1
|
Jiang H, Hu R, Wang YJ, Xie X. Predicting depression in patients with heart failure based on a stacking model. World J Clin Cases 2024; 12:4661-4672. [PMID: 39070824 PMCID: PMC11235518 DOI: 10.12998/wjcc.v12.i21.4661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure (HF). AIM To create a stacking model for predicting depression in patients with HF. METHODS This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018. Through univariate analysis and the use of an artificial neural network algorithm, predictors significantly linked to depression were identified. These predictors were utilized to create a stacking model employing tree-based learners. The performances of both the individual models and the stacking model were assessed by using the test dataset. Furthermore, the SHapley additive exPlanations (SHAP) model was applied to interpret the stacking model. RESULTS The models included five predictors. Among these models, the stacking model demonstrated the highest performance, achieving an area under the curve of 0.77 (95%CI: 0.71-0.84), a sensitivity of 0.71, and a specificity of 0.68. The calibration curve supported the reliability of the models, and decision curve analysis confirmed their clinical value. The SHAP plot demonstrated that age had the most significant impact on the stacking model's output. CONCLUSION The stacking model demonstrated strong predictive performance. Clinicians can utilize this model to identify high-risk depression patients with HF, thus enabling early provision of psychological interventions.
Collapse
Affiliation(s)
- Hui Jiang
- Department of Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Rui Hu
- Department of Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yu-Jie Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xiang Xie
- Department of Ultrasound Diagnosis, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| |
Collapse
|
2
|
Thapa A, Kang J, Chung ML, Wu JR, Latimer A, Lennie TA, Lin CY, Thompson JH, Cha G, Moser DK. Perceived Control, Functional Status, Depressive Symptoms, and Anxiety: Mediating and Moderating Influences on Health-Related Quality of Life in Patients With Heart Failure. J Cardiovasc Nurs 2024:00005082-990000000-00187. [PMID: 38687114 DOI: 10.1097/jcn.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is poor in patients with heart failure. Psychological (ie, depressive symptoms [DS], anxiety, and perceived control) and physical (ie, functional status) factors are associated with HRQoL. The dynamic relationships among these variables and their impact on HRQoL remain unclear, limiting the ability to design effective interventions. PURPOSE Our aim was to evaluate a moderated mediation model, in which the association between perceived control and HRQoL was hypothesized to be mediated by DS and anxiety in the presence of a moderator, functional status. METHODS Patients (N = 426) with heart failure completed the Control Attitudes Scale-Revised to measure perceived control, Duke Activity Status Index for functional status, Patient Health Questionnaire-9 for DS, Brief Symptom Inventory for anxiety, and Minnesota Living with Heart Failure Questionnaire for HRQoL. We performed a moderated parallel mediation analysis. RESULTS Higher levels of perceived control were associated with better HRQoL through lower levels of anxiety and DS in the presence of functional status (index of moderated mediation for DS, b = 0.029; 95% confidence interval, 0.016-0.045; for anxiety: b = 0.009, 95% confidence interval, 0.002-0.018). The effect of perceived control on psychological symptoms was stronger at low and moderate functional statuses; however, this effect diminished with increasing functional status. CONCLUSION Functional status moderated the indirect effects of perceived control on HRQoL through DS and anxiety in patients with heart failure. Efforts to improve HRQoL by targeting perceived control may be more effective when considering DS and anxiety in patients with low to moderate levels of functional status.
Collapse
|
3
|
Pedersen M, Rørth R, Andersen M, Sessa M, Polcwiartek C, Riddersholm S, Gislason G, Kristensen S, Andersen N, Køber L, Søgaard P, Torp-Pedersen C, Kragholm K. One-year incidence of depression, anxiety, or stress disorders following a first-time heart failure diagnosis: A Danish nationwide registry-based study. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 25:100240. [PMID: 38510497 PMCID: PMC10945984 DOI: 10.1016/j.ahjo.2022.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 03/22/2024]
Affiliation(s)
- M.W. Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - R. Rørth
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - M.P. Andersen
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - M. Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Universitetsparken 2, 2100 Copenhagen, Denmark
| | - C. Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - S.J. Riddersholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - G. Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Vognmagergade 7,3, 1120 Copenhagen K, Denmark
| | - S.L. Kristensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - N.H. Andersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - L. Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - P. Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
| | - C. Torp-Pedersen
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - K.H. Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej18-22, 9000 Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Sdr. Skovvej 15, 9000 Aalborg, Denmark
| |
Collapse
|
4
|
Abstract
BACKGROUND Depression and anxiety are common comorbidities in heart failure (HF) and are associated with adverse outcomes including unplanned hospitalization. However, there is insufficient evidence on the factors associated with depression and anxiety for community patients with HF to inform optimal assessment and treatment in this population. AIM The aim of this study was to examine the prevalence of and factors associated with depression and anxiety in community-dwelling patients with HF. METHODS A retrospective cohort study of 302 adult patients given a diagnosis of HF referred to United Kingdom's largest specialist cardiac rehabilitation center, from June 2013 to November 2020. Main study outcomes were symptoms of depression using Patient Health Questionnaire-9 and anxiety using the General Anxiety Disorder 7-item scale. Explanatory variables included demographic and clinical characteristics and functional status from the Dartmouth COOP questionnaire: quality of life, pain, level of social activity and daily activities, and being bothered by emotional problems (feelings). Logistic regressions were performed to evaluate the association between demographic and clinical characteristics and depression and anxiety. RESULTS Of the sample, 26.2% reported depression and 20.2% had anxiety. Higher depression and anxiety were associated with difficulty in performing daily activities (95% confidence interval, 1.11-6.46 and 1.13-8.09, respectively) and being bothered by feelings (95% confidence interval, 4.06-21.77 and 4.25-22.46, respectively). Depression was associated with limitations in social activity (95% confidence interval, 1.06-6.34) and anxiety with distressing pain (95% confidence interval, 1.38-7.23). CONCLUSION Findings indicate the importance of psychosocial interventions for patients with HF to minimize and manage depression and anxiety. Patients with HF may benefit from interventions targeted to maintain independence, promote participation in social activities, and optimally manage pain.
Collapse
|
5
|
Parent MB, Ferreira-Neto HC, Kruemmel AR, Althammer F, Patel AA, Keo S, Whitley KE, Cox DN, Stern JE. Heart failure impairs mood and memory in male rats and down-regulates the expression of numerous genes important for synaptic plasticity in related brain regions. Behav Brain Res 2021; 414:113452. [PMID: 34274373 DOI: 10.1016/j.bbr.2021.113452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/21/2021] [Accepted: 07/08/2021] [Indexed: 12/01/2022]
Abstract
Chronic heart failure (HF) is a serious disorder that afflicts more than 26 million patients worldwide. HF is comorbid with depression, anxiety and memory deficits that have serious implications for quality of life and self-care in patients who have HF. Still, there are few studies that have assessed the effects of severely reduced ejection fraction (≤40 %) on cognition in non-human animal models. Moreover, limited information is available regarding the effects of HF on genetic markers of synaptic plasticity in brain areas critical for memory and mood regulation. We induced HF in male rats and tested mood and anxiety (sucrose preference and elevated plus maze) and memory (spontaneous alternation and inhibitory avoidance) and measured the simultaneous expression of 84 synaptic plasticity-associated genes in dorsal (DH) and ventral hippocampus (VH), basolateral (BLA) and central amygdala (CeA) and prefrontal cortex (PFC). We also included the hypothalamic paraventricular nucleus (PVN), which is implicated in neurohumoral activation in HF. Our results show that rats with severely reduced ejection fraction recapitulate behavioral symptoms seen in patients with chronic HF including, increased anxiety and impaired memory in both tasks. HF also downregulated several synaptic-plasticity genes in PFC and PVN, moderate decreases in DH and CeA and minimal effects in BLA and VH. Collectively, these findings identify candidate brain areas and molecular mechanisms underlying HF-induced disturbances in mood and memory.
