoff
to 10 improved specificity but compromised sensitivity. The anxiety subscale was
performed similarly though with less accuracy. The total HADS score produced a
poor ROC curve and performed best when the cutoff was 14. CONCLUSIONS: The HADS
performs well as a screening instrument for anxiety and depression in this
population at the designed cutoff score 8. However, its use as a research
instrument and the practice of using the total score to detect caseness are not
supported by this study.
Publication Types:
Validation Studies
183: Am J Prev Med. 2005 Dec;29(5):428-33.
Depression as a predictor of hospitalization due to coronary heart disease.
Sundquist J, Li X, Johansson SE, Sundquist K.
Karolinska Institute, Center for Family and Community Medicine, Huddinge,
Sweden. kristina.sundquist@klinvet.ki.se
BACKGROUND: Studies have shown that patients with depression have higher rates
of coronary heart disease (CHD) than people in the general population. However,
large-scale population-based data on incidence rates of CHD in people with
depression are needed. This study analyzed whether hospitalization for
depression predicts CHD in men and women after accounting for socioeconomic
status and geographic region. METHODS: Data from the family coronary heart
disease database at the Karolinska Institute, Stockholm, were used to identify
all people in Sweden aged 25 to 64 at onset of depression and aged 25 to 79 at
onset of nonfatal CHD during the study period (1987 to 2001). Standardized
incidence ratios (SIRs) of CHD among those with and without depression were
compared. All analyses were conducted in 2005. RESULTS: There were 1767 cases of
CHD among those with depression during the study period. The risk of developing
CHD was strongest for those aged <40; the SIR was 2.17 (95% confidence interval
[CI]=1.50-3.03). The risk was attenuated with increasing age in both men and
women. People aged 70 to 79 at onset of depression did not have an increased
risk of CHD. CONCLUSIONS: Even after accounting for socioeconomic status and
geographic region, depression is a clinically significant risk factor for
developing CHD, especially in men and women aged 25 to 50. Primary healthcare
teams should make particular efforts to identify young to middle-aged women and
men who have depression, especially in combination with other CHD risk factors.
Publication Types:
184: Heart. 2006 Jan;92(1):57.
Images in cardiology. Dizziness and dyspnoea: psychiatry and cardiology.
Henriques JP, Bouma BJ, Kloek JJ.
j.p.henriques@amc.uva.nl
Publication Types:
Case Reports
185: Indian Heart J. 2005 Jul-Aug;57(4):360-3.
Depression in heart disease--a plea for help!
Hayes E, Mehta P, Mehta JL.
Department of Internal Medicine (Cardiovascular Medicine), University of
Arkansas for Medical Sciences College of Medicine, USA.
186: Arch Intern Med. 2005 Nov 28;165(21):2508-13.
Depression and medication adherence in outpatients with coronary heart disease:
findings from the Heart and Soul Study.
Gehi A, Haas D, Pipkin S, Whooley MA.
The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of
Medicine, New York, NY, USA.
BACKGROUND: Depression leads to adverse outcomes in patients with coronary heart
disease (CHD). Medication nonadherence is a potential mechanism for the
increased risk of CHD events associated with depression, but it is not known
whether depression is associated with medication nonadherence in outpatients
with stable CHD. METHODS: We examined the association between current major
depression (assessed using the Diagnostic Interview Schedule) and self-reported
medication adherence in a cross-sectional study of 940 outpatients with stable
CHD. RESULTS: A total of 204 participants (22%) had major depression.
Twenty-eight (14%) of 204 depressed participants reported not taking their
medications as prescribed compared with 40 (5%) of 736 nondepressed participants
(odds ratio [OR], 2.8; 95% confidence interval [CI], 1.7-4.7; P<.001). Twice as
many depressed participants as nondepressed participants (18% vs 9%) reported
forgetting to take their medications (OR, 2.4; 95% CI, 1.6-3.8; P<.001). Nine
percent of depressed participants and 4% of nondepressed participants reported
deciding to skip their medications (OR, 2.2; 95% CI, 1.2-4.2; P = .01). The
relationship between depression and nonadherence persisted after adjustment for
potential confounding variables, including age, ethnicity, education, social
support, and measures of cardiac disease severity (OR, 2.2; 95% CI, 1.2-3.9; P =
.009 for not taking medications as prescribed). CONCLUSIONS: Depression is
associated with medication nonadherence in outpatients with CHD. Medication
nonadherence may contribute to adverse cardiovascular outcomes in depressed
patients.
Publication Types:
Comparative Study
Multicenter Study
187: Arch Intern Med. 2005 Nov 28;165(21):2497-503.
Impact of antidepressant drug adherence on comorbid medication use and resource
utilization.
Katon W, Cantrell CR, Sokol MC, Chiao E, Gdovin JM.
Division of Health Services and Psychiatric Epidemiology, Department of
Psychiatry, University of Washington Medical School, Seattle, USA.
BACKGROUND: Patients with depression are often nonadherent to therapy for
depression and chronic comorbid conditions. METHODS: To determine whether
improved antidepressant medication adherence is associated with an increased
likelihood of chronic comorbid disease medication adherence and reduced medical
costs, we conducted a retrospective study of patients initiating antidepressant
drug therapy with evidence of dyslipidemia, coronary artery disease (CAD), or
both; diabetes mellitus (DM); or CAD/dyslipidemia and DM identified from a
claims database. Measures included antidepressant medication adherence, measured
by medication possession ratio during 180 days without a 15-day gap before 90
days of therapy; comorbid medication adherence, measured by medication
possession ratio during 1 year; and the association between improved
antidepressant drug adherence and disease-specific and total medical costs.
RESULTS: Of 8040 patients meeting the study criteria, those adherent to
antidepressant medication were more likely to be adherent to comorbid therapy vs
those nonadherent to antidepressant drug therapy (CAD/dyslipidemia: odds ratio
[OR], 2.13; DM: OR, 1.82; and CAD/dyslipidemia/DM: OR, 1.45; P<.001 for all).
Patients adherent to antidepressant drug therapy also had significantly lower
disease-specific charges vs nonadherent patients (17% lower in CAD/dyslipidemia,
P = .02; 8% lower in DM, P = .39; and 14% lower in CAD/dyslipidemia/DM, P =
.38). These patients also incurred lower total medical charges (6.4% lower in
CAD/dyslipidemia, P = .048; 11.8% lower in DM, P = .04; and 19.8% lower in
CAD/dyslipidemia/DM, P = .03). CONCLUSIONS: Antidepressant drug adherence was
associated with increased comorbid disease medication adherence and reduced
total medical costs for CAD/dyslipidemia, DM, and CAD/dyslipidemia/DM. Future
studies should investigate the relationship between increased adherence and
costs beyond 1 year.
Publication Types:
Comparative Study
188: Aust Fam Physician. 2005 Nov;34(11):985-9.
Depression after cardiac hospitalisation--the Identifying Depression as a
Comorbid Condition (IDACC) study.
Wade V, Cheok F, Schrader G, Hordacre AL, Marker J.
Primary Mental Health Care Australian Resource Centre, Department of General
Practice, Flinders University, South Australia. tori.wade@sadi.org.au
BACKGROUND: The Identifying Depression as a Comorbid Condition (IDACC) study
aimed to identify depressive symptoms in hospitalised cardiac patients and
support management of depression in general practice. OBJECTIVE: This post hoc
analysis of the IDACC trial examines the effectiveness and practicality of
different forms of communication between hospital psychiatric services and
general practitioners. METHODS: We randomised 669 cardiac inpatients with
depressive symptoms, identified with the Center for Epidemiological Studies
Depression Scale (CES-D), to an intervention or usual care control group.
Individual depression scores and depression management guidelines were sent to
GPs of all intervention patients. Where possible, psychiatric advice was
provided to the GP either by multidisciplinary enhanced primary care case
conference or one-to-one telephone advice. RESULTS: Multidisciplinary case
conferences were implemented for only 24% of intervention patients. General
practitioners received individual telephone advice in 40% of cases, and 36%
received written information only. The psychiatrist telephone advice resulted in
a significant reduction in the proportion of patients with moderate to severe
depression 12 months after cardiac hospitalisation (19% vs. 35%). DISCUSSION:
Screening, combined with psychiatrist telephone advice to GPs, was simple to
organise and effective in reducing depression severity after cardiac admission.
Publication Types:
189: Am Heart J. 2005 Nov;150(5):961-7.
Depression predicts mortality and hospitalization in patients with myocardial
infarction complicated by heart failure.
Rumsfeld JS, Jones PG, Whooley MA, Sullivan MD, Pitt B, Weintraub WS, Spertus
JA.
Section of Cardiology, Denver VA Medical Center, Denver, Colorado 80220, USA.
john.rumsfeld@med.va.gov
BACKGROUND: To evaluate whether depressive symptoms are independently predictive
of mortality and hospitalization among patients with acute myocardial infarction
(AMI) complicated by heart failure. METHODS: The EPHESUS trial enrolled patients
with AMI complicated by heart failure. Patients from Canada, the UK, and the
United States completed a Medical Outcomes Study-Depression questionnaire at
baseline in addition to a comprehensive clinical examination. Cox proportional
hazards regression was used to determine the relationship between depressive
symptoms and outcomes, including 2-year all-cause mortality and cardiovascular
death or hospitalization, adjusting for baseline clinical variables. RESULTS:
Overall, 143 of 634 patients (22.6%) had significant depressive symptoms at
baseline (Medical Outcomes Study-Depression score > or = 0.06). Depressed
patients had higher 2-year mortality (29% vs 18%; P = .004) and cardiovascular
death or hospitalization (42% vs 33%; P = .016). After risk adjustment,
depressive symptoms remained significantly associated with mortality (hazard
ratio 1.75, 95% CI 1.15-2.68, P = .01) and cardiovascular death or
hospitalization (hazard ratio 1.41, 95% CI 1.03-1.93, P = .03). Results were
consistent across demographic and clinical subgroups. CONCLUSIONS: Depression is
an independent predictor of all-cause mortality and cardiovascular death or
hospitalization after AMI complicated by heart failure. Although many factors
may mediate outcomes in patients with AMI, studies are warranted to evaluate
whether a depression intervention can improve survival and/or reduce
hospitalizations.
Publication Types:
190: Psychosomatics. 2005 Nov-Dec;46(6):523-8.
Association between depressive episode before first myocardial infarction and
worse cardiac failure following infarction.
Dickens C, McGowan L, Percival C, Douglas J, Tomenson B, Cotter L, Heagerty A,
Creed F.
Department of Psychiatry, Manchester University, and the Department of
Cardiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, U.K.
c.dickens@man.ac.uk
Depression following myocardial infarction is associated with a higher mortality
rate. The authors studied 314 patients admitted to the hospital with a first
myocardial infarction to assess whether cardiac failure after the infarction,
which is also linked to a higher mortality rate, was predicted by psychosocial
characteristics present before the myocardial infarction. One-fifth (20.7%) of
the subjects met the ICD-10 criteria for depressive episode in the 1 month
before the attack. Variables independently associated with worse cardiac failure
after the myocardial infarction were greater age, a history of angina preceding
the infarction, and a previous depressive episode. The impact of depression on
postinfarction outcome may result from the influence of preinfarction depression
on the degree of cardiac failure.
Publication Types:
191: Gen Hosp Psychiatry. 2005 Nov-Dec;27(6):411-7.
Comment in:
Gen Hosp Psychiatry. 2005 Nov-Dec;27(6):381-2.
Depression following myocardial infarction: first-ever versus ongoing and
recurrent episodes.
Spijkerman T, de Jonge P, van den Brink RH, Jansen JH, May JF, Crijns HJ, Ormel
J.
Department of Psychiatry, University Hospital Groningen, The Netherlands.
BACKGROUND: Depression following myocardial infarction (MI) can be a first-ever
episode for some, whereas for others, it may represent a recurrent episode or
one that was present at the onset of the infarction. We investigated if there
are differences in pre- and post-MI characteristics between these subtypes.
METHODS: Four hundred sixty-eight patients admitted for an MI were assessed for
the presence of an ICD-10 depressive disorder following MI. A comparison was
made between first-ever and ongoing or recurrent depression on demographic and
cardiac data, personality, and depression characteristics. RESULTS: Depressive
disorder during the first post-MI year was present in 25.4% of the MI patients
(n = 119), and almost half were ongoing or recurrent (n = 53, 44.5%). Recurrent
and ongoing depression was related to high neuroticism (Z = 2.77, P < .01),
whereas first-ever depression was associated with MI severity (poor left
ventricular ejection fraction: Z = 1.64, P = .05; PTCA or CABG during
hospitalization: Z = 1.88, P = .03; arrhythmic events: Z = 1.49, P = .06).
