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Khandoker AH, Luthra V, Abouallaban Y, Saha S, Ahmed KI, Mostafa R, Chowdhury N, Jelinek HF. Predicting depressed patients with suicidal ideation from ECG recordings. Med Biol Eng Comput 2016; 55:793-805. [PMID: 27538398 DOI: 10.1007/s11517-016-1557-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/30/2016] [Indexed: 12/11/2022]
Abstract
Globally suicidal behavior is the third most common cause of death among patients with major depressive disorder (MDD). This study presents multi-lag tone-entropy (T-E) analysis of heart rate variability (HRV) as a screening tool for identifying MDD patients with suicidal ideation. Sixty-one ECG recordings (10 min) were acquired and analyzed from control subjects (29 CONT), 16 MDD subjects with (MDDSI+) and 16 without suicidal ideation (MDDSI-). After ECG preprocessing, tone and entropy values were calculated for multiple lags (m: 1-10). The MDDSI+ group was found to have a higher mean tone value compared to that of the MDDSI- group for lags 1-8, whereas the mean entropy value was lower in MDDSI+ than that in CONT group at all lags (1-10). Leave-one-out cross-validation tests, using a classification and regression tree (CART), obtained 94.83 % accuracy in predicting MDDSI+ subjects by using a combination of tone and entropy values at all lags and including demographic factors (age, BMI and waist circumference) compared to results with time and frequency domain HRV analysis. The results of this pilot study demonstrate the usefulness of multi-lag T-E analysis in identifying MDD patients with suicidal ideation and highlight the change in autonomic nervous system modulation of the heart rate associated with depression and suicidal ideation.
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Affiliation(s)
- A H Khandoker
- Department of Biomedical Engineering, Khalifa University, PO Box 127788, Abu Dhabi, UAE. .,Department of Electrical and Electronic Engineering, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - V Luthra
- American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - Y Abouallaban
- American Center for Psychiatry and Neurology, Abu Dhabi, UAE
| | - S Saha
- United International University, Dhaka, Bangladesh
| | - K I Ahmed
- United International University, Dhaka, Bangladesh
| | - R Mostafa
- United International University, Dhaka, Bangladesh
| | - N Chowdhury
- Department of Biomedical Engineering, Khalifa University, PO Box 127788, Abu Dhabi, UAE
| | - H F Jelinek
- School of Community Health and Centre for Research in Complex Systems, Charles Sturt University, Albury, NSW, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
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102
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Wilcox ME, Freiheit EA, Faris P, Hogan DB, Patten SB, Anderson T, Ghali WA, Knudtson M, Demchuk A, Maxwell CJ. Depressive symptoms and functional decline following coronary interventions in older patients with coronary artery disease: a prospective cohort study. BMC Psychiatry 2016; 16:277. [PMID: 27491769 PMCID: PMC4973530 DOI: 10.1186/s12888-016-0986-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/28/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Depressive symptoms are prevalent in patients with coronary artery disease (CAD). It is unclear, however, how depressive symptoms change over time and the impact of these changes on long-term functional outcomes. We examined the association between different trajectories of depressive symptoms over 1 year and change in functional status over 30 months among patients undergoing coronary angiography. METHODS This was a prospective cohort study of 350 patients aged 60 and older undergoing non-emergent cardiac catheterization (October 2003-February 2007). A dynamic measure of significant depressive symptoms (i.e., Geriatric Depression Scale score 5+) capturing change over 12 months was derived that categorized patients into the following groups: (i) no clinically important depressive symptoms (at baseline, 6 and 12 months); (ii) baseline-only symptoms (at baseline but not at 6 and 12 months); (iii) new onset symptoms (not at baseline but present at either 6 or 12 months); and, (iv) persistent symptoms (at baseline and at either 6 or 12 month assessment). Primary outcomes were mean change in Older Americans Resources and Services (OARS) instrumental (IADL) and basic activities of daily living (BADL) scores (range 0-14 for each) across baseline (pre-procedure) and 6, 12, and 30 months post-procedure visits. RESULTS Estimates for the symptom categories were 71 % (none), 9 % (baseline only), 8 % (new onset) and 12 % (persistent). In adjusted models, patients with persistent symptoms showed a significant decrease in mean IADL and BADL scores from baseline to 6 months (-1.32 [95 % CI -1.78 to -0.86] and -0.63 [-0.97 to -0.30], respectively) and from 12 to 30 months (-0.79 [-1.27 to -0.31] and -1.00 [-1.35 to -0.65], respectively). New onset symptoms were associated with a significant decrease in mean IADL scores at 6 months and from 6 to 12 months. Patients with no depressive symptoms showed little change in scores whereas those with baseline only symptoms showed significant improvement in mean IADL at 6 months. CONCLUSIONS Patients with persistent depressive symptoms were at greatest risk for worse functional status 30 months following coronary interventions. Proactive screening and follow-up for depression in this population offers prognostic value and may facilitate the implementation of targeted interventions.
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Affiliation(s)
- M. Elizabeth Wilcox
- Department of Medicine, Division of Respirology, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | | | - Peter Faris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Research, Innovation and Analytics, Alberta Health Services, Foothills Medical Centre, Calgary, Canada
| | - David B. Hogan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine (Division of Geriatric Medicine), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott B. Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Psychiatry and Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Todd Anderson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - William A. Ghali
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Merril Knudtson
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | - Andrew Demchuk
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colleen J. Maxwell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada ,Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1 ON Canada ,Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
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103
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Psychometric assessment of the Cardiac Depression Scale Short Form in cardiac outpatients. Eur J Cardiovasc Nurs 2016; 16:249-255. [DOI: 10.1177/1474515116652759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Mounting evidence indicates that chronic stressors and depressive symptoms contribute to morbidity and mortality from cardiac disease. However, little is known about the underlying mechanisms responsible for these effects or about why depressive symptoms and cardiac disease co-occur so frequently. In this article we outline a novel model that seeks to address these issues. It asserts that chronic stressors activate the immune system in a way that leads to persistent inflammation. With long-term exposure to the products of inflammation, people develop symptoms of depression and experience progression of atherosclerosis, the pathologic condition that underlies cardiac disease.
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Affiliation(s)
| | - Ekin Blackwell
- Department of Psychology, University of British Columbia
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105
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Abstract
Beyond depression's impact on life quality, it is associated with both the incidence of coronary heart disease (CHD) and its prognosis. Depression is three times more common in CHD patients than in the general community. It is independently associated with at least a doubling in risk of subsequent cardiac events. Studies also show that it may precede the development of clinically evident CHD by many years. The mechanisms linking depression and CHD are currently unknown and likely to be complex. In addition to behavioral factors, changes in autonomic regulation, vascular disease of the brain, subchronic inflammation, reduced omega-3 free fatty acid levels, and enhanced platelet responsiveness may all be involved. Only one large clinical trial has attempted to alter CHD prognosis by treating depression. It succeeded in producing a small, but significant reduction in depression symptoms, but had no impact on subsequent CHD events. While debate continues about the causal relationship between CHD and depression, the best treatment strategy to improve prognosis in depressed CHD patients remains intensive modification of standard CHD risk factors in combination with treatment of depression to improve life quality.