Collapse
Affiliation(s)
- Marise B Parent
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | | | | | | | - Atit A Patel
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Sreinick Keo
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | | | - Daniel N Cox
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Javier E Stern
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA.
| |
Collapse
|
6
|
The prevalence of depression, stress and anxiety symptoms in patients with chronic heart failure. Int J Ment Health Syst 2021; 15:44. [PMID: 33980322 PMCID: PMC8114712 DOI: 10.1186/s13033-021-00467-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background Mental health illnesses are associated with frequent hospitalisation and an increased risk of all-cause mortality. Despite the high prevalence of depression in patients with chronic heart failure (CHF), there is a paucity of data on this subject from low and middle-income countries (LMIC). The aim of this study was to determine the prevalence of depression, anxiety, and stress symptoms in patients attending a dedicated CHF clinic. Methods A prospective study was conducted at an outpatient heart failure clinic in a tertiary academic centre. The study participants completed a Depression, Anxiety and Stress (DASS-21) questionnaire to screen for the presence and severity of depression, anxiety and stress symptoms. Furthermore, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was completed and used to evaluate the impact of CHF on health-related quality of life (QoL). Descriptive statistics were used to describe patients' characteristics and logistic regression analysis to identify predictors of symptoms of depression. Results The study population comprised of 103 patients, predominantly female (62.1%) with a median age of 53 (interquartile range 38–61) years. Symptoms of depression were reported by 52.4%, with 11.6% reporting symptoms suggestive of extremely severe depression. Anxiety was diagnosed in 53.4% of patients and extremely severe anxiety was reported by 18.4% of patients. Fifty patients were classified as stressed, and only 7.7% had extremely severe stress. More than half of the patients (54.4%) were in New York Heart Association functional class I. The mean left ventricular ejection fraction in the entire cohort was 30% (SD = ± 11.1%). In the multivariable logistic regression model, the MLHFQ score [odds ratio (OR) 1.04, 95% CI:1.02–1.06, p = 0.001] and the six-minute walk test [OR 0.99, 95% CI: 0.98–0.99, p = 0.014] were identified as independent predictors of depression. Conclusion Depression and anxiety symptoms were found in over half of patients attending the CHF clinic. We recommend that mental health screening should be routinely performed in patients with CHF. Prospective, adequately powered, multicentre studies from LMIC investigating the impact of depression, anxiety and stress on CHF outcomes such as health-related QoL, hospitalisation and mortality are required.
Collapse
|
7
|
Müller-Tasch T, Krug K, Peters-Klimm F. Associations between NT-proBNP and psychosocial factors in patients with chronic systolic heart failure. J Psychosom Res 2021; 143:110385. [PMID: 33601116 DOI: 10.1016/j.jpsychores.2021.110385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE B-type natriuretic peptides (BNPs) and their biologically inactive N-terminal parts, namely, NT-proBNPs, are used for diagnostic and prognostic purposes in patients with chronic heart failure (CHF). Associations of BNPs and NT-proBNPs with emotional factors may exist. As depressive and anxious comorbidities and decreases in quality of life (QoL) are common in CHF patients, we explored the associations between NT-proBNP and depression, anxiety, and QoL in patients with CHF using cross-sectional and longitudinal analyses. METHODS We used baseline and one-year follow-up NT-proBNP measurements and sociodemographic and clinical data from 180 patients with systolic CHF from a case management study. Depression was assessed with the Patient Health Questionnaire 9 (PHQ-9), anxiety was assessed with the Generalized Anxiety Disorder Scale 7 (GAD-7), and QoL was determined using the Short Form 36 (SF-36) health survey. RESULTS Univariate correlation analyses showed significant negative associations between NT-proBNP and the scores of four out of eight QoL domains (range: r = -0.159 to -0.285, p = .042 to 0.001) of the SF-36 but not between NT-proBNP and depression and anxiety scores. In cross-sectional and longitudinal multivariate regression analyses, no significant associations between NT-proBNP and psychometric variables were found. CONCLUSION In patients with stable, chronic systolic heart failure, only weak relations between NT-proBNP and QoL exist, but no relations between NT-proBNP and depression and anxiety were found. These findings are placed in the current research context of this topic. Implications for future experimental studies are discussed.
Collapse
Affiliation(s)
- Thomas Müller-Tasch
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum am Weissenhof, Germany; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, INF 410, 69120 Heidelberg, Germany.
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, INF 130.3, 69120 Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, University Hospital Heidelberg, INF 130.3, 69120 Heidelberg, Germany
| |
Collapse
|
8
|
Freedland KE, Skala JA, Steinmeyer BC, Carney RM, Rich MW. Effects of Depression on Heart Failure Self-Care. J Card Fail 2021; 27:522-532. [PMID: 33358958 DOI: 10.1016/j.cardfail.2020.12.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression has been identified as a barrier to effective heart failure self-care, but recent studies suggest that the relationship between depression and self-care is more complex than was previously believed. This study was designed to clarify the relationship between depression and self-care in hospitalized patients with HF. METHODS AND RESULTS During hospitalization with a confirmed clinical diagnosis of HF, 400 patients completed a structured interview to diagnose Diagnostic and Statistical Manual, 5th edition (DSM-5) depressive disorders, the Patient Health Questionnaire (PHQ-9) depression questionnaire, the Self-Care of Heart Failure Index (SCHFI), and several psychosocial questionnaires. Multivariable models were fitted to each SCHFI scale; separate models were run with DSM-5 disorders and PHQ-9 depression scores. Higher PHQ-9 depression scores were independently associated with lower (worse) scores on the SCHFI Maintenance (P < .05), Management (P < .01), and Confidence (P < .01) scales. No independent associations with DSM-5 depressive disorders were detected. Measures of perceived stress, anxiety, and low perceived social support were also significantly associated with poor HF self-care. CONCLUSIONS Patients with a combination of psychosocial problems, including symptoms of depression, stress, anxiety, and inadequate social support, may be more likely than other patients to display difficulties with HF self-care that can increase their risk for hospitalization. Research is needed on "broad-spectrum" psychosocial interventions for patients with HF self-care deficits.
Collapse
Affiliation(s)
| | - Judith A Skala
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Robert M Carney
- Washington University School of Medicine, St. Louis, Missouri
| | - Michael W Rich
- Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
9
|
Bobo WV, Ryu E, Petterson TM, Lackore K, Cheng Y, Liu H, Suarez L, Preisig M, Cooper LT, Roger VL, Pathak J, Chamberlain AM. Bi-directional association between depression and HF: An electronic health records-based cohort study. JOURNAL OF COMORBIDITY 2021; 10:2235042X20984059. [PMID: 33489926 PMCID: PMC7768856 DOI: 10.1177/2235042x20984059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/21/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
Objective: To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs). Methods: This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions. Results: 2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4–6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89–2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17–1.54) after adjusting for all 16 comorbid chronic conditions. Conclusion: These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses.
Collapse
Affiliation(s)
- William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Tanya M Petterson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace Lackore
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Yijing Cheng
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Division of Digital Health Science, Mayo Clinic, Rochester, MN, USA
| | - Laura Suarez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Veronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Jyotishman Pathak
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Population Health Sciences, Weill Cornell Medicine, NY, NY, USA
| | | |
Collapse
|
10
|
Broken Heartstrings—Post-Traumatic Stress Disorder and Psychological Burden after Acute Mitral Regurgitation Due to Chordae Tendineae Rupture. J Clin Med 2020; 9:jcm9124048. [PMID: 33333785 PMCID: PMC7765219 DOI: 10.3390/jcm9124048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
Chordae tendineae rupture (CTR) is a potentially life-threatening cardiac event often resulting in Acute mitral regurgitation (AMR). We assessed Post-traumatic stress disorder (PTSD), depression, and anxiety symptoms in n=21 CTR patients with AMR (age 82.3 ± 4.2 years; 66.7% men) and compared them to n=23 CTR patients with Chronic mitral regurgitation (CMR) and n=35 Myocardial infraction (MI) patients. Regression analyses revealed that PTSD scores were significantly higher in CTR patients with AMR than in CTR patients with CMR or MI patients. CTR patients with CMR had the lowest levels of PTSD-symptoms. Depression and anxiety scores were elevated across all three groups. Our results suggest that psychosocial factors need to be considered in CTR patients’ care.