CONCLUSIONS: Our results suggest that in the first-ever post-MI depression
cases, depression may be triggered by the severity of the MI, whereas ongoing
and recurrent depression is more related to personality. Future research should
address the question whether these subtypes of depression differ in
cardiovascular prognosis and response to psychiatric treatment.
Publication Types:
Comment on:
Gen Hosp Psychiatry. 2005 Nov-Dec;27(6):411-7.
Depression following myocardial infarction.
Carney RM, Freedland KE.
Publication Types:
Comment
Editorial
193: Eur Heart J. 2005 Dec;26(24):2607-8. Epub 2005 Oct 14.
Comment in:
Eur Heart J. 2006 Mar;27(6):757; author reply 757-8.
Comment on:
Eur Heart J. 2005 Dec;26(24):2650-6.
The brain and the heart: the twain meet.
Ziegelstein RC, Thombs BD.
Publication Types:
Comment
Editorial
194: J Psychosom Res. 2005 Oct;59(4):223-9.
A Cardiac Depression Visual Analogue Scale for the brief and rapid assessment of
depression following acute coronary syndromes.
Di Benedetto M, Lindner H, Hare DL, Kent S.
School of Psychological Science, La Trobe University, Melbourne, Australia.
OBJECTIVE: A Cardiac Depression Visual Analogue Scale (CD-VAS) was developed as
a rapid and easy method of assessing depressed mood in a cardiac population. The
CD-VAS was contrasted against the Cardiac Depression Scale (CDS) and the Beck
Depression Inventory-II (BDI-II). METHOD: Depression was assessed in 58
participants, 2 weeks postacute coronary syndrome (ACS), using the BDI-II and
the CDS. Participants then completed the six-item CD-VAS for 14 consecutive
days. RESULTS: Using mean weekly scores, the CD-VAS had strong internal
reliability (.91) and strong test-retest reliability that ranged from .85 to
.97. Principal components analyses found that the CD-VAS only measured one
component. The CD-VAS had strong concurrent validity with the BDI-II (r=.81) and
the CDS (r=.82) and was able to differentiate between depressed and nondepressed
participants. CONCLUSION: The CD-VAS is a valid and reliable measure for brief
and rapid repeated assessments of depressive symptoms in a cardiac population.
195: J Behav Med. 2005 Dec;28(6):507-11. Epub 2005 Oct 13.
A new potential marker for abnormal cardiac physiology in depression.
Iverson GL, Gaetz MB, Rzempoluck EJ, McLean P, Linden W, Remick R.
Department of Psychology, University of British Columbia, Vancouver, British
Columbia, Canada. giverson@interchange.ubc.ca
The purpose of the study was to determine if a nonlinear estimate of dimensional
complexity, Pointwise correlation dimension (Pd2), could be used to identify
abnormal cardiac physiology associated with depression in primary care
outpatients. The subjects were 22 medical controls and 30 general medical
outpatients with depression who wore a cardiac monitor for 24 h. There was a
significant difference between depressed and control subjects for Pd2 based on
the entire cardiac time-series, with depressed subjects exhibiting higher Pd2
values. A cutoff score reflecting high dimensional complexity was selected, and
an odds ratio was calculated demonstrating that patients with Pd2 values above
the cut-off were 8.8 times more likely to fall in the depressed group than the
control group. Additional research is needed to determine if Pd2 is useful for
identifying physiological markers of depression.
Publication Types:
196: Am J Cardiol. 2005 Oct 15;96(8):1076-81. Epub 2005 Aug 30.
Screening for depression in patients with coronary heart disease (data from the
Heart and Soul Study).
McManus D, Pipkin SS, Whooley MA.
Department of Medicine, University of California, San Francisco, USA.
Major depression is associated with adverse outcomes in patients who have
coronary heart disease. How best to identify depression in busy cardiology
practices is unknown. We compared the test characteristics of 4 depression
screening instruments with an interview diagnosis of depression (Diagnostic
Interview Schedule) in 1,024 outpatients who had coronary heart disease.
Screening instruments were the 10-item Center for Epidemiologic Studies
Depression Scale-10, the Patient Health Questionnaire-9, the Patient Health
Questionnaire-2, and a simple 2-item instrument that asks (1) "During the past
month, have you often been bothered by feeling down, depressed, or hopeless?"
and (2) "During the past month, have you often been bothered by little interest
or pleasure in doing things?" Of the 1,024 participants, 224 (22%) had major
depression based on the Diagnostic Interview Schedule. Areas under the
receiver-operating characteristic curves were similar for all instruments (range
0.84 to 0.87). In conclusion, a positive response to 1 of the 2 items was 90%
sensitive and 69% specific for depression, with a negative likelihood ratio of
0.14. Thus, negative responses to the 2 items effectively ruled out depression.
A score > or =10 on the Patient Health Questionnaire-9 was 54% sensitive and 90%
specific, with a positive likelihood ratio of 5.4. Thus, a cutpoint > or =10 was
virtually diagnostic for depression.
Publication Types:
197: Am Heart J. 2005 Oct;150(4):617-9.
Comment on:
Am Heart J. 2005 Oct;150(4):652-8.
Treating depression after myocardial infarction: can selecting patients on the
basis of genetic susceptibility improve psychiatric and medical outcomes?
Williams RB.
Publication Types:
Comment
Editorial
Depressive symptoms, coronary heart disease, and overall mortality in the
Framingham Heart Study.
Wulsin LR, Evans JC, Vasan RS, Murabito JM, Kelly-Hayes M, Benjamin EJ.
Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA.
Lawson.wulsin@uc.edu
OBJECTIVE: Although a substantial number of studies have shown that depressive
symptoms predict worse cardiac outcome for patients with existing coronary
disease, relatively few methodologically rigorous studies have examined the
relation of depressive symptoms to coronary disease incidence in individuals
initially free of heart disease in the community. METHODS: Using
multivariable-adjusted sex-stratified Cox proportional hazards regression, we
examined the association between depressive symptoms and incident coronary
disease and all-cause mortality in 3634 Framingham Heart Study original and
offspring cohort participants (mean age 52 years, 55% women) attending a routine
study examination between 1983 and 1994. RESULTS: Over 6 years of follow-up, 83
participants had a hard coronary heart disease event (myocardial infarction or
coronary death), and 133 died. Depressive symptoms (Center for Epidemiologic
Studies Depression Scale (CES-D) > or =16) did not predict hard coronary disease
events. All-cause mortality, however, was directly associated with depressive
symptoms. Compared with the lowest tertile of CES-D score,
multivariable-adjusted risks of death in the second and third tertiles were 33%
and 88% higher, respectively (hazards ratio per tertile increment = 1.37, 95%
confidence interval 1.10-1.71, p for trend = 0.005). CONCLUSION: These findings
underscore the importance of further research into the pathogenesis and
prevention of excess mortality experienced with depressive symptoms.
Publication Types:
Comparative Study
199: Heart. 2006 Jan;92(1):8-10. Epub 2005 Sep 13.
Comment on:
Heart. 2006 Jan;92(1):32-9.
Depression and disability in coronary patients: time to focus on quality of life
as an end point.
Haas DC.
Publication Types:
Comment
Editorial
200: Eur Heart J. 2005 Dec;26(24):2650-6. Epub 2005 Sep 5.
Comment in:
Eur Heart J. 2005 Dec;26(24):2607-8.
Relationship between left ventricular dysfunction and depression following
myocardial infarction: data from the MIND-IT.
van Melle JP, de Jonge P, Ormel J, Crijns HJ, van Veldhuisen DJ, Honig A, Schene
AH, van den Berg MP; MIND-IT investigators.
Department of Cardiology, Thorax Centre, University Medical Centre Groningen,
The Netherlands. j.p.van.melle@med.umcg.nl
AIMS: Depression in patients following myocardial infarction (MI) is associated
with an increased risk of mortality, but this association may be confounded by
cardiac disease severity. We explored the relationship between left ventricular
ejection fraction (LVEF) and depression in MI patients. METHODS AND RESULTS: In
the Myocardial Infarction and Depression-Intervention Trial (MIND-IT), 1989 MI
patients were assessed for depressive symptoms [Beck Depression Inventory (BDI)
t = 0, 3, 6, 9, and 12 months post-MI]. Patients with BDI score > or =10 were
assessed for the presence of International Classification of Diseases, 10th
revision (ICD-10) depressive disorder (t = 3, 6, 9, and 12 months post-MI).
Patients were divided into categories according to their LVEF during
hospitalization, i.e. LVEF <30%, LVEF 30-45%, LVEF 45-60%, and LVEF > or = 60%.
During hospitalization, presence of depressive symptoms was higher in patients
with LV dysfunction. A relationship was found between LVEF and ICD-10 depressive
disorder, i.e. a lower LVEF was associated with a higher rate of depression from
3-12 months post-MI (P < 0.01). Levels of LVEF inversely correlated with the BDI
score at 3 months post-MI. Associations persisted after adjustment for
demographics, risk factors for coronary artery disease, co-morbidity, Killip
class, and baseline BDI score. CONCLUSION: In MI patients, the rate of
depression and the severity of depressive symptoms are significantly related to
the severity of LV dysfunction. The association between depression and LV
dysfunction must be acknowledged when evaluating the prognostic effects of
depression in cardiac patients.
Publication Types:
Multicenter Study
201: J ECT. 2005 Sep;21(3):182-5.
Use of electroconvulsive therapy in a patient 10 days after myocardial
infarction.
Magid M, Lapid MI, Sampson SM, Mueller PS.
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
55905, USA.
Electroconvulsive therapy (ECT) is a safe and effective treatment of severe
depression, even in patients with cardiac risk factors. Although rare,
cardiovascular events during ECT remain a principal cause of morbidity and
mortality. In particular, a history of recent myocardial infarction (MI)
increases the risk of ventricular arrhythmias and cardiac rupture. A widely
accepted recommendation is to administer ECT at least 3 months after MI, but
sometimes a delay is not possible. Limited literature exists on the use of ECT
in severely depressed patients with recent MI. Our literature review revealed 1
previously published case, with less than favorable results. In this case
report, we describe a severely depressed, catatonic elderly man who was safely
and successfully treated with ECT 10 days after an acute MI. It is essential
that appropriate cardiac management be provided before, during, and after ECT by
a multidisciplinary team of psychiatrists, internists, cardiologists, and
anesthesiologists. Our case report suggests that, with proper management and
close monitoring, ECT can be administered safely, even in patients with recent
MI.
Publication Types:
Case Reports
202: Am Heart J. 2005 Jul;150(1):132-6.
Depressive symptoms and inflammation among heart failure patients.
Ferketich AK, Ferguson JP, Binkley PF.
Division of Epidemiology and Biostatistics, The Ohio State University College of
Medicine and Public Health, School of Public Health, Columbus, Ohio, USA.
aferketich@sph.osu.edu
BACKGROUND: Psychological depression has been linked to heart failure, both an
antecedent to and as a risk factor for poor outcomes among patients with
existing heart failure. Elevated levels of proinflammatory cytokines have been
proposed as a possible physiological link between the 2 conditions. The
objective of this study was to examine the proinflammatory cytokines interleukin
(IL)-6, IL-1beta, and tumor necrosis factor-alpha (TNFalpha) in heart failure
patients with and without elevated symptoms of depression. METHODS: Thirty-two
heart failure patients were recruited from an outpatient heart failure clinic.
Depressive symptoms were measured with the Beck Depression Inventory (BDI), and
a patient was classified as having elevated symptoms of depression if he/she
scored > or = 10. The cognitive-affective subscale score of the BDI, which
measures depressed mood independent of physical symptoms, was also examined.
RESULTS: In the multiple linear regression models controlling for age, sex,
smoking, and antidepressant medication use, there was no relation between BDI
score and IL-6 (P = .7612) or IL-1beta (P = .8261). However, there was a
statistically significant positive relation between BDI score and TNFalpha (P =
.0374). There was also a significant relation between an elevated
cognitive-affective score and TNFalpha (P = .0322) but no association with IL-6
(P = .8593) or IL-1beta (P = .3737). CONCLUSIONS: The association between
TNFalpha and the cognitive-affective subscale, which eliminates the physical
signs and symptoms that are shared by depression and heart failure, demonstrates
a depression-specific activation of proinflammatory cytokines that may promote
disease progression and mortality in patients with heart failure.
Publication Types:
203: Heart. 2005 Apr;91(4):531-2.
Comment in:
Heart. 2005 Apr;91(4):419-20.
Depression, indirect clinical markers of cardiac disease severity, and mortality
following myocardial infarction.
Lane D, Ring C, Lip GY, Carroll D.
Publication Types:
Letter
204: Med J Aust. 2005 Mar 21;182(6):272-6.
Effect of psychiatry liaison with general practitioners on depression severity
in recently hospitalised cardiac patients: a randomised controlled trial.
Schrader G, Cheok F, Hordacre AL, Marker J, Wade V.