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Affiliation(s)
- Nancy Frasure-Smith
- McGill University, University of Montreal, Montreal Heart Institute, and Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - François Lespérance
- McGill University, University of Montreal, Montreal Heart Institute, and Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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Gomez-Marcos MA, Martinez-Salgado C, Gonzalez-Sarmiento R, Hernandez-Rivas JM, Sanchez-Fernandez PL, Recio-Rodriguez JI, Rodriguez-Sanchez E, García-Ortiz L. Association between different risk factors and vascular accelerated ageing (EVA study): study protocol for a cross-sectional, descriptive observational study. BMJ Open 2016; 6:e011031. [PMID: 27267107 PMCID: PMC4908886 DOI: 10.1136/bmjopen-2016-011031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/19/2016] [Accepted: 05/13/2016] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The process of population ageing that is occurring in developed societies represents a major challenge for the health system. The aim of this study is to analyse factors that have an influence on early vascular ageing (EVA), estimated by carotid-femoral pulse wave velocity (cf-PWV) and Cardio Ankle Vascular Index (CAVI), and to determine differences by gender in a Spanish population. METHODS AND ANALYSIS An observational, descriptive, cross-sectional study. STUDY POPULATION From the population assigned to the participating healthcare centres, a cluster random sampling stratified by age and gender will be performed to obtain 500 participants aged between 35 and 75. Those who meet the inclusion criteria and give written informed consent will be included in the study. MEASUREMENTS Main dependent variables: cf-PWV determined using the SphygmoCor System and CAVI estimated using VASERA. Secondary dependent variables: telomere length, carotid intima-media thickness, central and peripheral augmentation index, ankle-brachial pulse wave velocity, ankle-brachial index, retinal arteriovenous index, and renal and cardiac organ damage. INDEPENDENT VARIABLES lifestyles (physical activity, adherence to the Mediterranean diet, alcohol and tobacco consumption); psychological factors (depression, anxiety and chronic stress); inflammatory factors and oxidative stress. ETHICS AND DISSEMINATION The study has been approved by the clinical research ethics committee of the healthcare area of Salamanca. All study participants will sign an informed consent form agreeing to participate in the study in compliance with the Declaration of Helsinki and the WHO standards for observational studies. The results of this study will allow the understanding of the relationship of the different influencing factors and their relative weight in the development of EVA. At least 5 publications in first-quartile scientific journals are planned. TRIAL REGISTRATION NUMBER NCT02623894; Pre-results.
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Affiliation(s)
- Manuel A Gomez-Marcos
- Primary Care Research Unit, Instituto of Investigación Biomédica of Salamanca (IBSAL), The Alamedilla Health Center, Castilla and León Health Service–SACYL, Salamanca, Castile and León, Spain
- Department of Medicine, REDIAPP, University of Salamanca, Salamanca, Castile and León, Spain
| | - Carlos Martinez-Salgado
- Unit Renal Physiology and Pathophysiology Cardiovascular Unit, Department of Physiology and Pharmacology, IBSAL, Queen Sofia Institute of Nephrology Research, University of Salamanca, Salamanca, Castile and León, Spain
| | - Rogelio Gonzalez-Sarmiento
- IBSAL and Instituto of Biología Molecular and Celular of Cáncer (IBMCC), University of Salamanca–SACYL, Salamanca, Castile and León, Spain
- Department of Medicine, University of Salamanca, Castile and León, Spain
| | - Jesus Ma Hernandez-Rivas
- IBSAL, IBMCC, Cancer Research Center, University of Salamanca, CSIC, University Hospital of Salamanca, Salamanca, Castile and León, Spain
- Department of Hematology, University of Salamanca, Salamanca, Castile and León, Spain
- Department of Medicine, University of Salamanca, Salamanca, Castile and León, Spain
| | - Pedro L Sanchez-Fernandez
- IBSAL, University Hospital of Salamanca, Salamanca, Castile and León, Spain
- Cardiology Department, University of Salamanca, Salamanca, Castile and León, Spain
| | - Jose I Recio-Rodriguez
- Primary Care Research Unit, IBSAL, The Alamedilla Health Center, Castilla and León Health Service–SACYL, REDIAPP, Salamanca, Castile and León, Spain
| | - Emiliano Rodriguez-Sanchez
- Primary Care Research Unit, Instituto of Investigación Biomédica of Salamanca (IBSAL), The Alamedilla Health Center, Castilla and León Health Service–SACYL, Salamanca, Castile and León, Spain
- Department of Medicine, REDIAPP, University of Salamanca, Salamanca, Castile and León, Spain
| | - Luis García-Ortiz
- Primary Care Research Unit, BSAL, The Alamedilla Health Center, Castilla and León Health Service–SACYL, Salamanca, Castile and León, Spain
- Biomedical and Diagnostic Sciences Department, REDIAPP, University of Salamanca, Salamanca, Castile and León, Spain
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Péquignot R, Dufouil C, Prugger C, Pérès K, Artero S, Tzourio C, Empana JP. High Level of Depressive Symptoms at Repeated Study Visits and Risk of Coronary Heart Disease and Stroke over 10 Years in Older Adults: The Three-City Study. J Am Geriatr Soc 2016; 64:118-25. [PMID: 26782860 DOI: 10.1111/jgs.13872] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKROUND Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease (CVD). OBJECTIVES Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease (CHD) and stroke events in older adults. DESIGN A population-based prospective observational study. SETTING Participants were randomly selected from the electoral rolls of three large French cities. PARTICIPANTS A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years. MEASUREMENTS High levels of depressive symptoms (HLDS) were defined as a score≥16 on the 20-item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models. RESULTS There were 7,313 participants (36.6% males) aged 73.8±5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow-up of 8.4 years (SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15-fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow-up. CONCLUSION Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events.
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Affiliation(s)
- Renaud Péquignot
- INSERM U970, Paris Cardiovascular Research Center, Paris, F-75015, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Service de Médecine et Réadaptation, Hôpitaux de Saint-Maurice, Saint-Maurice, F-94415, France
| | - Carole Dufouil
- INSERM, U897, Bordeaux, France.,Bordeaux 2 University, Bordeaux, France.,CIC-1401, Clinical Epidemiology Branch, Bordeaux Hospital, Bordeaux, France
| | - Christof Prugger
- INSERM U970, Paris Cardiovascular Research Center, Paris, F-75015, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Karine Pérès
- INSERM, U897, Bordeaux, France.,Bordeaux 2 University, Bordeaux, France
| | - Sylvaine Artero
- INSERM U1061, Neuropsychiatry, Montpellier, France.,University of Montpellier 1, Montpellier, France
| | | | - Jean-Philippe Empana
- INSERM U970, Paris Cardiovascular Research Center, Paris, F-75015, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Blumenthal JA, Sherwood A, Smith PJ, Watkins L, Mabe S, Kraus WE, Ingle K, Miller P, Hinderliter A. Enhancing Cardiac Rehabilitation With Stress Management Training: A Randomized, Clinical Efficacy Trial. Circulation 2016; 133:1341-50. [PMID: 27045127 DOI: 10.1161/circulationaha.115.018926] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 02/12/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is the standard of care for patients with coronary heart disease. Despite considerable epidemiological evidence that high stress is associated with worse health outcomes, stress management training (SMT) is not included routinely as a component of CR. METHODS AND RESULTS One hundred fifty-one outpatients with coronary heart disease who were 36 to 84 years of age were randomized to 12 weeks of comprehensive CR or comprehensive CR combined with SMT (CR+SMT), with assessments of stress and coronary heart disease biomarkers obtained before and after treatment. A matched sample of CR-eligible patients who did not receive CR made up the no-CR comparison group. All participants were followed up for up to 5.3 years (median, 3.2 years) for clinical events. Patients randomized to CR+SMT exhibited greater reductions in composite stress levels compared with those randomized to CR alone (P=0.022), an effect that was driven primarily by improvements in anxiety, distress, and perceived stress. Both CR groups achieved significant, and comparable, improvements in coronary heart disease biomarkers. Participants in the CR+SMT group exhibited lower rates of clinical events compared with those in the CR-alone group (18% versus 33%; hazard ratio=0.49; 95% confidence interval, 0.25-0.95; P=0.035), and both CR groups had lower event rates compared with the no-CR group (47%; hazard ratio=0.44; 95% confidence interval, 0.27-0.71; P<0.001). CONCLUSIONS CR enhanced by SMT produced significant reductions in stress and greater improvements in medical outcomes compared with standard CR. Our findings indicate that SMT may provide incremental benefit when combined with comprehensive CR and suggest that SMT should be incorporated routinely into CR. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00981253.
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Affiliation(s)
- James A Blumenthal
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.).
| | - Andrew Sherwood
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Patrick J Smith
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Lana Watkins
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Stephanie Mabe
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - William E Kraus
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Krista Ingle
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Paula Miller
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
| | - Alan Hinderliter
- From the Departments of Psychiatry and Behavioral Sciences (J.A.B., A.S., P.J.S., L.W., S.M., K.I.) and Medicine (W.E.K.), Duke University Medical Center, Durham, NC; and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (P.M., A.H.)