Collapse
|
11
|
Chandra A, Alcala MA, Claggett B, Desai AS, Fang JC, Heitner JF, Liu J, Pitt B, Solomon SD, Pfeffer MA, Lewis EF. Associations Between Depressive Symptoms and HFpEF-Related Outcomes. JACC-HEART FAILURE 2020; 8:1009-1020. [DOI: 10.1016/j.jchf.2020.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022]
|
12
|
Konrad C, Lossnitzer N, Boehlen FH, Haefeli WE, Holleczek B, Brenner H, Schoettker B, Wild B. Coping resources of heart failure patients - a comparison with cancer patients and individuals having no chronic condition results from the esther study. Heart Lung 2020; 49:829-835. [PMID: 33011461 DOI: 10.1016/j.hrtlng.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heart failure (HF) and cancer patients share similarities in symptom burden and depression prevalence. Coping resources, such as optimism have been associated with improved health-related quality of life (HRQoL) and mental health. OBJECTIVES To investigate a wide range of resources in a large population-based sample of HF patients; to compare resources between three groups: HF patients, cancer patients, and individuals having no chronic condition. METHODS This cross-sectional analysis was performed among n = 2761 subjects who participated in home visits during the 11-year follow-up of the epidemiological ESTHER study. Resources were assessed by trained medical doctors through a questionnaire that lists 26 items. One-way analyses of covariance (ANCOVAs) controlled for sociodemographic variables and depression were performed to compare resources between groups. RESULTS Family and self-efficacy were the most frequently reported resources in all groups. HF patients reported optimism significantly less frequently as a resource in comparison to cancer patients (p=.031). HF patients showed significantly lower levels of resource factor 3 (positive attitude), compared to cancer patients (p=.006), and not chronically ill participants (p=.037). CONCLUSIONS Family and self-efficacy seem to be the most important resources, regardless of diagnosis. HF patients appear to have significantly lower levels of resources concerning positive attitude, compared to cancer patients, and not chronically ill individuals. We suggest the development of psychosocial interventions to enhance optimism in HF.
Collapse
Affiliation(s)
- Cinara Konrad
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Nicole Lossnitzer
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Friederike H Boehlen
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Saarland Cancer Registry, Saarbruecken, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schoettker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, University of Heidelberg, Germany
| | - Beate Wild
- Heidelberg University Hospital, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| |
Collapse
|
13
|
Zhang X, Zou H, Hou D, He D, Fan X. Functional status mediates the association of nutritional status with depressive symptoms in patients with heart failure. J Adv Nurs 2020; 76:3363-3371. [PMID: 32932558 DOI: 10.1111/jan.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/15/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
AIMS The decline of nutritional status and depressive symptoms are pandemic in heart failure patients and functional status may play a pivotal role between these. This study aimed to determine whether nutritional status is associated with depressive symptoms and whether functional status mediates this relationship in heart failure patients. DESIGN This was a secondary analysis of a cross-sectional study. METHODS The data were collected from November 2015-April 2016. Heart failure patients (N = 254) being hospitalized were included in this secondary analysis. The Depression Sub-Scale of the Hospital Anxiety and Depression Scale and the Duke Activity Status Index were used to assess patients' depressive symptoms and functional status. The nutritional status of patients was calculated using the Geriatric Nutritional Risk Index. RESULTS In this study, the average scores of depressive symptoms, nutritional status and functional status were 4.91 (SD 3.12), 102.38 (SD 6.57) and 20.58 (SD 8.96) respectively. Out of the 254 patients, 46 patients (18.1%) had significant depressive symptoms (the score of Depression Sub-Scale of the Hospital Anxiety and Depression Scale ≥ 8) and 55 (21.7%) suffered from malnutrition (the score of Geriatric Nutritional Risk Index ≤ 98). In the multiple regression analyses, nutritional status was negatively associated with depressive symptoms (β = -0.142, p = .02) and functional status mediated the relationship between nutritional status and depressive symptoms. CONCLUSIONS Many patients with heart failure have malnutrition and depressive symptoms. Functional status plays a mediating role in the relationship between nutritional status and depressive symptoms. IMPACT To relieve depressive symptoms in patients with heart failure, it is of importance to improve the functional status, especially for those with poor nutritional status.
Collapse
Affiliation(s)
- Xiuting Zhang
- School of Nursing, Shandong University, Jinan, China
| | - Huijing Zou
- School of Nursing, Shandong University, Jinan, China
| | - Danhua Hou
- School of Nursing, Shandong University, Jinan, China
| | - Dengxin He
- School of Nursing, Shandong University, Jinan, China
| | - Xiuzhen Fan
- School of Nursing, Shandong University, Jinan, China
| |
Collapse
|
14
|
Lossnitzer N, Feisst M, Wild B, Katus HA, Schultz JH, Frankenstein L, Stock C. Cross-lagged analyses of the bidirectional relationship between depression and markers of chronic heart failure. Depress Anxiety 2020; 37:898-907. [PMID: 32542951 DOI: 10.1002/da.23041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/06/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depression is common in patients with chronic heart failure (CHF) and is a predictor of rehospitalization and mortality. However, the complex bidirectional relationships between these two conditions are barely understood. We investigated the course of depression and markers of CHF (New York Heart Association [NYHA] functional class, N-terminal-prohormone B-type natriuretic peptide [NT-proBNP], and left ventricular ejection fraction [LVEF]) in a longitudinal study over a period of 2 years, using three assessment points. METHODS Data of n = 446 patients with documented CHF were analyzed using structural equation modeling. Specifically, a Bayesian cross-lagged structural equation model was applied. RESULTS Our study revealed that an aggravation of depression predicted an increase in NYHA functional class (significant cross-lagged effect γh = 0.103, 95% confidence interval [CI] [0.017; 0.194]), whereas an increase in NYHA functional class did not predict an aggravation of depression (γd = 0.002 95% CI [-0.057; 0.194]). This association was found only for NYHA functional class and depression-not for NT-proBNP and LVEF. CONCLUSIONS Experiencing depression and associated symptoms, such as lack of energy and fatigue, may lead to a further decrease of functional capacity, and consequently to a higher NYHA functional class in CHF patients. As NYHA functional class is associated with higher mortality, this may be a critical development for affected patients. Further studies are required to investigate whether or not this association could be an essential key that explains the pathway from depression to increased mortality in heart failure patients.
Collapse
Affiliation(s)
- Nicole Lossnitzer
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of Psychosomatic and General Internal Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
15
|
Chen AMH, Yehle KS, Plake KS, Rathman LD, Heinle JW, Frase RT, Anderson JG, Bentley J. The role of health literacy, depression, disease knowledge, and self-efficacy in self-care among adults with heart failure: An updated model. Heart Lung 2020; 49:702-708. [PMID: 32861889 DOI: 10.1016/j.hrtlng.2020.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with inadequate health literacy and heart failure face high healthcare costs, more hospitalizations, and greater mortality. To address these negative consequences, patients need to improve heart failure self-care. Multiple factors may influence self-care, but the exact model by which they do so is not fully understood. OBJECTIVES The objective of this study was to examine a model exploring the contribution of health literacy, depression, disease knowledge, and self-efficacy to the performance of heart failure self-care. METHODS Using a cross-sectional design, patients were recruited from a heart failure clinic and completed validated assessments of their cognition, health literacy, depression, knowledge, self-efficacy and self-care. Patients were separated into two groups according to their health literacy level: inadequate/marginal and adequate. Differences between groups were assessed with an independent t-test. Hypothesized paths and mediated relationships were estimated and tested using observed variable path analysis. RESULTS Participants (n = 100) were mainly male (67%), white (93%), and at least had a high school education (85%). Health literacy was associated with disease knowledge (path coefficient=0.346, p = 0.002), depression was negatively associated with self-efficacy (path coefficient=-0.211, p = 0.037), self-efficacy was positively associated with self-care (path coefficient=0.402, p<0.0005), and there was evidence that self-efficacy mediated the link between depression and self-care. There was no evidence of: mediation of the link between health literacy and self-care by knowledge or self-efficacy; positive associations between knowledge and self-efficacy or self-care; or mediation of the disease knowledge and self-care relationship by self-efficacy. Further, depression was associated with self-care indirectly rather than also directly as hypothesized. CONCLUSIONS Self-efficacy and depression are associated with heart failure self-care. Data generated from the model suggest that healthcare professionals should actively engage all patients to gain self-efficacy and address depression to positively affect heart failure self-care.