Department of Psychiatry, University of Adelaide, Queen Elizabeth Hospital,
Woodville, SA 5011, Australia. geoffrey.schrader@adelaide.edu.au
OBJECTIVE: To evaluate the effect on depressive symptoms in cardiac patients of
patient-specific advice to general practitioners regarding management of
comorbid depression. DESIGN AND SETTING: A randomised controlled trial in four
general hospitals in Adelaide, South Australia. PARTICIPANTS: Patients (n = 669)
admitted to cardiology units for a range of cardiovascular conditions who were
screened and assessed as being depressed according to the Center for
Epidemiological Studies Depression Scale (CES-D). INTERVENTION: Inpatient
psychiatric review, followed by telephone case conferencing between specialist
hospital staff and GPs to provide patient-specific information about the
patient's depression and its management, educational material, and ongoing
clinical support. MAIN OUTCOME MEASURES: Level of depression severity at 12
months post-hospitalisation. RESULTS: On the basis of intention to treat,
intervention patients had lower rates of moderate to severe depression (CES-D >
or = 27) after 12 months (25% v 35%, relative risk, 0.72; 95% CI, 0.54-0.96,
number needed to treat for benefit, 11). The intervention was most effective in
preventing progression from mild depression to moderate to severe depression.
The multidisciplinary telephone case conferencing was difficult to implement
and, in a post hoc analysis, brief phone advice from a psychiatrist was found to
be effective. CONCLUSIONS: Screening hospitalised cardiac patients for
depression and providing targeted advice to their GPs reduces depression
severity 12 months after hospitalisation.
Publication Types:
Clinical Trial
205: Heart. 2005 Apr;91(4):419-20.
Comment on:
Heart. 2005 Apr;91(4):460-4.
Heart. 2005 Apr;91(4):531-2.
Depression, stress, and coronary heart disease: the need for more complex
models.
Steptoe A, Whitehead DL.
Depression has been related both to the development of coronary heart disease
and to prognosis in patients following acute myocardial infarction, but the
clinical significance of these associations remains uncertain.
Publication Types:
Comment
Editorial
206: Int J Cardiol. 2005 Mar 30;99(3):443-7.
Depressive symptoms and treatment after acute coronary syndrome.
Ellis JJ, Eagle KA, Kline-Rogers EM, Erickson SR.
Department of Pharmacy, Lincoln Surgical Hospital, Lincoln, NE, USA.
BACKGROUND: There is limited data regarding the effects of depression treatment
adequacy on the mental component of health-related quality of life in a
post-acute coronary syndrome population. METHODS: All patients diagnosed with an
acute coronary syndrome and discharged from a university-affiliated hospital
during a 3-year period were mailed a survey that included the SF-8, EQ-5D and
other self-reported measures of disease and treatment (e.g. physical
functioning, comorbidity, medication compliance and perceived cardiac severity).
Patients were categorized based on self-report of depressive symptoms and
antidepressant medication. Adjusted mean mental health-related quality of life
scores were determined by least square mean analysis controlling for independent
variables. RESULTS: Of 1217 eligible patients, 490 (40.3%) responded.
Respondents averaged 65.2 (+/-11.3) years of age, 71% male, 92% Caucasian, 64%
with MI history, 17% had their most recent cardiac event within 6 months. No
depressive symptoms and no depression treatment (without depression) were
reported by 59.8%, 27.6% reported untreated depressive symptoms (untreated),
8.6% reported depressive symptoms and antidepressant medication (undertreated),
and 4.1% reported no symptoms and antidepressant medication (adequately
treated). Adjusted mean SF-8 Mental Component Summary scores were 52.8, 52.5,
42.8 and 40.2 for patients without depression, adequately treated, untreated and
undertreated, respectively (p<0.0001 for all pairwise comparisons except for
patients without depression vs. adequately treated and untreated vs.
undertreated). CONCLUSIONS: Depressive symptoms are common in patients diagnosed
with acute coronary syndrome and appear to be related to lower mental
health-related quality of life. These observations stress the importance of
diagnosis and treatment of depression in this population.
Publication Types:
207: Health Qual Life Outcomes. 2005 Mar 16;3:15.
Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German
coronary heart disease patients.
Barth J, Martin CR.
University of Freiburg - Institute of Psychology, Department of Rehabilitation
Psychology, 79085 Freiburg, Germany. mail@juergen-barth.de
BACKGROUND: Depression and anxiety in patients with coronary heart disease (CHD)
are associated with a poorer prognosis. Therefore the screening for
psychological distress is strongly recommended in cardiac rehabilitation. The
Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool
that has demonstrated good sensitivity and specificity for mental disorders.
METHODS: We assessed mental distress in in-patient cardiac rehabilitation in
Germany. The factor structure of the German language version of the HADS was
investigated in 1320 patients with CHD. Exploratory factor analysis and
confirmatory factor analysis were used to determine the underlying factor
structure of the instrument. RESULTS: Three-factor models were found to offer a
superior fit to the data compared to two-factor (anxiety and depression) models.
The German language HADS performs similarly to the English language version of
the instrument in CHD patients. The German language HADS fundamentally comprises
a tri-dimensional underlying factor structure (labelled by Friedman et al. as
psychomotor agitation, psychic anxiety and depression). CONCLUSION: Despite of
clinical usefulness in screening for mental disturbances the construct validity
of the HADS is not clear. The resulting scores of the tri-dimensional model can
be interpreted as psychomotor agitation, psychic anxiety, and depression in
individual patient data or clinical investigations.
Publication Types:
208: J Clin Psychiatry. 2005 Mar;66(3):346-52.
Pharmacoeconomic analysis of sertraline treatment of depression in patients with
unstable angina or a recent myocardial infarction.
O'Connor CM, Glassman AH, Harrison DJ.
Department of Psychiatry & Behavioral Sciences, Duke University Medical Center,
Durham, NC, USA.
BACKGROUND: The prevalence of major depressive disorder in patients with acute
coronary syndromes (ACSs) is high and associated with worse cardiovascular
outcomes and higher health care costs. Sertraline is the only treatment for
major depressive disorder studied in a placebo-controlled trial of patients with
ACS and found to be safe and effective. The cost implications of providing
antidepressant treatment in this population have not yet been examined. The
objective was to evaluate from a payer perspective the potential reduction in
costs and psychiatric and cardiovascular events and procedures following
sertraline versus placebo treatment of major depressive disorder in patients
hospitalized for ACS. METHOD: Data were analyzed from a randomized,
double-blind, placebo-controlled 24-week trial (Sertraline Antidepressant Heart
Attack Randomized Trial) of sertraline treatment for major depressive disorder
in patients hospitalized for ACS. Main outcome measures included frequency and
costs (derived from Medicare diagnosis-related group fee schedules) of
psychiatric and cardiovascular events occurring during the treatment period.
RESULTS: There was a trend toward significantly fewer psychiatric or
cardiovascular hospitalizations in the sertraline compared with the placebo
group (55/186 vs. 76/183; p = .054). The mean per patient cost associated with
psychiatric and medical events over the course of treatment was 2733 US dollars
for sertraline and 3326 US dollars for placebo, but the difference was not
statistically significant (p = .32). After including the costs of the
sertra-line (360 US dollars over 24 weeks), there was no increase in treatment
costs for sertraline compared with placebo. CONCLUSION: Sertraline treatment of
major depressive disorder following hospitalization for a recent myocardial
infarction or unstable angina appears to be a cost-effective strategy.
Publication Types:
Clinical Trial
209: Int J Behav Med. 2005;12(1):24-9.
Effects of anxiety and depression on heart disease attributions.
Day RC, Freedland KE, Carney RM.
Department of Psychology, Washington University, St. Louis, Missouri 63108, USA.
Cardiac patients' beliefs about the causes of their illness may influence their
receptivity to psychosocial interventions. The purpose of this study was to
determine whether depression or anxiety influence patients' attributions about
the causes of their heart disease. The primary hypothesis was that depressed or
anxious patients are more likely to endorse negative emotions as among the
causes of their heart disease than are patients who are not depressed or
anxious. Sixty-nine patients with documented ischemic heart disease recruited
from an exercise stress testing laboratory completed the Beck Depression and
Anxiety Inventories and a heart disease attribution checklist. Univariate
analyses confirmed that patients who are depressed or anxious are more likely
than other patients to endorse negative emotions as causes of their heart
disease. Anxiety but not depression was retained as an independent predictor of
negative emotion attributions in a logistic regression analysis. We conclude
that mood state influences cardiac patients' beliefs about the causes of their
heart disease.
210: J Gerontol A Biol Sci Med Sci. 2005 Jan;60(1):85-92.
Depressive symptoms and development of coronary heart disease events: the
Italian longitudinal study on aging.
Marzari C, Maggi S, Manzato E, Destro C, Noale M, Bianchi D, Minicuci N, Farchi
G, Baldereschi M, Di Carlo A, Crepaldi G.
National Research Council, Aging Branch, Institute of Neuroscience, Padova,
Italy.
BACKGROUND: Studies on the association between depressive symptomatology (DS)
and cardiovascular events and mortality in elderly persons have yielded
contradictory findings. To address this issue, the authors assessed DS and an
extensive array of sociodemographic, behavioral, and biological variables in the
largest population-based sample of older Italians ever studied and analyzed
their association with coronary heart disease (CHD) morbidity and total number
of deaths. METHODS: This prospective, community-based cohort study included a
sample of 5632 Italians, 65 years and older, who were recruited from the
demographic registries of eight municipalities in Italy. Depressive
symptomatology was assessed using the Geriatric Depression Scale, and a score >
or =10 was used to indicate the presence of DS. All traditional cardiovascular
disease risk factors were assessed at baseline, through questionnaires, blood
tests, and physical examinations. The outcomes were CHD fatal and nonfatal
events and total number of deaths. The association of the predictive variables
with the outcomes was assessed using different Cox models. RESULTS: Baseline DS
was associated with a higher incidence of fatal and nonfatal CHD events (hazard
ratio [HR], 1.66; 95% confidence interval [CI], 1.06-2.60) and with
cardiovascular mortality in men (HR, 2.49; 95% CI, 1.60-3.87) and with total
mortality in men (HR, 2.02; 95% CI, 1.58-2.58) and women (HR, 1.43; 95% CI,
1.04-1.95) at the 4-year follow-up assessment. This association was observed
after adjusting for a vast array of potential confounding variables, including
major chronic conditions. CONCLUSIONS: Depressive symptomatology confers an
increased risk for CHD in men and for total mortality in men and women but is
not explained by health behaviors, social isolation, or biological or clinical
determinants.
Publication Types:
211: Biol Psychol. 2005 Apr;69(1):57-66. Epub 2005 Jan 23.
Multiple stressors and coronary disease in women. The Stockholm Female Coronary
Risk Study.
Orth-Gomer K, Leineweber C.
Karolinska Institutet, Department of Public Health Sciences, P.O. Box 220, 171
77 Stockholm, Sweden. k.orth-gomer@phs.ki.se
We proposed that double exposure to stressors at work and from family are
associated with increased coronary risk in women and that the same exposures are
accompanied by depressive feelings. The study group comprised 292 women coronary
patients (30-65 years) and 292 age-matched healthy controls. Work-stress,
marital-stress, and depressive symptoms were assessed by standardized
questionnaires and evaluated in both case-control and 5-year follow-up analyses.
We found that double exposure to stress from work and family was accompanied by
the highest risk and the worst prognosis in women's coronary disease. In women
patients depressive feelings were frequent, and they were more closely related
to family than to work stress. In healthy women, both stressors, but in
particular their combination, lead to depressive symptoms.
Publication Types:
212: Psychol Bull. 2005 Mar;131(2):260-300.
Anger, anxiety, and depression as risk factors for cardiovascular disease: the
problems and implications of overlapping affective dispositions.
Suls J, Bunde J.
Department of Psychology, University of Iowa, Iowa City, IA 52242, USA.
jerry-suls@uiowa.edu
Several recent reviews have identified 3 affective dispositions--depression,
anxiety, and anger-hostility--as putative risk factors for coronary heart
disease. There are, however, mixed and negative results. Following a critical
summary of epidemiological findings, the present article discusses the construct
and measurement overlap among the 3 negative affects. Recognition of the overlap
necessitates the development of more complex affect-disease models and has
implications for the interpretation of prior studies, statistical analyses,
prevention, and intervention in health psychology and behavioral medicine. The
overlap among the 3 negative dispositions also leaves open the possibility that
a general disposition toward negative affectivity may be more important for
disease risk than any specific negative affect.
Publication Types:
Meta-Analysis
213: Eur J Heart Fail. 2005 Mar 2;7(2):261-7.
Depression increasingly predicts mortality in the course of congestive heart
failure.