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Persons JE, Robinson JG, Coryell WH, Payne ME, Fiedorowicz JG. Longitudinal study of low serum LDL cholesterol and depressive symptom onset in postmenopause. J Clin Psychiatry 2016; 77:212-20. [PMID: 26930520 PMCID: PMC4906804 DOI: 10.4088/jcp.14m09505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/13/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to characterize the relationship between serum low-density lipoprotein cholesterol (LDL-c) and subsequent depressive symptoms onset in postmenopausal women. We secondarily assessed serum high-density lipoprotein (HDL-c), total cholesterol, and triglycerides. METHOD This population-based prospective cohort study utilizes data from 24,216 women between 50 and 79 years of age who were participants of the Women's Health Initiative, which originally ran from 1993 to 2005 and has since incorporated 2 extension studies, with the most recent culminating in 2015. Fasting lipids were measured for all participants at baseline and for a subset through 6 years of follow-up. Depressive symptoms were characterized using the Burnam 8-item scale for depressive disorders (Center for Epidemiologic Studies-Depression/Diagnostic Interview Schedule short form) at baseline and during follow-up, using a cut point of 0.06 to indicate presence of depressive symptoms. RESULTS The lowest quintile of LDL-c was associated with an increased risk of subsequent depressive symptoms (hazard ratio [HR] = 1.25, 95% CI = 1.05-1.49, P = .01), and follow-up analyses demonstrated that the elevated risk appeared to be confined to the lowest decile (LDL-c < 100 mg/dL). Further, this elevated risk was moderated by lipid-lowering drug treatment. Elevated risk was demonstrated among those who reported no lipid-lowering medication use (HR = 1.23, 95% CI = 1.03-1.47, P = .02), but not among those reporting use (HR = 0.65, 95% CI = 0.18-2.29, P = .50). CONCLUSIONS Among postmenopausal women, untreated serum LDL-c below 100 mg/dL was associated with an increased risk of developing depressive symptoms. No excess risk was observed in those attaining LDL-c < 100 mg/dL with lipid-lowering therapy. These findings have important implications for risk assessment, treatment considerations, and mechanistic insight.
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Affiliation(s)
- Jane E Persons
- The University of Iowa, Department of Epidemiology, 145 N Riverside Dr, Iowa City, IA 52246
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110
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Mello APD, Carvalho ACDC, Higa EMS. Depressive symptoms in patients with acute coronary syndrome. EINSTEIN-SAO PAULO 2016; 9:326-31. [PMID: 26761100 DOI: 10.1590/s1679-45082011ao1721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 12/20/2010] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To trace an epidemiological profile, to verify presence of depressive symptoms in patients with previous diagnosis of acute coronary syndrome and to identify factors that contribute to maintenance of depressive symptoms in the sample. METHODS A cross-section study carried out at the Cardiology Outpatients Clinics of Universidade Federal de São Paulo. An instrument prepared by the authors was used, which was based on similar studies with patient identification data, questions related to the psychological follow-up, relationship with family members and friends, in addition to use of the Beck Depression Inventory. METHODS A cross-section study carried out at the Cardiology Outpatients Clinics of Universidade Federal de São Paulo. An instrument prepared by the authors was used, which was based on similar studies with patient identification data, questions related to the psychological follow-up, relationship with family members and friends, in addition to use of the Beck Depression Inventory. RESULTS A total of 200 patients were interviewed, 127 (63.5%) were male. The mean age was 60.19 years with a standard deviation of 9.38, minimum age of 36 years and maximum of 81 years; 164 (82%) denied any follow-up with a psychologist or psychiatrist in the phase after acute coronary syndrome diagnosis and treatment. In the utilization of Beck Depression Inventory, 67 (33.5%) presented scores between 0 and 4, indicating mild depressive symptoms; 72 (36%) had scores between 5 and 9, indicating mild to moderate depressive symptoms, and 61 (30.5%) presented scores greater than 9, which point out moderate to severe depressive symptoms. CONCLUSION The evaluation and multiprofessional follow-up can help patients cope with the illness in addition to providing greater compliance to drug therapy and beginning changes in life habits.
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111
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Aksay SS, Bumb JM, Janke C, Biemann R, Borucki K, Lederbogen F, Deuschle M, Sartorius A, Kranaster L. Serum lipid profile changes after successful treatment with electroconvulsive therapy in major depression: A prospective pilot trial. J Affect Disord 2016; 189:85-8. [PMID: 26426831 DOI: 10.1016/j.jad.2015.09.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/20/2015] [Accepted: 09/20/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cholesterol is reduced in depressed patients, however, these patients have a higher risk for cardiovascular diseases. Electroconvulsive therapy (ECT) is a highly effective treatment option for specific forms of depression. Like for other non-pharmacological therapies targeting depression such as psychotherapy or sleep deprivation, there is a lack of evidence about the effects on peripheral lipid parameters. Our objective was to study the impact of ECT as a non-pharmacological treatment on the peripheral lipid pattern in depressive patients. METHOD Peripheral lipid profile composition before and after a course of ECT was analysed in 27 non-fasting inpatients at a university psychiatric hospital with DSM-IV major depressive episode. For the impact of ECT treatment on each lipid parameter a multivariate repeated measurement regression analysis was performed and computed separately for every dependent variable. RESULTS Total Cholesterol and the cholesterol subtypes HDL and LDL were increased after the treatment compared to baseline. Apolipoprotein A1 was also increased after ECT, whereas apolipoprotein B was not. Indices for the prediction of cardiovascular diseases were unchanged after successful treatment by ECT. The reduction of depressive psychopathology negatively correlated with increases of HDL cholesterol and apolipoprotein A1. LIMITATIONS Subjects received several antidepressants and other psychotropic medication before and during the ECT. CONCLUSIONS In our preliminary pilot study ECT as a non-pharmacological, effective treatment of depression led to distinct effects on the peripheral lipid pattern.
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Affiliation(s)
- Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jan Malte Bumb
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christoph Janke
- Department of Anesthesiology and Critical Care Medicine, Medical Centre Mannheim, Mannheim, Germany
| | - Ronald Biemann
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Katrin Borucki
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Florian Lederbogen
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
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Hirsh-Rokach B, Spectre G, Shai E, Lotan A, Ritter A, Al-Aieshy F, Malmström RE, Varon D, Alcalai R. Differential impact of selective serotonin reuptake inhibitors on platelet response to clopidogrel: a randomized, double-blind, crossover trial. Pharmacotherapy 2015; 35:140-7. [PMID: 25689244 DOI: 10.1002/phar.1542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE To assess the effect of two selective serotonin reuptake inhibitors (SSRIs), fluvoxamine and citalopram, that markedly differ in their level of cytochrome P450 (CYP) 2C19 inhibition, on the laboratory response to clopidogrel, a prodrug requiring metabolism by the CYP system, and especially CYP2C19, to produce its active form. DESIGN Randomized, double-blind, crossover trial. SETTING Clinical research unit of an academic medical center. SUBJECTS Fifteen healthy male volunteers. INTERVENTION All subjects received clopidogrel as a 300-mg loading dose on day 1, followed by 75 mg/day on days 2 and 3. Platelet function was tested at baseline and then after clopidogrel treatment on day 3. After a washout period of 2 weeks, subjects were randomly assigned in a double-blind manner to receive either citalopram 20 mg/day or fluvoxamine 100 mg/day for 7 days. On day 5, platelet function was tested while receiving the SSRI treatment alone; then, a 300-mg clopidogrel loading dose was administered, followed by clopidogrel 75 mg/day on days 6 and 7. Platelet function was then reassessed on day 7 while receiving the combination of the SSRI and clopidogrel. The treatment protocol was then repeated after a washout period of 2 weeks in all subjects with the other SSRI. MEASUREMENTS AND MAIN RESULTS The antiplatelet effects of fluvoxamine and citalopram and their interactions with clopidogrel were assessed. The response to these three drugs was assessed by light transmittance aggregometry and vasodilator-stimulated phosphoprotein phosphorylation, reporting P2Y12 receptor reactivity. Both fluvoxamine and citalopram tended to reduce adenosine diphosphate-induced aggregation: 80.8 ± 3.4% at baseline, 67.3 ± 6.3% while receiving citalopram, and 65.8 ± 6.4% while receiving fluvoxamine. All subjects had a good laboratory response to clopidogrel, with a mean aggregation of 23.5 ± 3.2% and a mean platelet reactivity index of 47.7 ± 3.9% (p<0.001 compared with baseline for both methods). Laboratory response to clopidogrel was significantly attenuated in the presence of fluvoxamine compared with the response in the presence of citalopram as tested both by aggregometry (32.3 ± 4.2% vs 23.4 ± 3%, p=0.04) and by vasodilator-stimulated phosphoprotein phosphorylation (52.7 ± 5.1% vs 35.9 ± 4.2%, p=0.02). CONCLUSION Fluvoxamine attenuated the laboratory response to clopidogrel, possibly through inhibition of CYP2C19, whereas citalopram did not affect this response. These potential drug interactions should be taken into consideration in the selection of the appropriate antidepressant agent for patients who are treated with clopidogrel.