Collapse
Affiliation(s)
- Aleda M H Chen
- Assistant Dean and Associate Professor, Cedarville University School of Pharmacy, 251N. Main St., Cedarville, OH 45314, USA.
| | - Karen S Yehle
- Professor Emerita, Purdue University, School of Nursing, 502N. University Street, West Lafayette, IN, 47907, USA.
| | - Kimberly S Plake
- Associate Head of Professional Education, Associate Professor, Director, Purdue University Academic and Ambulatory Care Fellowship Program, Faculty Associate, Center for Aging and the Life Course, 575 Stadium Mall Dr., West Lafayette, IN, 47907, USA.
| | - Lisa D Rathman
- Heart Failure Nurse Practitioner, The Heart Group of Lancaster General Health/PENN Medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA.
| | - J Wes Heinle
- At time of project: Research Assistant, The Heart Group of Lancaster General Health/PENN medicine, 217 Harrisburg Ave, Suite 100, Lancaster, PA 17603, USA
| | - Robert T Frase
- Graduate Student, Purdue University, Department of Sociology, 700W. State Street, West Lafayette, IN 47907, USA.
| | - James G Anderson
- Purdue University, Department of Medical Sociology and Health Communication, 700W. State Street, West Lafayette, IN 47907, USA.
| | - John Bentley
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Faser Hall 225, University, MS, 38677, USA.
| |
Collapse
|
16
|
Giles L, Freeman C, Field P, Sörstadius E, Kartman B. Humanistic burden and economic impact of heart failure – a systematic review of the literature. F1000Res 2020. [DOI: 10.12688/f1000research.19365.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Heart failure (HF) is increasing in prevalence worldwide. This systematic review was conducted to inform understanding of its humanistic and economic burden. Methods: Electronic databases (Embase, MEDLINE®, and Cochrane Library) were searched in May 2017. Data were extracted from studies reporting health-related quality of life (HRQoL) in 200 patients or more (published 2007–2017), or costs and resource use in 100 patients or more (published 2012–2017). Relevant HRQoL studies were those that used the 12- or 36-item Short-Form Health Surveys, EuroQol Group 5-dimensions measure of health status, Minnesota Living with Heart Failure Questionnaire or Kansas City Cardiomyopathy Questionnaire. Results: In total, 124 studies were identified: 54 for HRQoL and 71 for costs and resource use (Europe: 25/15; North America: 24/50; rest of world/multinational: 5/6). Overall, individuals with HF reported worse HRQoL than the general population and patients with other chronic diseases. Some evidence identified supports a correlation between increasing disease severity and worse HRQoL. Patients with HF incurred higher costs and resource use than the general population and patients with other chronic conditions. Inpatient care and hospitalizations were identified as major cost drivers in HF. Conclusions: Our findings indicate that patients with HF experience worse HRQoL and incur higher costs than individuals without HF or patients with other chronic diseases. Early treatment of HF and careful disease management to slow progression and to limit the requirement for hospital admission are likely to reduce both the humanistic burden and economic impact of HF.
Collapse
|
17
|
Vitinius F, Escherich S, Deter HC, Hellmich M, Jünger J, Petrowski K, Ladwig KH, Lambertus F, Michal M, Weber C, de Zwaan M, Herrmann-Lingen C, Ronel J, Albus C. Somatic and sociodemographic predictors of depression outcome among depressed patients with coronary artery disease - a secondary analysis of the SPIRR-CAD study. BMC Psychiatry 2019; 19:57. [PMID: 30717711 PMCID: PMC6360727 DOI: 10.1186/s12888-019-2026-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with coronary artery disease (CAD) and are associated with an unfavourable outcome. Establishing prognostic patient profiles prior to the beginning of mental health care may facilitate higher efficacy of targeted interventions. The aim of the current study was to identify sociodemographic and somatic predictors of depression outcome among depressed patients with CAD. METHODS Based on the dataset of the multicentre SPIRR-CAD randomised controlled trial (n = 570 patients with CAD and ≥ 8 points on the Hospital Anxiety and Depression Scale (HADS)), 141 potential sociodemographic and somatic predictors of the change in the HADS-D depression score from baseline to 18-month-follow-up were derived in two different ways. We screened for univariable association with response, using either analysis of (co)variance or logistic regression, respectively, both adjusted for baseline HADS-D value and treatment group. To guard against overfitting, multivariable association was evaluated by a linear or binomial (generalised) linear model with lasso regularisation, a machine learning approach. Outcome measures were the change in continuous HADS-D depression scores, as well as three established binary criteria. The Charlson Comorbidity Index (CCI) was calculated to assess possible influences of comorbidities on our results and was also entered in our machine learning approach. RESULTS Higher age (p = 0.002), unknown previous myocardial infarction (p = 0.013), and a higher heart rate variability during numeracy tests (p = .020) were univariably associated with a favourable depression outcome, whereas hyperuricemia (p ≤ 0.003), higher triglycerides (p = 0.014), NYHA class III (p ≤ 0.028), state after resuscitation (p ≤ 0.042), intake of thyroid hormones (p = 0.007), antidiabetic drugs (p = 0.015), analgesic drugs (p = 0.027), beta blockers (p = 0.035), uric acid drugs (p ≤ 0.039), and anticholinergic drugs (p = 0.045) were associated with an adverse effect on the HADS-D depression score. In all analyses, no significant differences between study arms could be found and physical comorbidities also had no significant influence on our results. CONCLUSION Our findings may contribute to identification of somatic and sociodemographic predictors of depression outcome in patients with CAD. The unexpected effects of specific medication require further clarification and further research is needed to establish a causal association between depression outcome and our predictors. TRIAL REGISTRATION www.clinicaltrials.gov NCT00705965 (registered 27th of June, 2008). www.isrctn.com ISRCTN76240576 (registered 27th of March, 2008).
Collapse
Affiliation(s)
- Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany.
| | - Steffen Escherich
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
| | - Hans-Christian Deter
- grid.412753.6Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martin Hellmich
- 0000 0000 8580 3777grid.6190.eInstitute of Medical Statistics and Computational Biology (IMSB), University of Cologne, Cologne, Germany
| | - Jana Jünger
- German National Institute for state examinations in Medicine, Pharmacy and Psychotherapy, Mainz, Germany
| | - Katja Petrowski
- 0000 0001 2111 7257grid.4488.0Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Karl-Heinz Ladwig
- German Research Center of Environmental Health, Helmholtz Zentrum Muenchen, Institute of Epidemiology, Oberschleißheim, Germany
| | - Frank Lambertus
- 0000 0000 8580 3777grid.6190.eDepartment of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| | - Matthias Michal
- grid.410607.4Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Mainz, Mainz, Germany
| | - Cora Weber
- grid.412753.6Department of Psychosomatics and Psychotherapy, Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martina de Zwaan
- 0000 0000 9529 9877grid.10423.34Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Christoph Herrmann-Lingen
- 0000 0001 2364 4210grid.7450.6Department of Psychosomatic Medicine and Psychotherapy, University of Goettingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Goettingen, Goettingen, Germany
| | - Joram Ronel
- 0000000123222966grid.6936.aDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universitaet München, Munich, Germany
| | - Christian Albus
- 0000 0000 8580 3777grid.6190.eDepartment of Psychosomatics and Psychotherapy, University of Cologne, Cologne, Germany
| |
Collapse
|
18
|
Nikendei C, Greinacher A, Berkunova A, Junghanss T, Stojkovic M. Psychological burden and resilience factors in patients with Alveolar Echinococcosis - A cross-sectional study. PLoS Negl Trop Dis 2019; 13:e0007082. [PMID: 30615695 PMCID: PMC6336346 DOI: 10.1371/journal.pntd.0007082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/17/2019] [Accepted: 12/15/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Alveolar echinococcosis (AE) is a parasitic zoonosis resembling malignancy due to its clinically silent infiltrative growth, predominately in the liver. The comorbid psychological burden and fear of disease progression in AE patients have hardly been examined to date. The aim of this study was to evaluate depression, anxiety, quality of life, and fear of disease progression in AE patients. METHODOLOGY/PRINCIPAL FINDINGS In a cross-sectional study, n = 57 AE patients were invited to report on depression (PHQ-9), anxiety (GAD-7), somatic symptom load (SSS 8), trauma symptoms (PTSS-10), quality of life (SF-12) and on fear of disease progression (FoP-Q-SF) using validated psychometric instruments. Furthermore, attachment style was assessed (RQ-2). N = 47 patients completed the questionnaires (response rate 82.5%). Depression, anxiety, and somatic symptom load were above norm sample means, while physical quality of life was below norm sample means. Existing traumatic symptoms were comparable to those in cancer patients, while fear of disease progression even exceeded cancer patient scores. Patients with a secure attachment style showed less pronounced psychological burden than patients with other attachment styles. Adequate, guideline-based depression and anxiety treatment was very rarely installed. CONCLUSION/SIGNIFICANCE The present study revealed remarkable levels of psychological burden in AE patients. In our study sample, we discovered high depression and anxiety levels, a significant reduction of physical quality of life, and fear of disease progression. These results show how important it is for AE patients to be thoroughly assessed with regard to psychological symptoms and mental disorders so that those in need can receive sufficient psychosocial support and treatment according to official guidelines.