Junger J, Schellberg D, Muller-Tasch T, Raupp G, Zugck C, Haunstetter A, Zipfel
S, Herzog W, Haass M.
Department of General Internal and Psychosomatic Medicine, University of
Heidelberg, INF 410, D-69120 Heidelberg, Germany.
Jana_Juenger@med.uni-heidelberg.de
BACKGROUND: Congestive heart failure (CHF) is frequently associated with
depression. However, the impact of depression on prognosis has not yet been
sufficiently established. AIMS: To prospectively investigate the influence of
depression on mortality in patients with CHF. METHODS: In 209 CHF patients
depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D).
RESULTS: Compared to survivors (n=164), non-survivors (n=45) were characterized
by a higher New York Heart Association (NYHA) functional class (2.8+/-0.7 vs.
2.5+/-0.6), and a lower left ventricular ejection fraction (LVEF) (18+/-8 vs.
23+/-10%) and peakVO(2) (13.1+/-4.5 vs. 15.4+/-5.2 ml/kg/min) at baseline.
Furthermore, non-survivors had a higher depression score (7.5+/-4.0 vs.
6.1+/-4.3) (all P<0.05). After a mean follow-up of 24.8 months the depression
score was identified as a significant indicator of mortality (P<0.01). In
multivariate analysis the depression score predicted mortality independent from
NYHA functional class, LVEF and peakVO(2). Combination of depression score, LVEF
and peakVO(2) allowed for a better risk stratification than combination of LVEF
and peakVO(2) alone. The risk ratio for mortality in patients with an elevated
depression score (i.e. above the median) rose over time to 8.2 after 30 months
(CI 2.62-25.84). CONCLUSIONS: The depression score predicts mortality
independent of somatic parameters in CHF patients not treated for depression.
Its prognostic power increases over time and should, thus, be accounted for in
risk stratification and therapy.
Publication Types:
Longitudinal course of depressive symptomatology after a cardiac event: effects
of gender and cardiac rehabilitation.
Grace SL, Abbey SE, Pinto R, Shnek ZM, Irvine J, Stewart DE.
Women's Health Program, Toronto General Research Institute, Behavioural Sciences
and Health Division, and Kinesiology and Health Sciences, York University,
Toronto, Ontario, Canada. sgrace@yorku.ca
OBJECTIVE: Recent research has linked depression to cardiac mortality, and shown
a high burden of persistent depressive symptomatology among cardiac patients.
The objective of this study was to longitudinally examine the prevalence and
course of depressive symptomatology among women and men for 1 year after a
cardiac event, and the effect of cardiac rehabilitation (CR) on this trajectory.
METHODS: Nine hundred thirteen unstable angina (UA) and myocardial infarction
patients from 12 coronary care units were recruited, and follow-up data were
collected at 6 and 12 months. Measures included CR participation, medication
usage, and the Beck Depression Inventory (BDI). The longitudinal analysis was
conducted using SAS PROC MIXED. RESULTS: At baseline there were 277 (31.3%)
participants with elevated depressive symptomatology (BDI > or = 10), 131
(25.2%) at 6 months, and 107 (21.7%) at 1 year. Overall, approximately 5% were
taking an antidepressant medication, and 20% attended CR over their year of
recovery. Participants with greater depressive symptomatology participated in
significantly fewer CR exercise sessions (r = -0.19, p = .02), and minimal
psychosocial interventions were offered. The longitudinal analysis revealed that
all participants experienced reduced depressive symptomatology over their year
of recovery (p = .04), and younger, UA participants with lower family income
fared worst (ps < 0.001). CR did not have an effect on depressive symptomatology
over time, but women who attended CR were significantly more depressed than men
(p = .01). CONCLUSION: Depressed cardiac patients are undertreated and their
symptomatology persists for up to 6 months. CR programs require greater
resources to ensure that depressed participants adhere to exercise regimens, and
are screened and treated for their elevated symptomatology.
Publication Types:
Perceived social support as a predictor of mortality in coronary patients:
effects of smoking, sedentary behavior, and depressive symptoms.
Brummett BH, Mark DB, Siegler IC, Williams RB, Babyak MA, Clapp-Channing NE,
Barefoot JC.
Center, Box 2969, Durham, NC 27710, USA. brummett@duke.edu
OBJECTIVE: Numerous studies have shown network assessments of social contact
predict mortality in patients with coronary artery disease (CAD). Fewer studies
have demonstrated an association between perceived social support and longevity
in patient samples. It has been suggested that 1 of the mechanisms linking
social support with elevated risk for mortality is the association between
social support and other risk factors associated with decreased longevity such
as smoking, failure to exercise, and depressive symptoms. The present study
examined an assessment of perceived support as a predictor of all-cause and CAD
mortality and examined the hypothesis that smoking, sedentary behavior, and
depressive symptoms may mediate and/or moderate this association. METHODS:
Ratings of social support and the risk factors of smoking, sedentary behavior,
and depressive symptoms were examined as predictors of survival in 2711 patients
with CAD, and associations between support and these risk factors were assessed.
Smoking, sedentary behavior, and depressive symptoms were examined as mediators
and/or moderators of the association between social support and mortality.
RESULTS: Social support, smoking, sedentary behavior, and depressive symptoms
were predictors of mortality (p's <.01). Results also indicated that sedentary
behavior, but not smoking status or depressive symptoms, may substantially
mediate the relationship between support and mortality. No evidence for
moderation was found. CONCLUSIONS: The relation between social support and
longevity may be partially accounted for by the association between support and
sedentary behavior.
Publication Types:
216: Am J Cardiol. 2005 Feb 1;95(3):317-21.
Relation of depressive symptoms to C-reactive protein and pathogen burden
(cytomegalovirus, herpes simplex virus, Epstein-Barr virus) in patients with
earlier acute coronary syndromes.
Miller GE, Freedland KE, Duntley S, Carney RM.
Department of Psychology, University of British Columbia, Vancouver, British
Columbia, Canada. gemiller@psych.ubc.ca
Despite mounting evidence that depressive symptoms increase the risk of
morbidity and mortality in patients who have coronary artery disease, little is
known about the biologic mechanisms that underlie this association. This study
examined whether depressive symptoms are associated with markers of infection
and inflammation that have been implicated in the pathogenesis of coronary
artery disease. Sixty-five patients who were recovering from an acute coronary
syndrome were enrolled (63% men; mean age 61 years, 90% white). Depressive
symptoms were assessed through self-report and observer ratings; the
inflammatory molecules C-reactive protein, interleukin-6, and tumor necrosis
factor-alpha were measured in serum, as were antibody titers to 3 latent viruses
associated with atherosclerosis. Patients who had more severe depressive
symptoms exhibited higher levels of C-reactive protein (r = 0.27, p = 0.03) and
higher rates of seropositivity to the latent viruses (r = 0.41, p = 0.001).
These effects were large in magnitude: patients in the highest tertile of the
depression distribution had C-reactive protein levels >50% higher than did
patients in the middle and lowest tertiles; they also were 2 times as likely to
show evidence of infection with all 3 latent viruses. Disparities in the extent,
severity, or management of cardiac disease were not responsible for these
associations. These findings provide evidence that depressive symptoms are
associated with increases in C-reactive protein and pathogen burden in patients
who have coronary artery disease. In doing so, they highlight a mechanism
through which depressive symptoms might foster morbidity and mortality among
patients who have cardiac disease.
Publication Types:
217: Acta Psychiatr Scand. 2005 Feb;111(2):116-24.
Psychosocial predictors of depression in patients with acute coronary syndrome.
Sorensen C, Brandes A, Hendricks O, Thrane J, Friis-Hasche E, Haghfelt T, Bech
P.
The Medical Reseach Unit, Ringkobing County, Ringkobing, Denmark. chs@dadlnet.dk
OBJECTIVE: To describe the prevalence of depression according to ICD-10 criteria
using a self-completed questionnaire and to identify psychosocial predictors of
depression at discharge in patients with acute coronary syndrome. METHOD: A
total of 899 patients with acute coronary syndrome completed the Major
Depression Inventory at discharge and a questionnaire regarding previous
depression and family history of depression. Information concerning civil status
was obtained from the Civil Person Registry. RESULTS: Ninety patients (10%) were
depressed according to ICD-10 criteria at discharge with 7.2% having a moderate
to severe depression at discharge. Women were significantly more frequently and
severely depressed than men. Patients with and without depression reported
primarily somatic symptoms of depression. Cardiovascular risk factors or
treatment did not differ between patients with and without depression. Previous
depression (OR 2.9, 95% CI 1.4-6.0 adjusted) and female gender (OR 2.5, 95% CI
1.5-4.3 adjusted) predicted depression at discharge in a logistic regression
model. CONCLUSION: Somatic symptoms of depression are prevalent in patients with
acute coronary syndrome. The use of self-completed non-diagnostic questionnaires
assessing symptoms of depression therefore is cautioned as patients may wrongly
be identified as depressed. In patients with acute coronary syndrome depression
is predicted by well-known psychosocial risk factors.
Publication Types:
218: Am J Psychiatry. 2005 Jan;162(1):195; author reply 195.
Comment on:
Am J Psychiatry. 2004 Feb;161(2):271-7.
Inflammatory markers, depression, and cardiac disease.
Lyness JM, Moynihan JA, Caine ED.
Publication Types:
Comment
Letter
219: Pharmacotherapy. 2004 Oct;24(10):1306-10.
History of depression as a predictor of adverse outcomes in patients
hospitalized for decompensated heart failure.
de Denus S, Spinler SA, Jessup M, Kao A.
Philadelphia College of Pharmacy, University of the Sciences in Philadelphia,
Philadelphia, Pennsylvania 19104, USA.
STUDY OBJECTIVE: To evaluate the prevalence and impact of depression on the risk
of in-hospital death or need for cardiopulmonary resuscitation (CPR) in patients
admitted for decompensated heart failure. DESIGN: Observational single-center
study. SETTING: Coronary care unit and cardiac intermediate-care unit of a
tertiary referral center. PATIENTS: One hundred seventy-one patients
hospitalized with decompensated heart failure who were included in the Acute
Decompensated Heart Failure Registry (ADHERE). MEASUREMENTS AND MAIN RESULTS:
The 34 patients with a history of depression had a higher likelihood of
experiencing the combined end point of in-hospital death or CPR compared with
the 137 patients without a history of depression (17.7% vs 6.6%, p<0.05). A
history of depression (odds ratio 3.3, 95% confidence interval 1.01-10.6,
p<0.05) was still predictive of in-hospital death or CPR in a multivariate
analysis after adjusting for predictors of the combined end point. CONCLUSIONS:
This study suggests that a history of depression is associated with an increased
risk of in-hospital mortality or CPR in patients hospitalized for decompensated
heart failure. Our results require confirmation in larger trials.
220: J Am Coll Cardiol. 2004 Dec 7;44(11):2254; author reply 2255-6.
Comment on:
J Am Coll Cardiol. 2004 May 5;43(9):1542-9.
Depression in older adults with heart failure.
Ahmed A.
Publication Types:
Comment
Letter
221: J Am Coll Cardiol. 2004 Dec 7;44(11):2253-4; author reply 2255-6.
Comment on:
J Am Coll Cardiol. 2004 May 5;43(9):1542-9.
Depression and heart failure.
Fauchier L.
Publication Types:
Comment
Letter
222: Eur J Cardiovasc Nurs. 2004 Dec;3(4):295-302.
Depressive mood after a cardiac event: gender inequality and participation in
rehabilitation programme.
Norrman S, Stegmayr B, Eriksson M, Hedback B, Burell G, Brulin C.
Department of Cardiology, Heart Center, University Hospital, SE-90185 Umea,
Sweden. signild.norrman@vll.se
BACKGROUND: Depressive mood after a cardiac event is common with serious
consequences for the patient. AIMS: To compare gender in depressive mood during
the first year after a cardiac event and to evaluate the effect of participating
in a multidimensional secondary prevention program on depressive mood. METHODS:
166 men and 54 women, <73 years, consecutively answered a questionnaire
concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after
discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was
informed about the disease and received individual support about lifestyle
changes. Of those invited to participate in a secondary prevention program, 127
patients accepted, and 93 declined participation. RESULTS: At each of the four
follow-ups, women had significantly higher depression scores than men.
Depressive mood in both women and men was significantly reduced at 6 weeks.
Thereafter, it increased to the 2-week level in women and to above the 2-week
level in men. No differences were seen in patients participating or not in
secondary prevention programs. CONCLUSION: Women had higher depressive mood
scores than men and secondary prevention programs failed to improve depressive
mood in both women and men.
Publication Types:
223: Med Sci Monit. 2004 Dec;10(12):CR643-8.
Depressive symptoms and mortality in patients with congestive heart failure: a
six-year follow-up study.
Murberg TA, Furze G.