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Affiliation(s)
- Bruria Hirsh-Rokach
- School of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Heart Institute, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Depression and cardiovascular disease. Trends Cardiovasc Med 2015; 25:614-22. [DOI: 10.1016/j.tcm.2015.02.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 01/17/2023]
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Denton EGD, Shaffer JA, Alcantara C, Cadermil E. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients. J Behav Med 2015; 39:28-40. [PMID: 26407692 DOI: 10.1007/s10865-015-9679-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 09/07/2015] [Indexed: 12/22/2022]
Abstract
The Ethnic Density hypothesis posits that living around others from similar ethnic backgrounds reduces the risk of adverse mental health outcomes such as depression. Contrary to this hypothesis, previous work has shown that Hispanic ethnic density is cross-sectionally associated with increased depressive symptom severity among patients hospitalized with an acute coronary syndrome (ACS; myocardial infarction or unstable angina pectoris). To date, no study has examined the prospective association of Hispanic ethnic density on long-term depressive symptom severity following an acute medical event. We prospectively assessed the impact of Hispanic ethnic density on depressive symptoms, 1-year following an ACS event, among Hispanic adult patients. We tested the non-linear association between ethnic density and depressive symptoms to account for inconsistent findings on the ethnic density hypothesis. At the time of an index ACS event (i.e., baseline, N = 326) and 1-year later (N = 252), Hispanic patients from the Prescription Usage, Lifestyle, and Stress Evaluation prospective cohort study completed the Beck Depression Inventory as a measure of depressive symptom severity. Hispanic ethnic density was defined by the percentage of Hispanic residents within each patient's census tract using data extracted from the American Community Survey Census (2010-2013). Covariates included baseline demographic factors (age, gender, English fluency, education, nativity status), cardiovascular factors (Charlson comorbidity index, left ventricular ejection fraction, Global Registry of Acute Coronary Events 6-month prognostic risk score), and neighborhood factors (residential density, income, and percentage of households receiving public assistance). In an adjusted multivariable linear regression analysis there was a significant curvilinear association between Hispanic ethnic density and depressive symptom severity at 1 year. As Hispanic ethnic density increased from low to moderate density, there was an increase in depressive symptoms, but depressive symptoms slightly declined in census tracts with the highest density of Hispanics. Furthermore, gender significantly moderated the relation between Hispanic ethnic density and 1-year depressive symptom severity, such that Hispanic ethnic density was significantly associated with increased depressive symptom severity for female Hispanic patients with ACS, but not for male Hispanic patients. Previous research suggests that ethnic density may be protective against depression in Hispanic enclaves; however, our findings suggest a non-linear ethnic density effect and an overall more complex association between ethnic density and depression. These data add to a growing body of literature on the effects of sociodemographic and contextual factors on health.
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Affiliation(s)
- Ellen-Ge D Denton
- Department of Psychology, City University of New York College of Staten Island, 2800 Victory Blvd., Building 4S, Room 229, Staten Island, NY, 10314, USA.
| | - Jonathan A Shaffer
- University of Colorado Denver - Denver Campus, CLAS-Psychology, 3NC North Classroom, 1255 10th Street Mall, Denver, CO, 80217, USA
| | - Carmela Alcantara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, Room 810, MC 4600, New York, NY, 10027, USA
| | - Esteban Cadermil
- Department of Psychology, Clark University, 950 Main Street, Worcester, MA, 01610-1477, USA
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Wang MY, Chiu CH, Lee HC, Su CT, Tsai PS. Cardiovascular Reactivity in Patients With Major Depressive Disorder With High- or Low-Level Depressive Symptoms. Biol Res Nurs 2015; 18:221-9. [DOI: 10.1177/1099800415596227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression increases the risk of adverse cardiac events. Cardiovascular reactivity is defined as the pattern of cardiovascular responses to mental stress. An altered pattern of cardiovascular reactivity is an indicator of subsequent cardiovascular disease. Because depression and adverse cardiac events may have a dose-dependent association, this study examined the differences in cardiovascular reactivity to mental stress between patients with major depressive disorder (MDD) with high depression levels and those with low depression levels. Moreover, autonomic nervous system regulation is a highly plausible biological mechanism for the pattern of cardiovascular reactivity to mental stress. The association between cardiovascular reactivity and parameters of heart rate variability (HRV), an index for quantifying autonomic nervous system activity modulation, was thus examined. This study included 88 patients with MDD. HRV was measured before stress induction. The Stroop Color and Word Test and mirror star-tracing task were used to induce mental stress. We observed no significant association between depressive symptom level and any of the cardiovascular reactivity parameters. Cardiovascular reactivity to mental stress was comparable between patients with MDD with high-level depressive symptoms and those with low-level depressive symptoms. After adjusting for confounding variables, the high-frequency domain of HRV was found to be an independent predictor of the magnitude of heart rate reactivity (β = −.33, p = .002). In conclusion, the magnitude of cardiovascular reactivity may be independent of depression severity in patients with MDD. The autonomic regulation of cardiovascular responses to mental stress primarily influences heart rate reactivity in patients with MDD.
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Affiliation(s)
- Mei-Yeh Wang
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, New Taipei City, Taiwan
| | - Chen-Huan Chiu
- Department of Community Psychiatry, Taipei City Psychiatric Center, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry & Sleep Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Tien Su
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Pei-Shan Tsai
- Graduate Institutes of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Nursing, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
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Navidian A, Yaghoubinia F, Ganjali A, Khoshsimaee S. The Effect of Self-Care Education on the Awareness, Attitude, and Adherence to Self-Care Behaviors in Hospitalized Patients Due to Heart Failure with and without Depression. PLoS One 2015; 10:e0130973. [PMID: 26091101 PMCID: PMC4475047 DOI: 10.1371/journal.pone.0130973] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 05/27/2015] [Indexed: 11/18/2022] Open
Abstract
Background Cardiovascular diseases are among somatic disorders and psychological factors affect their onset, exacerbation, and treatment. This study was conducted on the hospitalized patients who had heart failure with and without depression. The study criteria was to evaluate the effect of self-care education on awareness, attitude, and adherence to self-care behaviors on these patients. Materials and Methods In this quasi-experimental study, seventy patients with heart failure that met the inclusion criteria were recruited through purposive sampling method. They were assigned in to two equal size groups regarding their depression status. First, the eligible patients were selected; then Beck Depression Inventory was done on the patients followed by examination by the clinical psychologist. Patients with average and higher scores were classified in the depressed group and others who got lower than average scores were classified as the non -depressed group. A questionnaire containing items related to awareness, attitude, and adherence to self-care behaviors was used to collect the data. First, self-care behavior was determined and then a four-sessions of educational intervention were held individually for both groups. The second round of questionnaires were completed at patients’ home twelve weeks after the discharge. The Collected data was analyzed using independent-samples and paired-sample t tests, Chi square, and statistical analysis of covariance (ANCOVA) tests through SPSS (version 21, SPSS Inc., Chicago, IL, USA). Results After the educational sessions, the statistical analysis showed significant differences in the mean scores of awareness, attitude, and adherence to self-care behaviors between the two groups (P<0.0001). Conclusion Self-care behavior education had lower effects on the depressed patients with heart failure. Therefore, before providing education for these patients, it is necessary to consider their psychological problems such as depression.