Collapse
Affiliation(s)
- Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany
| | - Anja Greinacher
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany
| | - Anastasiya Berkunova
- Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Germany
| | - Thomas Junghanss
- Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Germany
| | - Marija Stojkovic
- Section Clinical Tropical Medicine, Department of Infectious Diseases, University Hospital Heidelberg, Germany
| |
Collapse
|
19
|
Deter HC, Kruse J, Zipfel S. History, aims and present structure of psychosomatic medicine in Germany. Biopsychosoc Med 2018; 12:1. [PMID: 29434655 PMCID: PMC5795290 DOI: 10.1186/s13030-017-0120-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
Combining its two traditions of integrated psychosomatics in internal medicine and focusing on psychotherapeutic/psychiatric methods in many clinical fields, German psychosomatic medicine has developed well over the last decades. It benefits from its institutional independence and the progressive changes in health care. Clinically, disorder-oriented psychotherapy is a core method integrated with other modes of therapy. As a conceptual base for empirical research, non-reductionist accounts of the interactions of (sick) persons with their environment are most important. Germany has developed a model of Psychosomatic Medicine that has conceptualized and integrated psychotherapeutic methods into clinical practice and realized one way to practice bio-psycho-social medicine in the health care system of the country.
Collapse
Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Johannes Kruse
- Clinic for Psychosomatic Medicine and Psychotherapy, German Association of Psychosomatic Medicine and Psychotherapy (DGPM), University Gießen und Marburg GmbH, Giessen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, German College of Psychosomatic Medicine (DKPM), Tuebingen, Germany
| |
Collapse
|
20
|
Fausto BA, Badana ANS, Valdes OM, Athilingam P, Edwards JD. Examination of Heart Failure as a Predictor of Driving Cessation. JOURNAL OF TRANSPORT & HEALTH 2017; 7:202-208. [PMID: 29552488 PMCID: PMC5851464 DOI: 10.1016/j.jth.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cognitive dysfunction is a predictor of driving cessation in older adults and a common sequela of heart failure (HF). Although HF has been associated with an increased risk of driving cessation, the independent relationship between HF and driving cessation after cognitive function is considered remains to be established. The objective of these analyses is to examine HF as an independent predictor of driving cessation across three years among a cohort of older drivers in the United States. Analyses included 850 older adults who completed sensory, cognitive, and physical measures at baseline and mobility and health measures at a three-year follow-up. Cox regression was used to examine the effects of HF, stroke, vision, cognition, and physical function as predictors of incident driving cessation over three years. Participants with HF were over three times more likely to cease driving, HR = 3.19, 95% CI [1.27, 8.02], p = .014. However, HF was no longer a significant predictor of driving cessation when cognitive performance was considered, HR = 1.70, 95% CI [0.67, 4.30], p = .262. These findings suggest that the risk of driving cessation may be a consequence of the cognitive dysfunction associated with HF, rather than from HF itself. Cognitive training should be investigated among persons with HF to potentially prolong driving mobility.
Collapse
Affiliation(s)
- Bernadette A Fausto
- School of Aging Studies, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States
| | - Adrian N S Badana
- School of Aging Studies, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, United States
| | - Olivia M Valdes
- Department of Psychology, Florida Atlantic University, 3200 College Avenue, Fort Lauderdale, FL 33314, United States
| | - Ponrathi Athilingam
- College of Nursing, University of South Florida, 12901 Bruce B Downs Blvd, MDC 22, Tampa, FL 33612, United States
| | - Jerri D Edwards
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 3515 E. Fletcher Ave., MDC 14, Tampa, FL 33613
| |
Collapse
|
21
|
[Bio-psycho-socio or psychotherapeutic medicine - actual development of psychosomatics in clinical practice]. Wien Med Wochenschr 2017; 168:52-61. [PMID: 28744775 DOI: 10.1007/s10354-017-0582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
In Germany a model of Psychosomatic Medicine has developed, which integrated several psychotherapeutic methods in clinical practice. The concept, which focused on disease mechanisms in the human body and the interaction between diseased individuals and their environment became a basic psychosomatic research strategy and was imlemented in medical care. In this paper the result of a psychosomatic development in clinical health care and research and possible deficiences are described. Perspectives of development and future tasks of Psychosomatic Medicine will be reviewed.
Collapse
|
22
|
Zipfel S, Herzog W, Kruse J, Henningsen P. Psychosomatic Medicine in Germany: More Timely than Ever. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:262-9. [PMID: 27509065 DOI: 10.1159/000447701] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | | | | | | |
Collapse
|
23
|
Silva AR, Sgnaolin V, Nogueira EL, Loureiro F, Engroff P, Gomes I. Doenças crônicas não transmissíveis e fatores sociodemográficos associados a sintomas de depressão em idosos. JORNAL BRASILEIRO DE PSIQUIATRIA 2017. [DOI: 10.1590/0047-2085000000149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
RESUMO Objetivo Investigar a associação das doenças crônicas não transmissíveis e fatores sociodemográficos com sintomas de depressão em idosos. Métodos Foi realizado um estudo transversal com 1.391 idosos cadastrados na Estratégia Saúde da Família. Os dados sociodemográficos e de doenças crônicas não transmissíveis foram coletados pelos agentes comunitários de saúde. A Escala de Depressão Geriátrica abreviada foi utilizada para investigar os sintomas de depressão. Resultados Aproximadamente 81% referiram ao menos uma doença crônica não transmissível. Os sintomas depressivos foram associados com sexo feminino, doença coronariana, insuficiência cardíaca e acidente vascular cerebral; ≥ 8 anos de estudo e ter companheiro foram protetores. Dentre as doenças crônicas não transmissíveis, as cardiovasculares e as cerebrovasculares têm associação independente com sintomas de depressão. Conclusões Esses resultados corroboram a hipótese de que a doença vascular seja um fator de risco para o comprometimento encefálico associado à depressão. Evidencia-se o importante papel dos agentes comunitários de saúde, na Estratégia Saúde da Família, com potencial utilidade nas políticas públicas para a saúde mental do idoso.
Collapse
Affiliation(s)
| | | | | | | | - Paula Engroff
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | - Irenio Gomes
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| |
Collapse
|
24
|
Steca P, Monzani D, Pierobon A, Avvenuti G, Greco A, Giardini A. Measuring dispositional optimism in patients with chronic heart failure and their healthcare providers: the validity of the Life Orientation Test-Revised. Patient Prefer Adherence 2017; 11:1497-1503. [PMID: 28919722 PMCID: PMC5593410 DOI: 10.2147/ppa.s139522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The Life Orientation Test-Revised (LOT-R) measures dispositional optimism (DO) - an individual difference promoting physical and psychological well-being in healthy adults (HAs) as well as in patients with chronic heart failure (CHF) and healthcare providers (HPs). Controversy has arisen regarding the dimensionality of the LOT-R. Whereas DO was originally defined as a one-dimensional construct, empirical evidence suggests two correlated factors in the LOT-R. This study was the first attempt to identify the best factor structure of the LOT-R in patients with CHF and HPs and to evaluate its measurement invariance among subsamples of patients with CHF, HPs, and a normative sample of HAs. Its validity was also evaluated in patients with CHF. The sample comprised 543 participants (34% HAs; 34% HPs; and 32% CHF patients). Congeneric, two correlated factor, and two orthogonal factor models for the LOT-R were compared by performing confirmatory factor analysis (CFA). Measurement invariance was evaluated by considering differential item functioning (DIF) among subsamples of HPs, patients with CHF, and HAs. In patients with CHF, validity was assessed by considering associations with anxiety and depression. The CFA demonstrated the superior fit of the two orthogonal factor model. Moreover, across patients with CHF, HPs, and HAs, the results highlighted a minimal DIF with only trivial consequences. Finally, negative but weak correlations of DO with anxiety and depression confirmed the validity of the LOT-R in patients with CHF. In summary, these findings supported the validity and suitability of the LOT-R for the assessment of DO in patients with CHF, HPs, and HAs.