University of York, York, UK. terje.a.murberg@hs.his.no
BACKGROUND: To evaluate the possible long-term effect of symptoms of depression
on mortality risk among patients with congestive heart failure.
MATERIAL/METHODS: Proportional hazard models were used to evaluate the effect of
symptoms of depression on mortality among 119 clinically stable patients with
symptomatic heart failure, recruited from an outpatient cardiology practice.
Fifty-one deaths were registered during the six years of data collection, all
from cardiac causes. RESULTS: Symptom of depression were a significant predictor
of mortality (relative risk per 1-point increase on the depression scale, 1.05,
confidence interval, 1.00 to 1.08; p = 0.016), controlling for the confounding
effects of the personality trait of neuroticism, heart failure severity
(proANP), gender and age. CONCLUSIONS: Given the long-term effect of depressive
symptomatology on CHF mortality found in the present study, health care
professionals should identify patients who are at risk of suffering from
depression as early as possible, and should try to provide appropriate
treatment. There is a need among CHF patients for studies that seek to examine
whether treatment of depression reduces the risk of mortality.
Publication Types:
224: Psychosom Med. 2004 Nov-Dec;66(6):814-22.
Comment in:
Evid Based Ment Health. 2005 Aug;8(3):67.
Psychosom Med. 2004 Nov-Dec;66(6):799-801.
Prognostic association of depression following myocardial infarction with
mortality and cardiovascular events: a meta-analysis.
van Melle JP, de Jonge P, Spijkerman TA, Tijssen JG, Ormel J, van Veldhuisen DJ,
van den Brink RH, van den Berg MP.
Department of Cardiology, Thoraxcenter, University Hospital Groningen, P.O. Box
30.001, 9700 RB, The Netherlands. j.p.van.melle@thorax.azg.nl
OBJECTIVE: To assess the association of depression following myocardial
infarction (MI) and cardiovascular prognosis. METHODS: The authors performed a
meta-analysis of references derived from MEDLINE, EMBASE, and PSYCINFO
(1975-2003) combined with crossreferencing without language restrictions. The
authors selected prospective studies that determined the association of
depression with the cardiovascular outcome of MI patients, defined as mortality
and cardiovascular events within 2 years from index MI. Depression had to be
assessed within 3 months after MI using established psychiatric instruments. A
quality assessment was performed. RESULTS: Twenty-two papers met the selection
criteria. These studies described follow up (on average, 13.7 months) of 6367 MI
patients (16 cohorts). Post-MI depression was significantly associated with
all-cause mortality (odds ratio [OR], fixed 2.38; 95% confidence interval [CI],
1.76-3.22; p <.00001) and cardiac mortality (OR fixed, 2.59; 95% CI, 1.77-3.77;
p <.00001). Depressive MI patients were also at risk for new cardiovascular
events (OR random, 1.95; 95% CI, 1.33-2.85; p = .0006). Secondary analyses
showed no significant effects of follow-up duration (0-6 months or longer) or
assessment of depression (self-report questionnaire vs. interview). However, the
year of data collection (before or after 1992) tended to influence the effect of
depression on mortality (p = .08), with stronger associations found in the
earlier studies (OR, 3.22; 95% CI, 2.14-4.86) compared with the later studies
(OR, 2.01; 95% CI, 1.45-2.78). CONCLUSIONS: Post-MI depression is associated
with a 2- to 2.5-fold increased risk of impaired cardiovascular outcome. The
association of depression with cardiac mortality or all-cause mortality was more
pronounced in the older studies (OR, 3.22 before 1992) than in the more recent
studies (OR, 2.01 after 1992).
Publication Types:
Comparative Study
Meta-Analysis
Comment in:
Evid Based Ment Health. 2005 Aug;8(3):66.
Depression as a risk factor for mortality in patients with coronary heart
disease: a meta-analysis.
Barth J, Schumacher M, Herrmann-Lingen C.
Department of Rehabilitation Psychology, Institute of Psychology, University of
Freiburg, Germany. mail@juergen-barth.de
BACKGROUND: Prospective studies on physically healthy subjects have shown an
association between depression and the subsequent development of coronary heart
disease (CHD). The relative risk in meta-analytic aggregation is 1.64
(confidence interval [CI], 1.29-2.08) for any CHD event. However, the adverse
impact of depression on CHD patients has not yet been the subject of a
meta-analysis. OBJECTIVE: To quantify the impact of depressive symptoms (eg,
BDI, HADS) or depressive disorders (major depression) on cardiac or all-cause
mortality. We analyzed the strength of the relationship, the time dependency,
and the differences in studies using depressive symptoms or a clinical diagnosis
as predictors of mortality. METHOD: English and German language databases
(Medline, PsycInfo, PSYNDEX) from 1980 to 2003 were searched for prospective
cohort studies. Sixty-two publications were identified. The inclusion criteria
were met by 29 publications reporting on 20 studies. A random model was used to
estimate the combined overall effect as crude odds ratios (OR) or adjusted
hazard ratios (HR [adj]). RESULTS: Depressive symptoms increase the risk of
mortality in CHD patients. The risk of depressed patients dying in the 2 years
after the initial assessment is two times higher than that of nondepressed
patients (OR, 2.24; 1.37-3.60). This negative prognostic effect also remains in
the long-term (OR, 1.78; 1.12-2.83) and after adjustment for other risk factors
(HR [adj], 1.76; 1.27-2.43). The unfavorable impact of depressive disorders was
reported for the most part in the form of crude odds ratios. Within the first 6
months, depressive disorders were found to have no significant effect on
mortality (OR, 2.07; CI, 0.82-5.26). However, after 2 years, the risk is more
than two times higher for CHD patients with clinical depression (OR, 2.61;
1.53-4.47). Only three studies reported adjusted hazard ratios for clinical
depression and supported the results of the bivariate models. CONCLUSIONS:
Depressive symptoms and clinical depression have an unfavorable impact on
mortality in CHD patients. The results are limited by heterogeneity of the
results in the primary studies. There is no clear evidence whether self-report
or clinical interview is the more precise predictor. Nevertheless, depression
has to be considered a relevant risk factor in patients with CHD.
Publication Types:
Comparative Study
Meta-Analysis
Comment on:
Depression is a risk factor for mortality in coronary heart disease.
Carney RM, Freedland KE, Sheps DS.
Publication Types:
Comment
Editorial
227: Circulation. 2004 Nov 30;110(22):3452-6. Epub 2004 Nov 22.
Prognostic value of anxiety and depression in patients with chronic heart
failure.
Jiang W, Kuchibhatla M, Cuffe MS, Christopher EJ, Alexander JD, Clary GL,
Blazing MA, Gaulden LH, Califf RM, Krishnan RR, O'Connor CM.
Center, Durham, NC 27710, USA. jiang001@mc.duke.edu
BACKGROUND: Anxiety is often present with depression and may be one of its
manifestations. Although the adverse effects of depression in patients with
chronic heart failure (CHF) have been well studied, the relation between anxiety
and CHF prognosis has not been addressed. In a secondary analysis of data
collected for a published study of depression and prognosis in patients with
CHF, we examined the relations among anxiety, depression, and prognosis. METHODS
AND RESULTS: We measured symptoms of anxiety with the Spielberger State-Trait
Anxiety Inventory (STAI) scale and symptoms of depression with the Beck
Depression Inventory (BDI) scale in 291 patients with CHF hospitalized as a
result of cardiac events. We followed up these patients for all-cause mortality
over 1 year. The mean scores for state anxiety (State-A) and trait anxiety
(Trait-A) were identical at 33.5; the mean BDI score was 8.7+/-7.6. State-A and
Trait-A scores correlated highly with each other (r=0.85; P<0.01) and with BDI
score (State-A, r=0.52; Trait-A, r=0.59; P<0.01). Cox proportional-hazards model
with and without confounding variables showed no relation between State-A or
Trait-A and 1-year mortality. BDI scores, however, significantly predicted
increased mortality during 1-year follow-up (hazard ratio, 1.04 for each 1-unit
increase; P<0.01). CONCLUSIONS: Although anxiety and depression are highly
correlated in CHF patients, depression alone predicts a significantly worse
prognosis for these patients.
Publication Types:
228: Psychol Med. 2004 Aug;34(6):1083-92.
The risk factors for depression in first myocardial infarction patients.
Dickens CM, Percival C, McGowan L, Douglas J, Tomenson B, Cotter L, Heagerty A,
Creed FH.
Department of Psychiatry, Manchester University, UK. c.dickens@man.ac.uk
BACKGROUND: Depression affects outcome following myocardial infarction but the
risk factors for such depression have been little studied. This study considered
whether the causes of depression occurring before and after myocardial
infarction were similar to those of depression in the general population.
METHOD: Consecutive patients admitted to hospital following their first
myocardial infarction were interviewed with the Schedule for Clinical Assessment
in Neuropsychiatry to detect psychiatric disorders and the Life Events and
Difficulties Schedule to assess recent stress. Participants completed the
Hospital Anxiety and Depression Scale (HADS) at entry to the study and 1 year
later and the risk factors associated with a high score at both times were
assessed. RESULTS: Of 314 (88% of eligible) patients who were recruited, 199
(63%) were male and 63 (20%) had depressive disorders. Logistic regression
identified the following as independently associated with depressive disorder
that had been present for at least I month before the myocardial infarction:
younger age, female sex, past psychiatric history, social isolation, having
marked non-health difficulties and lack of a close confidant. At follow-up
269/298 (90%) responded; of 189 participants not depressed at first assessment,
39 (21%) became depressed by the 1 year follow-up. Logistic regression
identified frequent angina as the only significant predictor of raised HADS
scores at 12 months. CONCLUSIONS: Depression developing during the year
following myocardial infarction does not have the same risk factors as that
which precedes myocardial infarction. Further clarification of the mechanisms
linking depression to poor outcome may require separation consideration of pre-
and post-myocardial infarction depression, and its risk factors.
Publication Types:
229: Am J Med. 2004 Nov 15;117(10):732-7.
Antidepressants and risk of first-time hospitalization for myocardial
infarction: a population-based case-control study.
Monster TB, Johnsen SP, Olsen ML, McLaughlin JK, Sorensen HT.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus and
Aalborg, Denmark. t.monster@home.nl
PURPOSE: Several studies have found an increased risk of myocardial infarction
among depressed patients. Selective serotonin reuptake inhibitors (SSRIs) appear
to lack the arrhythmic adverse effects of tricyclic antidepressants, and are
thought to inhibit platelet aggregation. We examined whether use of different
antidepressant classes is associated with a lower risk of first-time
hospitalization for myocardial infarction, as compared with nonuse. METHODS: We
identified 8887 cases of first-time hospitalization for myocardial infarction
and 88,862 age- and sex-matched population-based controls during 1994-2002,
using data from North Jutland County, Denmark. Cases and controls were
stratified according to history of cardiovascular disease. All prescriptions for
antidepressants before hospitalization for myocardial infarction were identified
using a prescription database. Conditional logistic regression was used to
estimate odds ratios of myocardial infarction associated with antidepressant
use, adjusted for possible confounding factors. RESULTS: In patients with a
history of cardiovascular disease, we found indications of a lower risk of
myocardial infarction among those who used SSRIs (adjusted odds ratio [OR] =
0.85; 95% confidence interval [CI]: 0.62 to 1.16), nonselective serotonin
reuptake inhibitors (adjusted OR = 0.83; 95% CI: 0.50 to 1.38), and other
antidepressants (adjusted OR = 0.55; 95% CI: 0.31 to 0.97). There were no such
associations among persons without a history of cardiovascular disease.
CONCLUSION: Antidepressant use may be associated with a decreased risk of
hospitalization for myocardial infarction among persons with a history of
cardiovascular disease, although it remains uncertain whether there are
differences by class of antidepressant.
230: S Afr Med J. 2004 Oct;94(10):821-3.
Health care discrimination against the mentally ill--a comparison of private
health insurance benefits for major depressive disorder and ischaemic heart
disease in South Africa.
Oosthuizen P, Scholtz O, Hugo C, Richards B, Emsley R.
Stellenbosch University.
231: J Card Fail. 2004 Oct;10(5):390-6.
Depression and health status in patients with advanced heart failure: a
prospective study in tertiary care.
Sullivan M, Levy WC, Russo JE, Spertus JA.
Department of Psychiatry & Behavioral Sciences, University of Washington School
of Medicine, Seattle 98195, USA.
BACKGROUND: Depression impairs health status among patients with coronary
disease. The effect of depression on patients with heart failure has been
studied to date only in hospitalized patients. METHODS AND RESULTS: Prospective
cohort study of 113 outpatients with advanced heart failure. At baseline, 19% (n
= 21) had major depression or dysthymia, 9% (n = 10) had minor depression, and
72% (n = 82) had no current depression diagnosis. Repeated measures analyses of
covariance adjusting for demographic and clinical differences demonstrated that
the depression groups differed on observed function (6-minute walk distance [F =
4.8, P = .01]), and self-reported generic (SF-36) and disease-specific (Kansas
City Cardiomyopathy Questionnaire) health status. Depression groups also
differed in severity of self-reported breathlessness, chest pain, and fatigue.