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Affiliation(s)
- Ali Navidian
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fariba Yaghoubinia
- Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
- * E-mail:
| | - Alireza Ganjali
- Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Sadegh Khoshsimaee
- Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
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von Känel R, Margani A, Stauber S, Meyer FA, Demarmels Biasiutti F, Vökt F, Wissmann T, Lämmle B, Lukas PS. Depressive symptoms as a novel risk factor for recurrent venous thromboembolism: a longitudinal observational study in patients referred for thrombophilia investigation. PLoS One 2015; 10:e0125858. [PMID: 25938663 PMCID: PMC4418654 DOI: 10.1371/journal.pone.0125858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/23/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Increasing evidence suggests that psychosocial factors, including depression predict incident venous thromboembolism (VTE) against a background of genetic and acquired risk factors. The role of psychosocial factors for the risk of recurrent VTE has not previously been examined. We hypothesized that depressive symptoms in patients with prior VTE are associated with an increased risk of recurrent VTE. METHODS In this longitudinal observational study, we investigated 271 consecutive patients, aged 18 years or older, referred for thrombophilia investigation with an objectively diagnosed episode of VTE. Patients completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). During the observation period, they were contacted by phone and information on recurrent VTE, anticoagulation therapy, and thromboprophylaxis in risk situations was collected. RESULTS Clinically relevant depressive symptoms (HADS-D score ≥ 8) were present in 10% of patients. During a median observation period of 13 months (range 5-48), 27 (10%) patients experienced recurrent VTE. After controlling for sociodemographic and clinical factors, a 3-point increase on the HADS-D score was associated with a 44% greater risk of recurrent VTE (OR 1.44, 95% CI 1.02, 2.06). Compared to patients with lower levels of depressive symptoms (HADS-D score: range 0-2), those with higher levels (HADS-D score: range 3-16) had a 4.1-times greater risk of recurrent VTE (OR 4.07, 95% CI 1.55, 10.66). CONCLUSIONS The findings suggest that depressive symptoms might contribute to an increased risk of recurrent VTE independent of other prognostic factors. An increased risk might already be present at subclinical levels of depressive symptoms.
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Affiliation(s)
- Roland von Känel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Clinical Research, University of Bern, Bern, Switzerland
- Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
- * E-mail:
| | - Angelina Margani
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Stefanie Stauber
- Department of Cardiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, and University of Bern, Bern Switzerland
| | - Fiorenza A. Meyer
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Franziska Demarmels Biasiutti
- University Clinic of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Franziska Vökt
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Thomas Wissmann
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Bernhard Lämmle
- University Clinic of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Center for Thrombosis and Hemostasis, University Medical Center, Mainz, Germany
| | - Paul S. Lukas
- Department of Clinical Research, University of Bern, Bern, Switzerland
- Privatklinik für Psychiatrie und Psychotherapie, Sanatorium Kilchberg, Kilchberg, Switzerland
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Meyer FA, Hugentobler E, Stauber S, Wilhelm M, Znoj H, von Känel R. Depressive symptoms at discharge from rehabilitation predict future cardiovascular-related hospitalizations. Cardiology 2015; 131:80-5. [PMID: 25870996 DOI: 10.1159/000375231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/12/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Depression is associated with poor prognosis in patients with cardiovascular disease (CVD). We hypothesized that depressive symptoms at discharge from a cardiac rehabilitation program are associated with an increased risk of future CVD-related hospitalizations. METHODS We examined 486 CVD patients (mean age=59.8±11.2) who enrolled in a comprehensive 3-month rehabilitation program and completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). At follow-up we evaluated the predictive value of depressive symptoms for CVD-related hospitalizations, controlling for sociodemographic factors, cardiovascular risk factors, and disease severity. RESULTS During a mean follow-up of 41.5±15.6 months, 63 patients experienced a CVD-related hospitalization. The percentage of depressive patients (HADS-D≥8) decreased from 16.9% at rehabilitation entry to 10.7% at discharge. Depressive symptoms at discharge from rehabilitation were a significant predictor of outcome (HR 1.32, 95% CI 1.09-1.60; p=0.004). Patients with clinically relevant depressive symptoms at discharge had a 2.5-fold increased relative risk of poor cardiac prognosis compared to patients without clinically relevant depressive symptoms independently of other prognostic variables. CONCLUSION In patients with CVD, depressive symptoms at discharge from rehabilitation indicated a poor cardiac prognosis.
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120
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Seligman F, Nemeroff CB. The interface of depression and cardiovascular disease: therapeutic implications. Ann N Y Acad Sci 2015; 1345:25-35. [PMID: 25809518 DOI: 10.1111/nyas.12738] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patients with major depression are at an increased risk for developing cardiovascular disease, respond more poorly to treatment, and exhibit worse outcomes, including increased morbidity and mortality. This article reviews the relationship between depression and heart disease, with an emphasis on epidemiology, biological substrates that likely underlie this relationship, and implications for treatment.
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Affiliation(s)
- Fred Seligman
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
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Lafitte M, Tastet S, Perez P, Serisé MA, Grandoulier AS, Aouizerate B, Sibon I, Capuron L, Couffinhal T. High sensitivity C reactive protein, fibrinogen levels and the onset of major depressive disorder in post-acute coronary syndrome. BMC Cardiovasc Disord 2015; 15:23. [PMID: 25888123 PMCID: PMC4436867 DOI: 10.1186/s12872-015-0015-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 02/27/2015] [Indexed: 11/28/2022] Open
Abstract
Background Major depression disorder (MDD) is a common condition in patients suffering from acute coronary syndrome (ACS), and depression is a risk factor for mortality following an ACS. Growing evidence suggests that there is an intricate interplay between atherosclerosis, inflammation and depression. The aim of this study was to investigate the role of atherosclerosis-induced inflammation in the mediation of MDD. Methods 87 patients without depression were recruited at the time of an ACS, evaluated at 3 and 7 days and followed at 1, 3 and 9 months for the occurrence of a MDD as assessed by structured interviews (MINI). At each time point, they were monitored for inflammatory markers (high sensitivity C Reactive Protein {hsCRP} and fibrinogen), cardiovascular risk factors and atherosclerosis burden. Association between possible predictive characteristics and depression was assessed using a multivariable logistic regression model. Results The overall incidence of MDD, in this population, was 28.7% [95% CI: 19.5 – 39.4] during the 9-month follow up period. Elevated hsCRP was not associated with depression onset after an ACS (adjusted OR: 1.07 [0.77 - 1.48]; p = 0.70), and similarly no association was found with fibrinogen. Furthermore, we found no association between hsCRP, fibrinogen or atherosclerosis burden at any time-point, and the occurrence of a MDD (or HDRS-17 and MADRS). The only factor associated with depression occurrence after an ACS was a previous personal history of depression (adjusted OR: 11.02 [2.74 to 44.34]; p = 0.0007). Conclusions The present study shows that after an ACS, patients treated with optimal medications could have a MDD independent of elevated hsCRP or fibrinogen levels. Personal history of depression may be a good marker to select patients who should be screened for depression after an ACS. Electronic supplementary material The online version of this article (doi:10.1186/s12872-015-0015-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marianne Lafitte
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France.
| | - Sandrine Tastet
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France.
| | - Paul Perez
- CHU de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, F-33000, Bordeaux, France.
| | - Marie-Aimée Serisé
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France.
| | - Anne-Sophie Grandoulier
- CHU de Bordeaux, Unité de Soutien Méthodologique à la Recherche Clinique et Epidémiologique, F-33000, Bordeaux, France.
| | - Bruno Aouizerate
- CHU de Bordeaux, Pôle Universitaire de Psychiatrie, F-33000, Bordeaux, France.
| | - Igor Sibon
- CHU de Bordeaux, Unité Neurovasculaire, F-33000, Bordeaux, France.
| | - Lucile Capuron
- INRA, Nutrition et Neurobiologie intégrée, UMR 1286, F-33000, Bordeaux, France.
| | - Thierry Couffinhal
- CHU de Bordeaux, Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, CEPTA, Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33604 PESSAC Cedex, F-33000, Bordeaux, France. .,Univ. Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600, Pessac, France. .,INSERM, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600, Pessac, France.