Collapse
Affiliation(s)
- Patrizia Steca
- Department of Psychology, University of Milano – Bicocca, Milan
| | - Dario Monzani
- Department of Psychology, University of Milano – Bicocca, Milan
- Correspondence: Dario Monzani, Department of Psychology, University of Milano – Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milano, Italy, Tel +39 02 6448 3803, Fax +39 02 6448 3706, Email
| | - Antonia Pierobon
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Montescano, Montescano, Italy
| | - Giulia Avvenuti
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Montescano, Montescano, Italy
| | - Andrea Greco
- Department of Psychology, University of Milano – Bicocca, Milan
| | - Anna Giardini
- Psychology Unit, Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Montescano, Montescano, Italy
| |
Collapse
|
25
|
|
26
|
Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies. Int J Cardiol 2016; 224:170-177. [PMID: 27657469 DOI: 10.1016/j.ijcard.2016.09.063] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) is a burgeoning chronic health condition affecting more than 20million people worldwide. Patients with HF have a significant (17.1%) 30-day readmission rate, which invites substantial penalty in payment to hospitals from Centers for Medicare and Medicaid Services, as per the newly introduced Hospital Readmissions Reduction Program. Depression is one of the important risk factors for readmission in HF patients. It has a significant prevalence in patients with HF and contributes to the overall poor quality of life in them. Several behavioral (smoking, obesity, lack of exercise and medication noncompliance) and pathophysiological factors (hypercortisolism, elevated inflammatory biomarkers, fibrinogen, and atherosclerosis) have been found responsible for the adverse outcome in patients with HF and concomitant depression. Hippocampal volume loss noted in patients with acute HF exacerbations may contribute to the development of depressive symptoms in them. Screening for depression in HF patients continues to be challenging due to a considerable overlap in symptoms. Published trials on the use of antidepressants and cognitive behavioral therapy (CBT) have shown variable outcomes. Newer modalities like internet-based CBT have been tried in small studies, with promising results. A recent meta-analysis observed the beneficial role of aerobic exercise training in patients with HFrEF. Future long-term prospective studies may contribute to the formulation of a detailed screening and management guideline for patients with HF and depression. Our review is aimed to summarize the intricate relationship between depression and heart failure, with respect to their epidemiology, pathophysiological aspects, and optimal management approach.
Collapse
|
27
|
Drosselmeyer J, Rapp MA, Hadji P, Kostev K. Depression risk in female patients with osteoporosis in primary care practices in Germany. Osteoporos Int 2016; 27:2739-2744. [PMID: 27026332 DOI: 10.1007/s00198-016-3584-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/22/2016] [Indexed: 01/07/2023]
Abstract
UNLABELLED Thirty-five thousand four hundred eighty-three female osteoporosis patients were compared with 35,483 patients without osteoporosis regarding the incidence of depression. The risk of depression is significantly increased for patients with osteoporosis compared with patients without osteoporosis in primary care practices within Germany. INTRODUCTION The objectives of the present study were to analyze the incidence of depression in German female patients with osteoporosis and to evaluate the risk factors for depression diagnosis within this patient population. METHODS This study was a retrospective database analysis conducted in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 70,966 patients between 40 and 80 years of age from 1072 primary care practices. The observation period was between 2004 and 2013. Follow-up duration was 5 years and was completed in April 2015. A total of 35,483 osteoporosis patients were selected after applying exclusion criteria, and 35,483 controls were chosen and then matched (1:1) to osteoporosis patients based on age, sex, health insurance coverage, depression diagnosis in the past, and follow-up duration after index date. The analyses of depression-free survival were carried out using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models (dependent variable: depression) were used to adjust for confounders. RESULTS Depression diagnoses were presented in 33.0 % of the osteoporosis group and 22.7 % of the control group after the 5-year follow-up (p < 0.001). Dementia, cancer, heart failure, coronary heart disease, and diabetes were associated with a higher risk of developing depression (p < 0.001). Private health insurance was associated with a lower risk of depression. There was no significant effect of fractures on depression risk. CONCLUSION The risk of depression is significantly increased for patients with osteoporosis in primary care practices within Germany.
Collapse
Affiliation(s)
- J Drosselmeyer
- Fresenius University of Applied Sciences, Idstein, Germany
| | - M A Rapp
- Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt am Main, Germany
| | - K Kostev
- Epidemiology, IMS Health GmbH & Co. OHG, Darmstädter Landstraße 108, 60598, Frankfurt am Main, Germany.
| |
Collapse
|
28
|
Papasavvas T, Al-Amin H, Ghabrash HF, Micklewright D. Translation and validation of the Cardiac Depression Scale to Arabic. Asian J Psychiatr 2016; 22:60-6. [PMID: 27520895 DOI: 10.1016/j.ajp.2016.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/09/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Cardiac Depression Scale (CDS) has been designed to measure depressive symptoms in patients with heart disease. There is no Arabic version of the CDS. We translated and validated the CDS in an Arabic sample of patients with heart disease. METHODS Forward and back translation of the CDS was followed by assessment of cultural relevance and content validity. The Arabic version of the CDS (A-CDS) and the Arabic version of the Hospital Anxiety and Depression Scale (A-HADS) were then administered to 260 Arab in-patients with heart disease from 18 Arabic countries. Construct validity was assessed using exploratory factor analysis with polychoric correlations. Internal consistency was assessed using ordinal reliability alpha and item-to-factor polychoric correlations. Concurrent validity was assessed using Pearson's correlation coefficient between the A-CDS and the depression subscale of the A-HADS (A-HADS-D). RESULTS Cultural relevance and content validity of the A-CDS were satisfactory. Exploratory factor analysis revealed three robust factors, without cross-loadings, that formed a single dimension. Internal consistency was high (ordinal reliability alpha for the total scale and the three factors were .94, .91, .86, and .87, respectively; item-to-factor correlations ranged from .77 to .91). Concurrent validity was high (r=.72). The A-CDS demonstrated a closer to normal distribution of scores than the A-HADS-D. LIMITATIONS Sensitivity and specificity of the A-CDS were not objectively assessed. CONCLUSIONS The A-CDS appears to be a valid and reliable instrument to measure depressive symptoms in a representative sample of Arab in-patients with heart disease.
Collapse
Affiliation(s)
- T Papasavvas
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar; School of Biological Sciences, University of Essex, Colchester, UK.
| | - H Al-Amin
- Weill Cornell Medical College in Qatar, Doha, Qatar; Psychiatry Department, Rumeilah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - H F Ghabrash
- The Northern Hospital, Northwestern Mental Health, Melbourne Health, Melbourne, Australia
| | - D Micklewright
- School of Biological Sciences, University of Essex, Colchester, UK
| |
Collapse
|
29
|
Triposkiadis F, Giamouzis G, Parissis J, Starling RC, Boudoulas H, Skoularigis J, Butler J, Filippatos G. Reframing the association and significance of co-morbidities in heart failure. Eur J Heart Fail 2016; 18:744-58. [DOI: 10.1002/ejhf.600] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/18/2016] [Accepted: 03/20/2016] [Indexed: 01/09/2023] Open
Affiliation(s)
| | - Gregory Giamouzis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | - John Parissis
- Department of Cardiology; Athens University Hospital Attikon; Athens Greece
| | - Randall C. Starling
- Kaufman Center for Heart Failure; Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine; Cleveland OH USA
| | - Harisios Boudoulas
- The Ohio State University, Columbus, OH, USA; Biomedical Research Foundation Academy of Athens, Athens, and; Aristotelian University of Thessaloniki; Thessaloniki Greece
| | - John Skoularigis
- Department of Cardiology; Larissa University Hospital; Larissa Greece
| | - Javed Butler
- Cardiology Division, School of Medicine; Stony Brook University; Stony Brook NY USA
| | | |
Collapse
|
30
|
Orszulak M, Mizia-Stec K, Siennicka A, Goscinska-Bis K, Waga K, Wojcik M, Blaszczyk R, Michalski B, Szymanski FM, Ptaszynska-Kopczynska K, Kopec G, Nadrowski P, Hrynkiewicz-Szymanska A, Krzych L, Jankowska EA. Differences of psychological features in patients with heart failure with regard to gender and aetiology - Results of a CAPS-LOCK-HF (Complex Assessment of Psychological Status Located in Heart Failure) study. Int J Cardiol 2016; 219:380-6. [PMID: 27356026 DOI: 10.1016/j.ijcard.2016.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/12/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Objective of the study was to assess the psychological state of HF patients with reduced ejection fraction (HFrEF) with regard to gender and aetiology. METHODS 758 patients with HFrEF (mean age - 64±11years, men - 79%, NYHA class III-IV - 40%, ischemic aetiology - 61%) in a prospective Polish multicenter Caps-Lock-HF study. Scores on five different self-report inventories: CISS, MHLC, GSES, BDI and modified Mini-MAC were compared between the sexes taking into account the aetiology of HFrEF. RESULTS There were differences in the CISS and BDI score between the genders - women had higher CISS (emotion- and avoidance-oriented) and BDI (general score - 14.2±8.7 vs 12.3±8.6, P<0.05; subscale - somatic score - 7.3±3.7 vs 6.1±3.7, P<0.05). In the ischemic subpopulation, women had higher BDI (general and subscales) than men. In the non-ischemic subpopulation the differences between genders were limited to CISS scale. In a multivariable analysis with demographic and clinical data female sex, NYHA class, atrial fibrillation and diabetes mellitus determined BDI score. Similarly, in the ischemic subpopulation, the female sex, NYHA class and atrial fibrillation determined the BDI, while in the non-ischemic population NYHA class was the only factor that influenced the BDI score. Adding the psychological data made a significant additional contribution to the prediction of depression status. CONCLUSIONS There are distinct differences in psychological features with regard to gender in patients with HFrEF. Women demonstrate less favourable psychological characteristics. Gender-related differences in BDI score are especially explicit in patients with ischemic aetiology of HF. The BDI score is related to psychological predisposition.