Subject- and spouse-reported role function also differed between the groups.
Partial correlation (controlling for the same covariates) between baseline
Hamilton Depression Scale scores and these outcomes was highly significant at
baseline and follow-up. CONCLUSIONS: Depression is prospectively associated with
poorer health status in patients with advanced heart failure. Physical and role
function, symptom severity, and quality of life are all significantly affected.
Publication Types:
232: J Psychosom Res. 2004 Aug;57(2):183-8.
The relationship between vital exhaustion, depression and comorbid illnesses in
patients following first myocardial infarction.
McGowan L, Dickens C, Percival C, Douglas J, Tomenson B, Creed F.
Department of Psychiatry, University of Manchester, Manchester M13 9PL, UK.
linda.mcgowan@man.ac.uk
OBJECTIVE: Vital exhaustion and depression are both independent risk factors for
cardiovascular disease, yet the relationship between these highly similar
dimensions remains unclear. We have examined the association between depression
and vital exhaustion and investigated the extent to which any association is the
result of comorbid illnesses. METHODS: Three hundred and five consecutive
patients were examined on average 3.6 days following hospital admission with
first myocardial infarction (MI). The Maastricht Questionnaire (MQ; vital
exhaustion) was administered together with the Hospital Anxiety and Depression
Scale (HADS), and details of comorbid physical illness were recorded. The factor
structure of the MQ was explored using factor analysis. RESULTS: Depression and
vital exhaustion were highly correlated (r=.61, P<.01). This correlation did not
diminish on controlling for age, sex, and comorbidity (r=.59, P<.01). Factor
analysis of MQ score gave a four-factor solution: fatigue (18.2% of variance),
depression (17.9%), lack of concentration (9.5%), and sleep difficulties (8.1%).
The fatigue dimension of the MQ remained highly associated with HADS depression
score (r=.50, P<.01), controlling for age, sex, and comorbidity. CONCLUSIONS:
Depression and fatigue are highly correlated and their association is not
attributable to comorbid physical illnesses or the tendency of the MQ to measure
depression. Future studies should investigate fatigue instead of vital
exhaustion as a potential risk factor for poor cardiac prognosis independent of
the influence of depression.
Publication Types:
233: J Coll Physicians Surg Pak. 2004 Oct;14(10):615-8.
Symptoms of depression and anxiety in post-myocardial infarction patients.
Akhtar MS, Malik SB, Ahmed MM.
Department of Psychiatry, Punjab Institute of Mental Health, Lahore.
msakhtar65@hotmail.com
OBJECTIVE: To assess the frequency of symptoms of depression and/or anxiety
following acute myocardial infarction (AMI) and to analyse their association
with demographic variables. DESIGN: A cross-sectional analytical,
non-interventional hospital based study. PLACE AND DURATION OF STUDY: The study
was carried out at Punjab Institute of Cardiology (PIC), Lahore, from January
2000 to January 2001. PATIENTS AND METHODS: A total number of 100 inpatients
suffering from AMI were studied. After a careful selection of the subjects the
Urdu version of Hospital Anxiety and Depression Scale (HADS) was administered to
each patient during the period of 5-7 days following AMI to assess symptoms of
depression and anxiety. A semi-structured clinical interview was also conducted
which included demographic information, psychiatric history and other variables.
Results were analyzed by using Statistical Package for Social Sciences (SPSS
version 8.0). RESULTS: Out of 100 subjects, 80 (80%) were males and 20 (20%)
were females. Their ages ranged from 30-60 years (mean age, 50.92+/-8.53).
Overall, symptoms of anxiety and/or depression were found in 50 (50%) patients.
More specifically, symptoms of depression were found in 14%, anxiety symptoms in
18% and mixed symptoms (anxiety and depression) in 18% of the patients. Results
revealed that patients above 45 years of age (i.e. 46-60 years) were more likely
to experience symptoms of depression and/ or anxiety following AMI. A
significant association was also found between female sex (p <0.02), lower
socioeconomic status (p <0.05) and symptoms of depression and/ or anxiety in
these patients. However, no significant association was found in relation to
educational status, marital status and origin (urban/rural). CONCLUSION: The
high proportion of patients with AMI found to be suffering from symptoms of
depression and/ or anxiety one week after AMI highlights the essential need to
assess these symptoms in all such patients during the post-MI period as they
merit appropriate treatment along with the other complications of AMI.
234: Eur Heart J. 2004 Oct;25(19):1695-701.
Comment in:
Eur Heart J. 2004 Oct;25(19):1672-4.
Distinct psychosocial differences between women with coronary heart disease and
cardiac syndrome X.
Asbury EA, Creed F, Collins P.
Department of Cardiac Medicine, National Heart and Lung Institute, Imperial
College London, Dovehouse Street, London SW3 6LY, UK. e.asbury@ic.ac.uk
AIMS: To compare the impact of oestrogen, gynaecological history, social
support, life events and family history of CHD on psychosocial morbidity in
syndrome X, CHD patients and healthy controls. METHODS AND RESULTS: 100 female
syndrome X (60 +/- 9 years), 100 female CHD (65 +/- 9 years) and 100 healthy
female volunteers (61 +/- 10 years) completed the hospital anxiety and
depression scale (HADS), health anxiety questionnaire (HAQ), a demographic
information scale, life events scale, family history of CHD, menopausal,
menstrual and gynaecological history. A 17beta-oestradiol sample was taken.
Syndrome X patients had higher levels of life interference (p < 0.05) and HADS
anxiety (p < 0.05) than CHD patients, and higher levels of all HADS and HAQ
scales than controls (p < 0.01). Syndrome X patients with a large social network
had lower HADS anxiety (p < 0.05), health worry (p < 0.05), life interference (p
< 0.01) and total HAQ (p < 0.01). Social network (p = 0.003), divorced/separated
or widowed status (p = 0.005), HRT (p = 0.008) and HADS anxiety score (p <
0.001) accounted for 41.9% of the variance in HAQ scores in syndrome X.
Oestrogen was unrelated to the HADS or HAQ for any group. CONCLUSION: Syndrome X
patients suffered higher levels of psychological morbidity in comparison to CHD
patients and controls. Life events and social network size were related to
health anxiety, general anxiety and depression in women with syndrome X.
Publication Types:
Comparative Study
235: Am J Geriatr Cardiol. 2004 Sep-Oct;13(5):252-60.
Comment in:
Am J Geriatr Cardiol. 2004 Sep-Oct;13(5):237-8.
Depression and health status in elderly patients with heart failure: a 6-month
prospective study in primary care.
Sullivan MD, Newton K, Hecht J, Russo JE, Spertus JA.
Department of Psychiatry and Behavioral Studies, University of Washington,
Seattle, WA 98195, USA. sullimar@u.washington.edu
To determine the prevalence and effects of depression on health status among
elderly outpatients with heart failure, the authors conducted a 6-month
prospective cohort study of 139 older outpatients with heart failure managed in
primary care and 80 of their spouses. Primary care heart failure diagnosis was
confirmed through chart review. The Primary Care Evaluation of Mental Disorders
psychiatric diagnostic interview and Hamilton Depression Rating Scale were
administered by phone. EQ-5D feeling thermometer, Medical Outcomes Study Short
Form 36-Item Questionnaire, Kansas City Cardiomyopathy Questionnaire, and heart
failure symptom severity questionnaires were administered by self-report.
Depression diagnoses at baseline were: major depression and/or dysthymia (n=12,
9%), minor depression (n=14, 10%), and no depression (n=113, 81%). After
adjusting for age, gender, and medical comorbidity, these depression groups
differed by repeated measures analysis of covariance on most health status
measures including the EQ-5D feeling thermometer; Medical Outcomes Study Short
Form 36-Item Questionnaire general health and physical role function subscales;
Kansas City Cardiomyopathy Questionnaire total score, symptom total, physical
limitations, and quality of life subscales; as well as severity of chest pain
and fatigue. Depression has significant and persistent effects on health status
of elderly patients with heart failure, including heart failure symptoms,
physical and role function, and quality of life. This may help explain why
depression has been associated with increased health care utilization and costs
in this population. Copyright 2004 Le Jacq Communications, Inc.
Publication Types:
Comparative Study
236: J Affect Disord. 2007 May 16; [Epub ahead of print]
Depression profile in patients with and without chronic heart failure.
Holzapfel N, Muller-Tasch T, Wild B, Junger J, Zugck C, Remppis A, Herzog W,
Lowe B.
Department of Psychosomatic and General Internal Medicine, Medical University
Hospital Heidelberg, Germany.
OBJECTIVE: Depression often goes undetected and untreated in patients with
chronic heart failure (CHF). To investigate whether patients with CHF show a
specific profile of depression symptoms, we compared depression symptoms in
depressed patients with and without CHF. METHODS: Of a total of 921 patients
from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic
criteria for major depressive disorder and 113 for other depressive disorders.
Depressed patients with CHF (n=113) and without CHF (n=137) were compared with
respect to severity of individual DSM-IV depressive symptoms, as measured with
the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic
characteristics as covariates were performed separately for patients with major
depressive disorder and other depressive disorders. RESULTS: Among the patients
meeting the criteria for major depressive disorder, patients with CHF reported
significantly lower levels of depressed mood (p=.006) and worthlessness/guilt
(p=.019) than patients without CHF. In contrast, no significant group
differences were found for any of the other depression symptoms. Group
comparisons among the patients with other depressive disorders completely
replicated these results (p</=.001, and p=.04, respectively). LIMITATIONS: Our
study population of CHF patients may not be representative for CHF patients
recruited in the general population. CONCLUSIONS: The diagnostic features
discriminating between depressed patients with and without CHF are the
cognitive-emotional symptoms of depression, not the somatic symptoms. This
finding may partially explain the low recognition rate of depression in patients
with CHF. The different profile of depression symptoms in patients with and
without CHF should be considered in diagnosis, treatment and medical education.
237: J Heart Lung Transplant. 2007 May;26(5):544-8. Epub 2007 Mar 26.
Getting old with a new heart: impact of age on depression and quality of life in
long-term heart transplant recipients.
Martinelli V, Fusar-Poli P, Emanuele E, Klersy C, Campana C, Barale F, Vigano M,
Politi P.
DSSAeP, Section of Psychiatry, University of Pavia, Pavia, Italy.
martinelli.vl@libero.it <martinelli.vl@libero.it>
BACKGROUND: Limited research has been done on depression and quality of life in
long-term survival after heart transplantation. The aim of the present study was
to investigate the role of age on depression and quality of life in a sample of
long-term heart transplant recipients. METHODS: We investigated 137 consecutive
patients recruited in a single center who were still alive at more than 10 years
after transplantation. Quality of life and depression were rated with the
Medical Outcome Study Short Form (SF-36) and the Beck Depression Inventory
(BDI), respectively. Sociodemographic, clinical, affective, and quality of life
data for long-term survival patients stratified by current age younger than 70
years (young) and 70 years or older (old) were compared using Fisher's exact
tests and Student's t-tests. RESULTS: The SF-36 Mental Component Summary did not
significantly differ between the young subjects (48.75 +/- 10.2) compared with
old (48.47 +/- 10.1; p = 0.897). By contrast, the SF-36 Physical Component
Summary was higher in younger subjects (46.88 +/- 10.2 vs 40.81 +/- 10.6, p =
0.008). According to BDI, 37.4% of the young group and 13.3% of the old group
scored above the selected threshold of 10 (p = 0.014). CONCLUSIONS: In the light
of our findings, older age does not seem to negatively affect the mental
component of quality of life in the long term after heart transplantation, but
it does on the physical component, as expected. On the other hand, it may be
even associated with a lower prevalence of depressive symptoms more than 10
years after surgery. Hence, age per se does not represent a major limiting
factor when considering candidates for this procedure, at least with regard to
the issue of psychologic distress.
Publication Types:
Comparative Study
238: J Heart Lung Transplant. 2005 Dec;24(12):2269-78. Epub 2005 Nov 17.
Depression and quality of life in patients living 10 to 18 years beyond heart
transplantation.
Fusar-Poli P, Martinelli V, Klersy C, Campana C, Callegari A, Barale F, Vigano
M, Politi P.