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van Dijk MR, Utens EMWJ, Dulfer K, Al-Qezweny MNA, van Geuns RJ, Daemen J, van Domburg RT. Depression and anxiety symptoms as predictors of mortality in PCI patients at 10 years of follow-up. Eur J Prev Cardiol 2015; 23:552-8. [PMID: 25665581 DOI: 10.1177/2047487315571889] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 01/19/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression has been shown to be an independent risk factor for short-term mortality in patients with coronary artery disease (CAD). There are studies suggesting that depression might also be associated with long-term mortality. Anxiety has also been associated with mortality. This study aimed to further investigate the predictive value of depression and anxiety symptoms on all-cause mortality, 10 years after percutaneous coronary intervention (PCI). METHODS The study population comprised a consecutive series of CAD patients (n = 1411) treated with PCI between September 2001 and October 2002 at the Erasmus Medical Centre, Rotterdam. The Hospital Anxiety and Depression Scale (HADS) was completed by 1112 patients at baseline to assess levels of depression and anxiety. The endpoint was defined as all-cause mortality. RESULTS The prevalence of depression and anxiety was 24.8% and 27.7%, respectively. The cumulative all-cause mortality rate in depressed patients was 37% versus 20% in non-depressed patients (log-rank p < 0.001). After adjustment, depression remained a predictor of all-cause mortality (hazard ratio (HR) 1.77; 95% confidence interval (CI) 1.36-2.29). Cumulative survival rates did not differ for anxious versus non-anxious patients (log-rank p = .79). However, after adjustment, anxiety was associated with an increased risk for all-cause mortality (HR 1.50; 95% CI 1.14-1.98). A sub-analysis showed that cumulative survival rates did not differ for depressed and anxious patients versus depressed but non-anxious patients (log-rank p = 0.46). CONCLUSIONS Depression is associated with an increased risk of 77% for all-cause mortality, 10 years post-PCI, independently of anxiety. Although anxiety was associated with all-cause mortality, it has no additional value in the case of co-occurring depression.
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Affiliation(s)
- Milan R van Dijk
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, The Netherlands
| | - Karolijn Dulfer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, The Netherlands
| | | | | | - Joost Daemen
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, The Netherlands
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Paine NJ, Watkins LL, Blumenthal JA, Kuhn CM, Sherwood A. Association of depressive and anxiety symptoms with 24-hour urinary catecholamines in individuals with untreated high blood pressure. Psychosom Med 2015; 77:136-44. [PMID: 25647750 PMCID: PMC5119914 DOI: 10.1097/psy.0000000000000144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Depression and anxiety are considered risk factors for cardiovascular disease (CVD). The explanatory mechanisms, however, are still to be characterized. One proposed pathophysiological pathway is dysregulation of the autonomic nervous system, including heightened sympathetic nervous system activity. This study examined the relationship between symptoms of depression, anxiety, and sympathetic nervous system activity in individuals with untreated high blood pressure. METHODS A total of 140 participants with untreated high blood pressure (55% white, 38.5% female, mean [standard deviation] age = 45.5 [8.55] years) collected urine over a 24-hour period on 3 separate occasions. Urine samples were assayed for mean 24-hour epinephrine (EPI24) and norepinephrine excretion. Depressive symptoms were assessed using the Beck Depression Inventory, with anxiety symptoms assessed using the Spielberger State-Trait Anxiety Inventory. RESULTS Depression and anxiety scores were intercorrelated (r = 0.76, p < .001). EPI24 was positively correlated with anxiety (r = 0.20, p = .02) but not depression (r = 0.02, p = .77), whereas 24-hour urinary norepinephrine excretion was not correlated with anxiety (r = 0.10, p = .21) or with depression (r = 0.07, p = .39). Regression models, accounting for sex, age, body mass index, race, mean systolic ambulatory blood pressure, tobacco use, alcohol use, physical activity, and sleep efficiency confirmed that anxiety was associated with EPI24 excretion (p = .023) and that depressive symptoms were not (p = .54). CONCLUSIONS Anxiety was associated with heightened sympathoadrenal activity, suggesting a biological pathway through which anxiety could increase CVD risk. Anxiety and depression may confer increased CVD risk via different mechanisms.
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Affiliation(s)
- Nicola J. Paine
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
| | - Cynthia M. Kuhn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC 27710 USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710 USA
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Collins M, Carey TA. Identification of Real and Artifactual Moderators of Effect Size in Meta-Analysis. MULTIVARIATE BEHAVIORAL RESEARCH 2015; 50:109-125. [PMID: 26609746 DOI: 10.1080/00273171.2014.963193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This article argues that while meta-analytic studies are widely used in psychological literature, heterogeneity and the potential for confounding remain major problems in the interpretation of meta-analytic study results. The article demonstrates the use of exploratory analysis including graphical methods prior to meta-analysis, and introduces a methodology to screen for artifactual effects. These procedures are illustrated on effect size data comparing depression treatment outcome from psychotherapy versus pharmacotherapy. Results support prior findings of a nonsignificant difference in effect size between the two treatments. They also support findings that treatment type accounts for only a very small proportion of outcome variance. However, the results indicate that some previously reported covariates of depression treatment outcome may be artifactual.
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Affiliation(s)
- Mark Collins
- a Center of Applied Psychology , University of Canberra
| | - Timothy A Carey
- b Centre for Remote Health , A Joint Centre of Flinders University and Charles Darwin University
- c Central Australian Mental Health Service, NT Department of Health and Families
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Jelinek MV, Thompson DR, Ski C, Bunker S, Vale MJ. 40years of cardiac rehabilitation and secondary prevention in post-cardiac ischaemic patients. Are we still in the wilderness? Int J Cardiol 2015; 179:153-9. [DOI: 10.1016/j.ijcard.2014.10.154] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 12/15/2022]
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Burg MM, Meadows J, Shimbo D, Davidson KW, Schwartz JE, Soufer R. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion. J Am Heart Assoc 2014; 3:e000898. [PMID: 25359402 PMCID: PMC4338683 DOI: 10.1161/jaha.114.000898] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Methods and Results Patients (N=146) completed the Beck Depression Inventory‐I (BDI‐I), a measure of depression linked to recurrent ACS and post‐ACS mortality, and underwent single‐photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI‐I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI‐I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Conclusions Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression‐associated risk for ACS recurrence and mortality.
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Affiliation(s)
- Matthew M Burg
- Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.) Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Judith Meadows
- Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.)
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Joseph E Schwartz
- Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.)
| | - Robert Soufer
- Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.)
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Desvenlafaxine reduces apoptosis in amygdala after myocardial infarction. Brain Res Bull 2014; 109:158-63. [DOI: 10.1016/j.brainresbull.2014.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/25/2014] [Accepted: 10/29/2014] [Indexed: 01/10/2023]
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128
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Abstract
Depression constitutes a novel and independent risk factor for cardiovascular disease, which despite extensive support in the literature has been underappreciated. While much of the evidence for depression as a risk factor for cardiovascular disease is based on studies following myocardial infarction, the elevated vascular risk conveyed by depression is not confined to periods following acute coronary syndromes. For that matter, the risk appears across mood disorders with evidence for even greater risk in bipolar disorder. This review summarizes the literature linking depressive disorders to cardiovascular mortality with a focus on how the course of illness of mood disorders may influence this risk. Mood disorders may influence risk over decades of illness in a dose-response to symptom burden, or the persistence of affective symptomatology. This may be mediated through changes in the activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and inflammatory cytokines. Whether treatment of depression can mitigate this risk is not established although there are suggestions to support this contention, which could be better studied with more effective treatments of depression and larger standardized samples. Directions for future study of mechanisms and treatment are discussed. Regardless of causal mechanisms, persons with depressive disorders and other risk factors for vascular disease represent a neglected, high-risk group for cardiovascular events. In addition to the appropriate treatment for depression, screening and optimized management of traditional risk factors for cardiovascular diseases is necessary.