Collapse
Affiliation(s)
- Michal Orszulak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Siennicka
- Department of Physiology, Wroclaw Medical University, Wroclaw, Poland; Center for Heart Diseases, Department of Cardiology, Military Hospital in Wroclaw, Wroclaw, Poland;; Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Goscinska-Bis
- Department of Electrocardiology, Medical University of Silesia, Upper-Silesian Medical Centre, Katowice, Poland
| | - Karolina Waga
- Department of Electrocardiology, Medical University of Silesia, Upper-Silesian Medical Centre, Katowice, Poland
| | - Maciej Wojcik
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Robert Blaszczyk
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | - Blazej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Filip M Szymanski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Grzegorz Kopec
- John Paul II Hospital, Department of Cardiac and Vascular Diseases of the Jagiellonian University Medical College, Krakow, Poland
| | - Pawel Nadrowski
- Third Department of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | - Anna Hrynkiewicz-Szymanska
- Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Krzych
- Department of Cardiac Anaestesiology and Intensive Care, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, Poland
| | - Ewa A Jankowska
- Laboratory for Applied Research on Cardiovascular System, Wroclaw Medical University, Wroclaw, Poland; Department of Cardiology, Center for Heart Diseases, Military Hospital in Wroclaw, Wroclaw, Poland
| |
Collapse
|
31
|
[Competence Network Heart Failure (CNHF). Together against heart failure]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:506-13. [PMID: 26979718 DOI: 10.1007/s00103-016-2322-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Heart failure is one of the most urgent medical and socio-economic challenges of the 21(st) century. Up to three million people are affected in Germany; this means one in ten people over the age of 65 live with heart failure. The current demographic changes will accentuate the importance of this grave health problem. The care of patients with heart failure, as well as the associated research mandates a comprehensive, multidisciplinary approach. The Competence Network Heart Failure (CNHF) pursues this objective. CNHF is a research alliance with 11 sites in Germany and was funded by the Federal Ministry of Research (BMBF) from 2003 through 2014. Since January 2015, the network has been an associate cooperating partner of the German Centre for Cardiovascular Research (DZHK). During the 12-year funding period by the BMBF, scientists in the field of heart failure from 30 university hospitals, 5 research institutes, 7 heart centers, 17 cardiovascular clinics, over 200 general practitioners, 4 rehabilitation clinics, as well as numerous organizations and associations were involved in cooperative CNHF research. In the context of 22 projects, the CNHF covered basic, clinical, and health care research, and generated numerous groundbreaking insights into disease mechanisms, as well as diagnosis and treatment of heart failure, which are documented in more than 350 publications. With its central study database and bank of biomaterials, the network has set up a Europe-wide unique research resource, which can be used in the future for national and international cooperations with the DZHK and other partners. Furthermore, the CNHF strongly promotes nation- and Europe-wide public relations and heart failure awareness activities.
Collapse
|
32
|
Ossola P, Paglia F, Pelosi A, De Panfilis C, Conte G, Tonna M, Ardissino D, Marchesi C. Risk factors for incident depression in patients at first acute coronary syndrome. Psychiatry Res 2015; 228:448-53. [PMID: 26144582 DOI: 10.1016/j.psychres.2015.05.063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 05/06/2015] [Accepted: 05/25/2015] [Indexed: 01/08/2023]
Abstract
The association between depression and acute coronary syndrome (ACS) is well-established and the first seems to impact meaningfully on cardiac prognosis. Nonetheless only a few studies have evaluated the relationship between incident depression, defined as new cases in patients with no history of depression, and ACS. Therefore the aim of this study is to analyse the risk factors of incident depression in a sample of patients who were presenting their first ACS. 304 consecutive patients were recruited. The presence of major (MD) and minor (md) depression was assessed with the Primary Care Evaluation of Mental Disorders (PRIME-MD), whereas its severity was evaluated with the Hospital Anxiety and Depression Scale (HADS). Evaluations were collected both at baseline and at 1, 2, 4, 6, 9 and 12 month follow ups. Out of 304 subjects (80.6% males), MD was diagnosed in 15 (4.9%) and md in 25 patients (8.2%). At baseline risk factors for a post-ACS depressive disorder were being women (MD only), widowed (md only) and having mild anhedonic depressive symptoms few days after the ACS. Clinicians should keep in mind these variables when facing a patient at his/her first ACS, given the detrimental effect of depression on cardiac prognosis.
Collapse
Affiliation(s)
- Paolo Ossola
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy.
| | - Francesca Paglia
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
| | - Annalisa Pelosi
- Department of Neuroscience, Psychology Unit, University of Parma, Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| | - Giulio Conte
- Department of Cardiology, University Hospital, Parma, Italy
| | | | | | - Carlo Marchesi
- Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy; Mental Health Department, AUSL, Parma, Italy
| |
Collapse
|
33
|
Lossnitzer N, Herzog W, Schultz JH, Taeger T, Frankenstein L, Wild B. A patient-centered perspective of treating depressive symptoms in chronic heart failure: What do patients prefer? PATIENT EDUCATION AND COUNSELING 2015; 98:783-787. [PMID: 25753404 DOI: 10.1016/j.pec.2015.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 12/19/2014] [Accepted: 02/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To date, very little is known about the specific needs of patients with chronic heart failure (CHF) who must cope with depression. We therefore questioned CHF patients reporting depressive symptoms about their concerns and preferences regarding various psychosocial treatment options. After three-month, we determined how many patients had actually participated in a treatment. METHODS 85 patients with CHF fulfilling the criteria of a depressive disorder according to the PHQ-9 were investigated. Data were analyzed using descriptive and frequency, as well as logistic regression analyses. RESULTS 64.7% of the sample reported that they could envision adhering to supportive talks at longer intervals, whereas only 34.1% would accept an antidepressant. After three months, 24.7% of the patients had actually participated in a treatment. Generalized anxiety severity (GAD-7) was very closely associated with treatment preferences and treatment utilization: The higher the generalized anxiety severity, the more likely was the patients' disposition to begin an antidepressant and/or psychotherapy. CONCLUSIONS The most favoured treatment option was a low-threshold service with supportive talks. PRACTICE IMPLICATIONS Future studies investigating the improvement of patient-centred care in CHF patients should include measurements of generalized anxiety.