DSSAeP, Sezione di Psichiatria, Universita di Pavia and Servizio Psichiatrico di
Diagnosi e Cura San Matteo, Pavia, Italy. p.fusar@libero.it
BACKGROUND: The purpose of this study was to advance current understanding of
factors that influence long-term quality-of-life (QoL) outcomes after heart
transplantation, by addressing the influence of depression on perceived health
status. METHODS: Data were collected from all recipients (n = 137) still alive
at >10 years after transplantation. They completed the Short Form Health Survey
(SF-36) inventory and the Beck Depression Inventory (BDI) questionnaire, while
objective measures of health status were retrieved from medical records. All
instruments used had acceptable reliability and validity. Data were analyzed
using descriptive statistics, general linear regression models and survival
analysis. RESULTS: We assessed 137 patients who received transplants between
November 1985 and June 1994 in Pavia and have survived 10 to 18 years after
transplantation (mean 13.64 years, SD 2.25). They rated their health as good and
only the physical QoL (PCS) was impaired when compared with the general
population. Thirty-two percent of patients experienced mood depressive symptoms
in the long term after transplantation, indicating a low perceived QoL. Higher
educational qualification (p = 0.049), being unemployed and receiving a
disability pension (p = 0.001), high triglycerides levels (p = 0.020) and lack
of physical activity (p < 0.001) were predictors of high BDI scores.
CONCLUSIONS: Assessment of depression levels and better understanding of risk
factors for psychiatric disorders in the long term after transplantation could
be of benefit in predicting negative outcomes and allowing future developments
in patient management.
239: Int J Geriatr Psychiatry. 2007 Jul;22(7):613-26.
Depression and the risk for cardiovascular diseases: systematic review and meta
analysis.
Van der Kooy K, van Hout H, Marwijk H, Marten H, Stehouwer C, Beekman A.
VU University Medical Center, Amsterdam, The Netherlands.
BACKGROUND: Depression and cardiovascular diseases are both common among
elderly. Depression is suspected to be an independent risk factor for the onset
of coronary heart disease, yet it is not clear to what extent and if depression
also is associated with the onset of other diseases of the circulatory system.
AIMS: To estimate the risk of depression as an independent risk factor for
various cardiovascular diseases (CVD) and explore the effects of heterogeneity
and methodological quality. METHOD: Meta-analyses and meta-regression analyses
of longitudinal cohort and case-control studies reporting depression at baseline
and CVD outcomes at follow-up. DATA SOURCES: MEDLINE (1966-2005) and PSYCHINFO
(1966-2005). RESULTS: Of the 28 studies that met the inclusion criteria, 11 were
assesed as high quality studies. Although depressed mood increased the risk for
a wide range of CVDs, heterogeneity was substantial in most cases. Only the
overall combined risk of depression for the onset of myocardial infarctions
(n=8, OR=1.60, 95%CI 1.34-1.92) was homogenous. Clinically diagnosed major
depressive disorder was identified as the most important risk factor for
developing CVD. CONCLUSIONS: Depression seems to be an independent risk factor
for the onset of a wide range of CVDs, although this evidence is related to a
high level of heterogeneity. Copyright (c) 2007 John Wiley & Sons, Ltd.
240: Am J Crit Care. 2007 May;16(3):260-9.
Utility of observer-rated and self-report instruments for detecting major
depression in women after cardiac surgery: a pilot study.
Doering LV, Cross R, Magsarili MC, Howitt LY, Cowan MJ.
University of California--Los Angeles School of Nursing, Los Angeles, CA 90095,
USA. ldoering@sonnet.ucla.edu
BACKGROUND: Major depression is common after coronary artery bypass graft
surgery and is associated with increased mortality and morbidity. Clinicians
have few practical options for detecting depression, especially in women, who
are at higher risk for depression than men. OBJECTIVES: To evaluate the clinical
utility of common self-report and observer-rated instruments for detection of
major depression in women after coronary artery bypass graft surgery. METHODS:
In 66 women being discharged after coronary artery bypass graft surgery, 4
instruments were completed: the Hamilton Depression Rating Scale, Beck
Depression Inventory, Beck Depression Inventory Short Form, and Beck Depression
Inventory for Primary Care. For each instrument,
receiver-operating-characteristic curves were analyzed, and positive and
negative predictive values were calculated for cutoff points determined from the
curves. RESULTS: At hospital discharge, all 4 instruments yielded highly
accurate curves. Compared with cutoffs suggested for patients without medical
illness and hospitalized nonsurgical patients, identified cutoffs for screening
were higher when all types of depressive symptoms (cognitive, affective,
behavioral, somatic) were measured with the Hamilton Depression Rating Scale and
the Beck Depression Inventory but lower when only cognitive and/or affective
symptoms were measured with the 2 subscales of the Beck Depression Inventory.
CONCLUSIONS: The Hamilton Depression Rating Scale and both subscales of the Beck
Depression Inventory may be useful for detecting major depression in women
shortly after coronary artery bypass graft surgery. Further study is warranted
to confirm cutoffs in these patients.
Publication Types:
241: Altern Ther Health Med. 2007 May-Jun;13(3):18-21.
Infection, depression, and immunity in women after coronary artery bypass: a
pilot study of cognitive behavioral therapy.
Doering LV, Cross R, Vredevoe D, Martinez-Maza O, Cowan MJ.
University of California, Los Angeles School of Nursing, USA.
CONTEXT: Depression is common after coronary artery bypass graft (CABG) surgery,
but little is known about its effect on post-CABG inflammation or infection or
about the most effective treatment for post-CABG depression. OBJECTIVES: (1) To
determine ifpost-CABG depression is associated with increased infectious illness
and (2) to test effects of cognitive behavioral therapy (CBT) on depressive
symptoms, inflammatory biomarkers, and post-CABG infections in depressed
post-CABG women. DESIGN: Randomized, controlled trial. SETTING: Two urban
tertiary care centers. PATIENTS: Fifteen clinically depressed women in the first
month after CABG, along with a comparison group of 37 non-depressed postCABG
women, were studied. Inclusion criteria were: < or = 75 years old,
English-speaking, undergoing first-time CABG, available for 6 months
offollow-up, and without malignancy or autoimmune disorders. INTERVENTION: Eight
weeks of individual home-based CBT. MAIN OUTCOME MEASURES: (1) Depressive
symptoms measured by the Beck Depression Inventory, (2) natural killer cell
cytotoxicity (NKCC) measured by 51Cr-release assay, (3) infectious illness
episodes measured by the Modified Health Review, (4) interleukin (IL)-6 and C
reactive protein (CRP) measured by enzyme immunoabsorbent assay. RESULTS:
Clinically depressed post-CABG women exhibited decreased NKCC and a higher
incidence of in-hospital fevers and infectious illness in the first 6 months
after CABG. Among depressed women, CBT yielded moderate to large effects for
improved NKCC (D=0.67) and decreased IL-6 (D=0.61), CRP (D=0.85), and
postoperative infectious illnesses (D=0.93). CBT holds promise for improving
depression and immunity and reducing infection and inflammation after CABG.
Publication Types:
Multicenter Study
242: J Psychosom Res. 2006 Dec;61(6):775-81.
Psychological risk factors for cardiac-related hospital readmission within 6
months of coronary artery bypass graft surgery.
Oxlad M, Stubberfield J, Stuklis R, Edwards J, Wade TD.
School of Psychology, Flinders University, Adelaide, South Australia, Australia.
melissa.oxlad@flinders.edu.au
OBJECTIVE: The objective of this study was to examine the psychological risk
factors for cardiac-related readmission within 6 months of coronary artery
bypass graft surgery (CABG). METHODS: Consecutive patients awaiting elective
CABG (N=119; 100 males and 19 females), with a mean age of 63.3 years, completed
a battery of psychosocial measures in a three-stage repeated-measures design.
Relevant medical data were also extracted from patients' medical records 6
months postoperatively to allow for the examination of potential covariates.
RESULTS: Two psychological variables, increased postoperative anxiety and
increased preoperative depression, were identified as risk factors for
cardiac-related readmission independent of the only significant covariate
identified, cardiopulmonary bypass time. CONCLUSION: Anxiety in the immediate
postoperative period and, to a lesser extent, preoperative depression are
important determinants of health care utilization postdischarge. Further
research to clarify the psychological factors that are predictive of
readmission, and that attempt to determine both the underlying cause of
readmissions and potential mechanisms through which psychological factors act is
recommended. Such research may highlight potential factors to target in
interventions and the best time at which to intervene.
Publication Types:
Multicenter Study
243: J Psychosom Res. 2006 Dec;61(6):783-9.
Anxiety enhances the detrimental effect of depressive symptoms on health status
following percutaneous coronary intervention.
Pedersen SS, Denollet J, Spindler H, Ong AT, Serruys PW, Erdman RA, van Domburg
RT.
Department of Cardiology, Thoraxcentre, Erasmus Medical Centre Rotterdam, The
Netherlands. s.s.pedersen@uvt.nl
OBJECTIVE: We examined whether anxiety has incremental value to depressive
symptoms in predicting health status in patients undergoing percutaneous
coronary intervention (PCI) treated in the drug-eluting stent era. METHODS: A
series of consecutive patients (n=692) undergoing PCI as part of the
Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital registry
completed the Hospital Anxiety and Depression Scale at 6 months and the
Short-Form Health Survey (SF-36) at 6 and 12 months post-PCI. RESULTS: Of 692
patients, 471 (68.1%) had no symptoms of anxiety nor depression, 62 (9.0%) had
anxiety only, 59 (8.5%) had depressive symptoms only, and 100 (14.5%) had
co-occurring symptoms. There was an overall significant improvement in health
status between 6 and 12 months post-PCI (P<.001); the interaction effect for
time by psychological symptoms was also significant (P=.003). Generally,
patients with co-occurring symptoms reported significantly poorer health status
compared with the other three groups (Ps <.001). Patients with co-occurring
symptomatology were also at greater risk of impaired health status on six of the
eight subdomains of the SF-36 compared with the other three symptom groups,
adjusting for baseline characteristics and health status at 6 months.
CONCLUSION: Patients with co-occurring symptoms of anxiety and depression
reported poorer health status compared with anxious or depressed-only patients
and no-symptom patients, showing that anxiety has incremental value to
depressive symptoms in identifying PCI patients at risk for impaired health
status treated in the drug-eluting stent era.
Preoperative predictors of delirium after cardiac surgery: a preliminary study.
Kazmierski J, Kowman M, Banach M, Pawelczyk T, Okonski P, Iwaszkiewicz A,
Zaslonka J, Sobow T, Kloszewska I.
Department of Old Age Psychiatry and Psychotic Disorders, Medical University of
Lodz, 92-216 Lodz, Poland.
Preoperative risk factors of postoperative delirium were evaluated in 260
patients admitted for open heart surgery. The incidence of delirium was 11.5%.
Independent predictors included cognitive impairment, atrial fibrillation, a
history of peripheral vascular disease major depression and advanced age.
Aforementioned factors might be helpful in predicting delirium following cardiac
surgery.
245: Prog Transplant. 2006 Sep;16(3):215-21.
Relationship between coping and depression in heart transplant candidates and
their spouses.
Burker EJ, Evon DM, Ascari JC, Loiselle MM, Finkel JB, Mill MR.
University of North Carolina, Chapel Hill, NC, USA.
CONTEXT: Survival rates for heart transplantation are encouraging, but the
pretransplant period can be extremely stressful for patients and their spouses.
Although a relationship between patients' depression levels and the coping
strategies employed by their spouses has been demonstrated, this association has
not been examined in heart transplant candidates and their spouses. Depression
in this group of patients is important because heart transplant patients with
preoperative depression have been found to have a higher mortality rate after
transplantation. OBJECTIVE: To determine if a relationship exists between
spousal coping strategies and heart transplant candidates' depression. METHODS:
A descriptive, exploratory pilot study. PARTICIPANTS: Twenty-two individuals
with end-stage heart disease who were undergoing an inpatient evaluation for
heart transplantation, plus their spouses. Design-Heart transplant candidates
were assessed via the Structured Interview Guide for the Hamilton Depression
Scale. Spouses completed the COPE Inventory and the Center for Epidemiological
Studies Depression Scale. RESULTS: Spousal behavioral disengagement was
positively associated with heart transplant candidates' depression. CONCLUSIONS:
Heart transplant candidate depression may follow spousal disengagement, or,
conversely, a spouse may disengage in response to the patient becoming
depressed. Identification during the pretransplant evaluation of those spouses
who cope using behavioral disengagement might be a first step in the process of
assessment and intervention. Clinical interventions may need to focus on the
spouse as well as on the transplant candidate.
246: Br J Health Psychol. 2006 Sep;11(Pt 3):401-19.
Application of a chronic illness model as a means of understanding pre-operative
psychological adjustment in coronary artery bypass graft patients.
Oxlad M, Wade TD.