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Young QR, Nguyen M, Roth S, Broadberry A, Mackay MH. Single-item measures for depression and anxiety: Validation of the Screening Tool for Psychological Distress in an inpatient cardiology setting. Eur J Cardiovasc Nurs 2014; 14:544-51. [DOI: 10.1177/1474515114548649] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Susan Roth
- Heart Centre, St. Paul’s Hospital, Canada
| | | | - Martha H Mackay
- Heart Centre, St. Paul’s Hospital, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul’s Hospital, Canada
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130
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Is there a new finding added to the fibromyalgia syndrome? North Clin Istanb 2014; 1:6-12. [PMID: 28058295 PMCID: PMC5175027 DOI: 10.14744/nci.2014.37450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/01/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to examine depression and anxiety related arrhytmia risk in fibromyalgia syndrome (FMS). METHODS Fifty-nine patients with the diagnosis of FMS and 20 control participants were included in the study. Fibromyalgia Impact Questionnaire (FIQ), Visual Pain Scale (VPS) surveys were applied to determine the severity of the disease. Beck Anxiety (BAS) and Beck Depression scales (BDS) were applied to all participants. Electrocardiograms were obtained from all participants. P-wave dispersions (Pd) were estimated to determine the risk of the atrial arrhythmia, and QT wave dispersion (QTd) and corrected QT(QTdd) values were used to predict the risk of ventricular arrhythmia. RESULTS BAS and BDS results were significantly higher in the patient group compared to the control group (p˂0001). In the patient group, Pd was significantly longer (p=0.034). Other clinical, and demographic data did not differ significantly between groups. CONCLUSION In this study, the risk of arrhythmia in FMS was evaluated and increased Pd in patients with FMS compared to the control group was detected. This finding shows increased risk of atrial fibrilation (AF) in patients with FMS. If we consider that patients with fibromyalgia consist relatively of young patients together with the increased risk of AF with age, it is important to follow-up these patients in later ages for AF risk.
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Rothenbacher D, Jaensch A, Mons U, Hahmann H, Becker T, Koenig W, Brenner H. Prognostic value of one-year course of symptoms of anxiety and depression in patients with coronary heart disease: Role of physical activity and unmet medical need. Eur J Prev Cardiol 2014; 22:1129-38. [DOI: 10.1177/2047487314545317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 07/08/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Thomas Becker
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Centre, Ulm, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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132
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Goodhart A. The relationship between heart and 'inner self' from Aristotle to current clinical practice. MEDICAL HUMANITIES 2014; 40:61-66. [PMID: 24100141 DOI: 10.1136/medhum-2013-010392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Modern songs, films, novels and daily speech often use heart imagery to illustrate 'inner self' experiences, such as deeply felt emotions. Where do these ideas come from and what relevance (if any) do they have for medicine today? This article explores some of the key origins and periods of development of heart/'inner self' ideas before considering the significance of heart/'inner self' interactions in modern clinical practice: from Aristotelian anatomy and the translated Hebrew Scriptures; through Shakespeare, William Harvey and the Protestant Reformation; to theories of emotion and modern-day cardiology. I conclude that heart/'inner self' interactions exist in clinically significant ways, but are poorly understood and under-recognised in healthcare settings. Greater integration of cardiovascular and psychosocial medicine would improve patient care.
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133
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Rayner L, Matcham F, Hutton J, Stringer C, Dobson J, Steer S, Hotopf M. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatry 2014; 36:318-24. [PMID: 24630892 DOI: 10.1016/j.genhosppsych.2013.12.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 12/05/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.
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Affiliation(s)
- L Rayner
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK.
| | - F Matcham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
| | - J Hutton
- South London and Maudsley and King's College Hospital NHS Foundation Trusts, UK
| | - C Stringer
- Information and Communication Technology, King's College Hospital NHS Foundation Trust, UK
| | - J Dobson
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - S Steer
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
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134
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Fan X, Meng Z. The mutual association between depressive symptoms and dyspnea in Chinese patients with chronic heart failure. Eur J Cardiovasc Nurs 2014; 14:310-6. [PMID: 24634388 DOI: 10.1177/1474515114528071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 02/24/2014] [Indexed: 11/16/2022]
Affiliation(s)
| | - Zhu Meng
- Shandong University, PR China
- Shandong Provincial Hospital, PR China
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135
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Rafael B, Simon A, Drótos G, Balog P. Vital exhaustion and anxiety are related to subjective quality of life in patients with acute myocardial infarct before cardiac rehabilitation. J Clin Nurs 2014; 23:2864-73. [DOI: 10.1111/jocn.12563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Beatrix Rafael
- Psychiatric Clinic; University of Szeged; Szeged Hungary
- Special Hospital of Chest Illnesses; Deszk Hungary
| | - Attila Simon
- State Hospital for Cardiology; Balatonfüred Hungary
| | - Gergely Drótos
- Psychiatric Clinic; University of Szeged; Szeged Hungary
| | - Piroska Balog
- Institute of Behavioural Sciences; Semmelweis University; Budapest Hungary
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136
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Ward EC, Mengesha MM, Issa F. Older African American women's lived experiences with depression and coping behaviours. J Psychiatr Ment Health Nurs 2014; 21:46-59. [PMID: 23742034 PMCID: PMC4114393 DOI: 10.1111/jpm.12046] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
Abstract
Little is known about older African American women's lived experiences with depression. What does depression mean to this group? What are they doing about their depression? Unfortunately, these questions are unanswered. This study examined older African American women's lived experiences with depression and coping behaviours. The common sense model provided the theoretical framework for present study. Thirteen community-dwelling African American women aged 60 and older (M = 71 years) participated. Using qualitative phenomenological data analysis, results showed the women held beliefs about factors that can cause depression including experiences of trauma, poverty and disempowerment. Results also indicated the women believed that depression is a normal reaction to life circumstances and did not see the need to seek professional treatment for depression. They coped by use of culturally sanctioned behaviours including religious practices and resilience. It appears these women's beliefs about depression and use of culturally sanctioned coping behaviours might potentially be a barrier to seeking professional mental healthcare, which could result in missed opportunities for early diagnosis and treatment of depression among this group. Implications for research, educational and clinical interventions are discussed.
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Affiliation(s)
- E C Ward
- School of Nursing, University of Wisconsin, Madison, WI, USA
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137
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Rueda-Lara M, Lopez-Patton MR. Psychiatric and psychosocial challenges in patients undergoing haematopoietic stem cell transplants. Int Rev Psychiatry 2014; 26:74-86. [PMID: 24716502 DOI: 10.3109/09540261.2013.866075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Haematological malignancies are often treated with haematopoietic stem cell transplants (HSCT). The disease and its treatment are challenging and life threatening, as they not only affect the recipients, but also their families. This review highlights the available data on the psychological, psychiatric and social impact of these illnesses and their treatment on recipients and families. There are robust data that correlate HSCT with emotional distress, as emotional and physical functioning significantly affect quality of life. Psychiatric co-morbidity including anxiety, depression, adjustment and post-traumatic stress disorder, delirium and cognitive deficits have been reported at different stages in the transplant process. This review will highlight the psychosocial and clinical research findings relevant to HSCT patients and will summarize recommendations for future psychosocial research in this population.
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Affiliation(s)
- Maria Rueda-Lara
- University of Miami/Leonard Miller School of Medicine, Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center , Miami, Florida , USA
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138
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Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting. Eur J Heart Fail 2014; 10:714-21. [DOI: 10.1016/j.ejheart.2008.05.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 04/17/2008] [Accepted: 05/21/2008] [Indexed: 11/18/2022] Open
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139
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Swenson JR. Depression and quality of life in patients with coronary artery disease. Expert Rev Pharmacoecon Outcomes Res 2014; 4:255-64. [DOI: 10.1586/14737167.4.3.255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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140
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Abstract
OBJECTIVES Clinical outcomes are worse for patients with heart failure (HF) and elevated depression symptoms. Depression-related sympathoimmune dysregulation may be one mechanism leading to poorer HF prognosis. Sympathetically mediated adrenergic activity is known to regulate immune activity via β-adrenergic receptors (β-ARs). However, studies show conflicting relationships between leukocyte β-AR sensitivity and depression symptoms. The aim of this study was to determine in patients with HF the relationship of leukocyte β-AR sensitivity with two diverse measures of depression, self-report questionnaire versus clinical diagnostic interview. METHODS Patients with HF (N = 73, mean [standard deviation] age = 56.3 [13.0]) completed the Beck Depression Inventory-1A and a modified Structured Clinical Interview for the DSM-IV. Leukocyte β-AR sensitivity was determined from isoproterenol-stimulated cyclic adenosine monophosphate levels; plasma norepinephrine and epinephrine were also assessed. RESULTS Patients with major depression determined by Structured Clinical Interview for the DSM-IV had significantly higher β-AR sensitivity than did nondepressed patients (F(6,72) = 9.27, p = .003, η = 0.12). The Beck Depression Inventory-1A revealed a more complex relationship. Minimal, mild, and moderate-to-severe depression symptom groups had significant differences in β-AR sensitivity (F(7,72) = 7.03, p = .002, η = 0.18); mild symptoms were associated with reduced β-AR sensitivity and moderate-to-severe symptoms with higher β-AR sensitivity compared with patients with minimal depressive symptoms. CONCLUSIONS Clinical depression was associated with elevated β-AR sensitivity in patients with HF. By deconstructing depression measurements, a greater depth of information may be garnered to potentially reveal subtypes of depression symptoms and their relation to β-AR sensitivity.
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142
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Abstract
Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes.
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Affiliation(s)
- David L Hare
- Department of Medicine, University of Melbourne, Heidelberg Vic 3084, Australia Department of Cardiology, Austin Health, Heidelberg Vic 3084, Australia
| | - Samia R Toukhsati
- Department of Cardiology, Austin Health, Heidelberg Vic 3084, Australia
| | - Peter Johansson
- Department of Health and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
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143
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Oldroyd JC, Cyril S, Wijayatilaka BS, O'Neil A, McKenzie DP, Zavarsek S, Sanderson K, Hare DL, Fisher AJ, Forbes AB, Barr Taylor C, Clarke DM, Meredith IT, Oldenburg B. Evaluating the impact of depression, anxiety & autonomic function on health related quality of life, vocational functioning and health care utilisation in acute coronary syndrome patients: the ADVENT study protocol. BMC Cardiovasc Disord 2013; 13:103. [PMID: 24237848 PMCID: PMC4225620 DOI: 10.1186/1471-2261-13-103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality although their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. We are conducting a prospective cohort study which aims to examine in acute coronary syndrome patients: (1) the role of somatic subtypes of depression and anxiety as predictors of health related quality of life outcomes; (2) how somatic subtypes of depression and anxiety relate to long term vocational functioning and healthcare utilisation; and (3) the role of the autonomic nervous system assessed by heart rate variability as a moderator of these associations. METHODS Patients are being screened after index admission for acute coronary syndrome at a single, high volume centre, MonashHeart, Monash Health, Victoria, Australia. The inclusion criterion is all patients aged > 21 years old and fluent in English admitted to MonashHeart, Monash Health with a diagnosis of acute coronary syndrome. The primary outcome is mean health related quality of life (Short Form-36) Physical and Mental Health Summary scores at 12 and 24 months in subtypes with somatic symptoms of depression and anxiety. Depressive domains are assessed by the Beck Depression Inventory II and the Cardiac Depression Scale. Anxiety is measured using the Speilberger State-Trait Anxiety Inventory and the Crown Crisp Phobic Anxiety questionnaire. Secondary outcomes include clinical variables, healthcare service utilisation and vocational functioning. DISCUSSION This manuscript presents the protocol for a prospective cohort study which will investigate the role of somatic subtypes of depression and anxiety as predictors of health related quality of life, long-term vocational functioning and health service use, and the role of the autonomic nervous system in moderating these associations. Findings from the study have the potential to inform more effective pharmacological, psychological and behavioural interventions and better guide health policy on the use of health care resources.
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Affiliation(s)
- John C Oldroyd
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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The burden of cardiovascular disease amongst psychiatric patients. Int J Cardiol 2013; 169:e65-6. [DOI: 10.1016/j.ijcard.2013.08.129] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
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145
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Randomized Trial of Nordic Walking in Patients With Moderate to Severe Heart Failure. Can J Cardiol 2013; 29:1470-6. [DOI: 10.1016/j.cjca.2013.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/15/2013] [Accepted: 03/03/2013] [Indexed: 11/19/2022] Open
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146
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Abstract
Morbidity and mortality of cardiovascular disease is exceedingly high worldwide. Depressive illness afflicts a significant portion of the population worldwide. Epidemiological studies have confirmed the high co-morbidity between these two entities and the co-morbidity is bidirectional. Systems that contribute to this co-morbidity include the central and autonomic nervous systems, the neuroendocrine, immune, vascular and hematologic systems. Specific pathophysiologic factors include imbalance between the sympathetic and the parasympathetic systems, sympathoadrenal activation, hypothalamic-pituitary-adrenal axis activation, immune system dysregulation with release of pro-inflammatory cytokines and chemokines, platelet activation and hypercoaguability. Inflammation occurs in cardiac and cardiovascular pathology independent of the presence or absence of depression and in depression. Inflammation is closely associated with endothelial dysfunction which is a preamble to atherosclerosis and atherothrombosis. A likely common instigator underlying this co-morbidity is mental stress leading to sustained sympathetic overdrive and diminished vagal tone. Diminished vagal tone contributes to a pro-inflammatory status which affects neurotransmitter regulation, specifically serotonergic transmission. Stress hormones and certain pro-inflammatory substances released by macrophages and microglia upregulate the rate-limiting enzymes in the metabolic pathway of tryptophan. This results in a shunt in tryprophan metabolism away from serotonin formation and down the kynurenine pathway with resulting formation of neurotoxic metabolites.
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147
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Abstract
Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Major depression is estimated in these surveys to be a commonly occurring disorder. Although estimates of lifetime prevalence and course vary substantially across countries for reasons that could involve both substantive and methodological processes, the cross-national data are clear in documenting meaningful lifetime prevalence with wide variation in age-of-onset and high risk of lifelong chronic-recurrent persistence. A number of sociodemographic correlates of major depression are found consistently across countries, and cross-national data also document associations with numerous adverse outcomes, including difficulties in role transitions (e.g., low education, high teen childbearing, marital disruption, unstable employment), reduced role functioning (e.g., low marital quality, low work performance, low earnings), elevated risk of onset, persistence and severity of a wide range of secondary disorders, and increased risk of early mortality due to physical disorders and suicide.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Self-reported depressive symptoms, diagnosed clinical depression and cardiac morbidity and mortality after myocardial infarction. Int J Cardiol 2013; 167:2775-80. [DOI: 10.1016/j.ijcard.2012.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 07/07/2012] [Accepted: 07/07/2012] [Indexed: 12/23/2022]
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Singh I, Ramakrishna S, Williamson K. The Rapid Assessment Interface and Discharge service and its implications for patients with dementia. Clin Interv Aging 2013; 8:1101-8. [PMID: 23986633 PMCID: PMC3754487 DOI: 10.2147/cia.s36398] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The rising prevalence of dementia will have an effect on acute care hospitals around the world. At present, around 40% of patients older than 70 years with acute medical admissions have dementia, but only half of these patients have been diagnosed. Patients with dementia have poorer health outcomes, longer hospital stays, and higher rates of readmissions and institutionalization. Worldwide, health care budgets are severely constrained. National Institute for Health and Care Excellence (NICE) has listed ten quality standards for supporting people in living well with dementia. NICE resource implications and commissioning support to implement these guidelines and improve dementia services have been recently published. Although most of the frail elderly patients with dementia are cared for by geriatricians, obstacles to making a diagnosis and to the management of dementia have been recognized. To provide a timely diagnosis of dementia, better care in acute hospital settings, and continuity of care in the community, services integrating all these elements are warranted. Extra resources also will be required for intermediate, palliative care, and mental health liaison services for people with dementia. The Birmingham Rapid Assessment Interface and Discharge service model uses a multiskilled team that provides comprehensive assessment of a person’s physical and psychological well-being in a general hospital setting. It has been shown to be an effective model in terms of reducing both length of stay and avoiding readmission. The aim of this review is to discuss the implications of the Rapid Assessment Interface and Discharge model in people with dementia and to critically compare this model with similar published service provisions.
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Affiliation(s)
- Inderpal Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Ystrad Mynach, Caerphilly, United Kingdom.
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150
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Rustad JK, Stern TA, Hebert KA, Musselman DL. Diagnosis and treatment of depression in patients with congestive heart failure: a review of the literature. Prim Care Companion CNS Disord 2013; 15:13r01511. [PMID: 24392265 DOI: 10.4088/pcc.13r01511] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/12/2013] [Indexed: 01/02/2023] Open
Abstract
CONTEXT Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. OBJECTIVE We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. DATA SOURCES A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. STUDY SELECTION We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. DATA EXTRACTION The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. RESULTS MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality. CONCLUSIONS At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy.
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Affiliation(s)
- James K Rustad
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Theodore A Stern
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Kathy A Hebert
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Dominique L Musselman
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
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