School of Psychology, Flinders University, South Australia, Australia.
melissa.oxlad@flinders.edu.au
OBJECTIVES: To increase understanding of the factors associated with
pre-operative psychological adjustment in coronary artery bypass graft (CABG)
patients by assessing the utility of a chronic illness model developed by
Scharloo, Kaptein, Weinman, Willems, and Rooijmans (2000). DESIGN: A
cross-sectional design was employed. METHOD: Elective CABG patients (N=119)
completed self-report measures of illness representation, self-rated health,
social support, coping methods, and pre-operative adjustment (depression and
post-traumatic stress disorder (PTSD) symptomatology) an average of 30 days
prior to surgery. Hierarchical multiple regression was used to assess the
mediational relationships proposed by the chronic illness model. RESULTS: Five
3-variable mediational chains were assessed. In all instances, the results
conformed to the relationships suggested by the chronic illness model where the
strength of the relationship between the independent and dependent variables was
reduced when the mediator variable was controlled. However, a significant
reduction of this relationship was found in three of the five chains examined.
The most rigorous support for the model occurred, where increased use of
avoidance coping mediated the relationship between poorer self-rated health and
increased PTSD symptomatology, and also where increased use of avoidance coping
partially mediated the relationship between a more negative illness
representation and increased PTSD symptomatology, and poorer self-rated health
and increased depression. CONCLUSIONS: The chronic illness model of Scharloo and
colleagues shows potential in explaining pre-operative adjustment in CABG
patients. Longitudinal examination of the model is recommended.
Publication Types:
Minor depression as a cardiac risk factor after coronary artery bypass surgery.
Rafanelli C, Roncuzzi R, Milaneschi Y.
Dept. of Psychology, Univ. of Bologna, Viale Berti Pichat 5, 40127 Bologna,
Italy. chiara.rafanelli3@unibo.it
A few studies have investigated the role of psychosocial variables on clinical
outcomes in coronary artery bypass grafting patients. The aims of this
prospective study were 1) to assess clinical and subclinical distress in a
consecutive sample of patients who underwent coronary artery bypass grafting
surgery at both a 1-month assessment and a 6- to 8-year follow-up visit; and 2)
to investigate the relationship between psychological variables and coronary
events. A consecutive series of 47 patients with recent coronary artery bypass
grafting surgery was evaluated by means of observer-rated categories (both the
Diagnostic and Statistical Manual [DSM] and the new Diagnostic Criteria for
Psychosomatic Research [DCPR]), and self-rated scales such as the Psychosocial
Index. Survival analysis was used to characterize the clinical course of
patients at the 6- to 8-year follow-up. One month after surgery, at the first
psychological assessment, 36% of patients received a psychiatric diagnosis, and
almost half of the sample met the criteria for a DCPR cluster. At follow-up,
only abnormal illness behavior scores varied significantly from those at the
first evaluation. Among the variables examined as potential risk factors for
coronary events, only minor depression attained statistical significance.
Psychological evaluation of patients who underwent coronary artery bypass
grafting surgery needs to incorporate both clinical (DSM) and subclinical (DCPR)
methods of classification. Furthermore, the data suggest minor depression as a
potential cardiac risk factor in coronary artery bypass grafting patients. The
clinical approach to coronary artery bypass grafting patients should thus
include not only major depressive symptoms but also minor depression.
248: J Heart Lung Transplant. 2006 Jul;25(7):785-93.
Anti-depressive therapies after heart transplantation.
Fusar-Poli P, Picchioni M, Martinelli V, Bhattacharyya S, Cortesi M, Barale F,
Politi P.
Department of Applied and Psychobehavioural Sciences, University of Pavia,
Pavia, Italy. p.fusar@libero.it
OBJECTIVE: Despite an improved quality of life, about 33% of heart transplant
recipients will develop depressive symptoms post-operatively. To date, no review
has explored the efficacy and safety of pharmacologic or psychologic
interventions in this patient group. METHODS: We conducted a comprehensive
Medline, EmBase, Psycinfo search for studies of the treatment of depression in
heart transplant recipients. RESULTS: We identified 34 studies of variable
methodologic quality. Selective serotonin re-uptake inhibitors (SSRIs),
particularly citalopram and new-generation anti-depressants (mirtazapine), seem
to represent the best therapeutic choices for this population. Tricyclic
anti-depressants (TCAs), and electroconvulsive therapy (ECT) should be reserved
for severe depression unresponsive to other treatments, whereas monoamine
oxidase inhibitors (MAOIs) should be avoided. St John's wort, an alternative
herbal drug, has been associated with life-threatening immunosuppression.
Psychologic therapy offers further advantages after heart transplantation.
CONCLUSIONS: Further well-conducted, randomized, controlled trials are needed to
clarify the efficacy and the safety of pharmacologic (SSRIs and atypical
anti-depressants) and psychologic interventions in the management of depression
after heart transplantation.
Publication Types:
Review
249: Circ J. 2006 Apr;70(4):389-92.
Risk analysis for depression and patient prognosis after open heart surgery.
Hata M, Yagi Y, Sezai A, Niino T, Yoda M, Wakui S, Soeda M, Nohata I, Shiono M,
Minami K.
Department of Cardiovascular Surgery and Psychosomatic Medicine, Nihon
University School of Medicine Ooyaguchi Kamimachi, Tokyo, Japan.
mihata@med.nihon-u.ac.jp
BACKGROUND: The aim of the present study was to determine the predictors of
depression as a complication after open heart surgery and influence of
depression on the patients' prognosis. METHODS AND RESULTS: During the last 3
years, 97 patients (21.5%) of the 452 adult patients who had open heart surgery
at our institute experienced depression after the operation. Patients who scored
over 16 points using a Center for Epidemiological Studies Depression Scale were
diagnosed with significant symptoms of depression. Depressed patients (group I,
n=97) and non-depressed patients (group II, n=355) in terms of mortality and
length of hospital stay were compared. Predictors for depression were identified
by logistic regression analysis. The postoperative hospital stay was
significantly longer in group I. Hospital mortality was also significantly
higher in group I. Female gender (odds ratio (OR): 5.15, p<0.0001), emergency
surgery (OR: 4.46, p<0.0001), and being over 70 years of age (OR: 4.67,
p<0.0001) were found to be significant predictors for postoperative depression.
CONCLUSION: The prognosis for patients who had depression developed after open
heart surgery was poor. It might be important to start prophylactic medication
as soon as possible after the operation, particularly for patients at risk of
having depression.
250: Prog Transplant. 2005 Sep;15(3):276-82.
Preoperative predictors for postoperative problems in heart transplantation:
psychiatric and psychosocial considerations.
Rivard AL, Hellmich C, Sampson B, Bianco RW, Crow SJ, Miller LW.
University of Minnesota, Minneapolis, MN, USA.
The psychiatric and psychosocial evaluation of the heart transplant candidate
can identify particular predictors for postoperative problems. These factors, as
identified during the comprehensive evaluation phase, provide an assessment of
the candidate in context of the proposed transplantation protocol. Previous
issues with compliance, substance abuse, and psychosis are clear indictors of
postoperative problems. The prolonged waiting list time provides an additional
period to evaluate and provide support to patients having a terminal disease who
need a heart transplant, and are undergoing prolonged hospitalization. Following
transplantation, the patient is faced with additional challenges of a new
self-image, multiple concerns, anxiety, and depression. Ultimately, the success
of the heart transplantation remains dependent upon the recipient's ability to
cope psychologically and comply with the medication regimen. The limited
resource of donor hearts and the high emotional and financial cost of heart
transplantation lead to an exhaustive effort to select those patients who will
benefit from the improved physical health the heart transplant confers.
Publication Types:
Review
251: J Psychosom Res. 2005 Oct;59(4):215-22.
Erratum in:
J Psychosom Res. 2006 Jul;61(1):137. Marroquin Losielle, Marci [corrected to
Marroquin Loiselle, Marci].
J Psychosom Res. 2006 Mar;60(3):319.
Coping predicts depression and disability in heart transplant candidates.
Burker EJ, Evon DM, Marroquin Loiselle M, Finkel JB, Mill MR.
Department of Allied Health Sciences, University of North Carolina at Chapel
Hill, Chapel Hill, NC 27599-7205, USA. eburker@med.unc.edu
OBJECTIVE: The aim of this study was to describe the coping strategies used by
cardiac patients who are pursuing heart transplant and to determine which coping
strategies are related to depression and self-reported disability. METHOD: This
is a cross-sectional design with 50 cardiac patients (74% male) who were
inpatients being evaluated for heart transplant at a large medical center.
Coping styles were measured using the COPE Inventory (Carver CS, Scheier MF,
Weintraub, JK. Assessing coping strategies: a theoretically based approach. J
Pers Soc Psychol 1989;56:267-83). Depression was assessed with the Structured
Interview Guide for the Hamilton Depression Rating Scale (HAM-SIGH-D; Hamilton
M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62),
and disability was assessed using the Sickness Impact Profile (SIP; Bergner M,
Bobbitt R, Carter W, Gilson B. The Sickness Impact Profile: development and
final revision of a health status measure. Med Care 1981;19:787-805). RESULTS:
Patients reported using a variety of adaptive coping strategies, but depression
and disability were only significantly correlated with maladaptive coping
strategies. Multiple regressions demonstrated that denial had the strongest
association with depression, and focusing on and venting emotions had the
strongest association with disability. CONCLUSIONS: Maladaptive coping styles,
such as denial and focusing and venting of emotions, can serve as markers of
emotional distress and disability that may identify patients who may benefit
from psychologic and psychiatric interventions.
Quality of life following cardiac surgery: impact of the severity and course of
Goyal TM, Idler EL, Krause TJ, Contrada RJ.
Department of Psychology, Rutgers, The State University of New Jersey,
Piscataway, New Jersey, USA.
OBJECTIVES: The purpose of this study was to examine the impact of the severity
and course of depressive symptoms on change in quality of life (QOL) 6 months
after cardiac surgery. METHODS: Ninety patients were interviewed before heart
surgery and 2 and 6 months after surgery. Depressive symptoms were assessed
using the Beck Depression Inventory, and QOL was assessed using physical and
psychosocial functioning indices derived from the Medical Outcomes Study
instrument. Multiple regression examined the effects of the severity and course
of depressive symptoms on QOL adjusting for demographic and biomedical
predictors. RESULTS: Higher levels of presurgical depressive symptoms predicted
poorer physical functioning after cardiac surgery. A similar effect on
psychosocial functioning fell short of significance. An increase in depressive
symptoms 2 months after surgery was significantly predictive of poorer physical
and psychosocial functioning at 6 months. The effect of increased depressive
symptoms on psychosocial functioning was significantly stronger in patients with
high presurgical Beck Depression Inventory scores. CONCLUSIONS: Both
preoperative depressive symptoms and postoperative increases in depressive
symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further
examination of these associations and the mechanisms they reflect may provide a
basis for guiding treatment decisions before and after coronary artery bypass
graft surgery.
Publication Types:
253: J Behav Med. 2005 Oct;28(5):433-42. Epub 2005 Sep 23.
Perceived cognitive function and emotional distress following coronary artery
bypass surgery.
Gallo LC, Malek MJ, Gilbertson AD, Moore JL.
SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State
University, San Diego, California 92120, USA. lcgallo@sciences.sdsu.edu
Many patients experience decrements in cognitive function and emotional
adjustment following coronary artery bypass graft (CABG) surgery. Moreover,
cognitive decline and emotional distress are often positively related. This
study evaluated the cross-sectional and prospective associations of emotional
and subjective cognitive complaints, to assess the hypothesis that they would be
mutually reinforcing. Participants were 76 CABG patients recruited from Akron
General Medical Center. Depression and anxiety symptoms and perceived cognitive
difficulties were evaluated at a baseline postsurgical visit and re-assessed 5
months later. Emotional symptoms and perceived cognitive difficulties were
significantly related both within and across time. After controlling for
numerous potential confounds, baseline perceived cognitive difficulties
predicted a more negative course of emotional symptoms during follow-up.
Baseline emotional symptoms did not predict the course of perceived cognitive
difficulties. Perceptions of cognitive decline may contribute to emotional
distress in patients post-CABG.
Publication Types:
254: Ann Thorac Surg. 2003 Jan;75(1):314-21.
Depression and anxiety and outcomes of coronary artery bypass surgery.
Pignay-Demaria V, Lesperance F, Demaria RG, Frasure-Smith N, Perrault LP.
Department of Psychosomatic Medicine, Montreal Heart Institute, Montreal,
Quebec, Canada.
Psychological and psychiatric disorders independently increase the risk of
cardiovascular disease and worsen the prognosis in patients with established
cardiovascular lesions. The objective of this literature review is to discuss
recent data concerning the relationships between depression and anxiety and the
outcomes of coronary artery bypass grafting. Pathophysiological hypotheses are
put forward to explain observed links. We suggest recommendations aimed at
improving the psychological evaluation and management of heart surgery
candidates, as well as postbypass patients, in the hope of improving quality of
life and cardiovascular outcomes in these patients.
Publication Types:
Review

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