Collapse
Affiliation(s)
- Nicole Lossnitzer
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Jobst Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Tobias Taeger
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
34
|
Depressive symptoms in heart failure: Independent prognostic factor or marker of functional status? J Psychosom Res 2015; 78:569-72. [PMID: 25770643 DOI: 10.1016/j.jpsychores.2015.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The prognostic potential of depressive symptoms independent of somatic features of heart failure severity has repeatedly been demonstrated. However, patient-reported functional status has rarely been accounted for in these studies. Thus, it has remained unclear to what extent the predictive power of depressive symptoms may mirror functional status. We therefore aimed to evaluate the prognostic value of depressive symptoms adjusting for patient-reported functional status in a large, well-characterized sample of patients with systolic heart failure. METHODS Eight hundred sixty-three patients, 67±12 years old, 72% men, and 42% with New York Heart Association functional classes III/IV, who participated in the extended Interdisciplinary Network Heart Failure (INH) study were investigated. We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9) and patient-reported functional status with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Data on survival was obtained after a follow-up of 18 months (100% complete). RESULTS Depressive symptoms predicted mortality risk (HR per PHQ-9 scale point=1.07, 95% CI 1.04-1.09, p<.001), even after adjustment for heart failure severity and co-morbidities (HR=1.04, 95% CI 1.01-1.07, p=.017). However, they were no longer significant predictors (HR=1.01, 95% CI 0.98-1.05, p=0.46) after additional adjustment for patient-reported functional status, which proved predictive of mortality risk (HR=0.90, 95% CI 0.82-0.99, p=.025). CONCLUSION Our results suggest that the association of depressive symptoms with functional status may at least partly explain the prognostic potential of depressive symptoms.
Collapse
|
35
|
Piepenburg SM, Faller H, Gelbrich G, Störk S, Warrings B, Ertl G, Angermann CE. Comparative potential of the 2-item versus the 9-item patient health questionnaire to predict death or rehospitalization in heart failure. Circ Heart Fail 2015; 8:464-72. [PMID: 25878325 DOI: 10.1161/circheartfailure.114.001488] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression is common in heart failure and associated with adverse clinical outcomes. We investigated the potential of the 2-item patient health questionnaire (PHQ-2) versus that of the 9-item version (PHQ-9) to predict death or rehospitalization. METHODS AND RESULTS Participants of the Interdisciplinary Network for Heart Failure program were eligible, if they completed the PHQ-9 during baseline assessment. All participants were hospitalized for cardiac decompensation and had a left ventricular ejection fraction ≤40% before discharge. PHQ-2 scores were extracted from the answers to the first 2 PHQ-9 questions. To analyze associations of PHQ-2 and PHQ-9 with both, death and rehospitalization, univariable Cox regression models were used. To compare screening efficacy of both tools, c-statistics were computed. The sample consisted of 852 patients, (67.6±12.1 years; 27.7% women; 42.3% New York Heart Association class III/IV). Follow-up was 18 months (100% complete). During follow-up, 152 patients died and 482 were rehospitalized. Both, PHQ-2 and PHQ-9, predicted death in univariable analysis (hazard ratio, 1.18; 95% confidence interval, 1.09-1.29; P<0.001 and hazard ratio, 1.07; 95% confidence interval, 1.04-1.09; P<0.001, respectively), as well as rehospitalization (hazard ratio, 1.07; confidence interval, 1.01-1.21; P=0.02 and hazard ratio, 1.03; confidence interval, 1.01-1.04; P=0.001, respectively). These results were confirmed by c-statistics. CONCLUSIONS In univariable models and confirmed by c-statistics the potential of both PHQ-2 and PHQ-9 to predict death and hospitalization was similar. In clinical practice, PHQ-2 screening seems thus sufficiently reliable and more feasible than the time-consuming PHQ-9 to identify patients at an increased risk of adverse outcomes. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN 23325295.
Collapse
Affiliation(s)
- Sven M Piepenburg
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany
| | - Hermann Faller
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany
| | - Bodo Warrings
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany
| | - Georg Ertl
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany
| | - Christiane E Angermann
- From the Comprehensive Heart Failure Center (S.M.P., S.S., G.E., C.E.A.), Department of Medicine I (S.M.P., S.S., G.E., C.E.A.), Clinical Trial Center Würzburg (G.G.), and Department of Psychiatry, Psychosomatic Medicine and Psychotherapy (B.W.), University Hospital Würzburg, Würzburg, Germany; and Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences (H.F.) and Institute of Clinical Epidemiology and Biometry (G.G.), University of Würzburg, Würzburg, Germany.
| |
Collapse
|
36
|
Frey A, Popp S, Post A, Langer S, Lehmann M, Hofmann U, Sirén AL, Hommers L, Schmitt A, Strekalova T, Ertl G, Lesch KP, Frantz S. Experimental heart failure causes depression-like behavior together with differential regulation of inflammatory and structural genes in the brain. Front Behav Neurosci 2014; 8:376. [PMID: 25400562 PMCID: PMC4215623 DOI: 10.3389/fnbeh.2014.00376] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/11/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Depression and anxiety are common and independent outcome predictors in patients with chronic heart failure (CHF). However, it is unclear whether CHF causes depression. Thus, we investigated whether mice develop anxiety- and depression-like behavior after induction of ischemic CHF by myocardial infarction (MI). METHODS AND RESULTS In order to assess depression-like behavior, anhedonia was investigated by repeatedly testing sucrose preference for 8 weeks after coronary artery ligation or sham operation. Mice with large MI and increased left ventricular dimensions on echocardiography (termed CHF mice) showed reduced preference for sucrose, indicating depression-like behavior. 6 weeks after MI, mice were tested for exploratory activity, anxiety-like behavior and cognitive function using the elevated plus maze (EPM), light-dark box (LDB), open field (OF), and object recognition (OR) tests. In the EPM and OF, CHF mice exhibited diminished exploratory behavior and motivation despite similar movement capability. In the OR, CHF mice had reduced preference for novelty and impaired short-term memory. On histology, CHF mice had unaltered overall cerebral morphology. However, analysis of gene expression by RNA-sequencing in prefrontal cortical, hippocampal, and left ventricular tissue revealed changes in genes related to inflammation and cofactors of neuronal signal transduction in CHF mice, with Nr4a1 being dysregulated both in prefrontal cortex and myocardium after MI. CONCLUSIONS After induction of ischemic CHF, mice exhibited anhedonic behavior, decreased exploratory activity and interest in novelty, and cognitive impairment. Thus, ischemic CHF leads to distinct behavioral changes in mice analogous to symptoms observed in humans with CHF and comorbid depression.
Collapse
Affiliation(s)
- Anna Frey
- Medical Clinic and Policlinic I, University Hospital of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany
| | - Sandy Popp
- Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany ; Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg Würzburg, Germany
| | - Antonia Post
- Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg Würzburg, Germany
| | - Simon Langer
- Medical Clinic and Policlinic I, University Hospital of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany
| | - Marc Lehmann
- Medical Clinic and Policlinic I, University Hospital of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany
| | - Ulrich Hofmann
- Medical Clinic and Policlinic I, University Hospital of Würzburg Würzburg, Germany ; Interdisziplinäres Zentrum für Klinische Forschung, University Hospital of Würzburg Würzburg, Germany
| | - Anna-Leena Sirén
- Department of Neurosurgery, University Hospital of Würzburg Würzburg, Germany
| | - Leif Hommers
- Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany ; Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg Würzburg, Germany ; Interdisziplinäres Zentrum für Klinische Forschung, University Hospital of Würzburg Würzburg, Germany
| | - Angelika Schmitt
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg Würzburg, Germany
| | - Tatyana Strekalova
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | - Georg Ertl
- Medical Clinic and Policlinic I, University Hospital of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany
| | - Klaus-Peter Lesch
- Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany ; Division of Molecular Psychiatry, Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg Würzburg, Germany ; Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University Maastricht, Netherlands
| | - Stefan Frantz
- Medical Clinic and Policlinic I, University Hospital of Würzburg Würzburg, Germany ; Comprehensive Heart Failure Center, University Hospital of Würzburg Würzburg, Germany
| |
Collapse
|
37
|
Patient perspectives about depressive symptoms in heart failure: a review of the qualitative literature. J Cardiovasc Nurs 2014; 29:E9-15. [PMID: 23151836 DOI: 10.1097/jcn.0b013e318273a5d6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Scientists have systematically established the prevalence and the consequences of depressive symptoms in patients with heart failure (HF). However, a comprehensive understanding of patient perspectives about depressive symptoms, in combination with HF, has not been published. A patient-centered approach may support the design of interventions that are effective and acceptable to patients with HF and depressive symptoms. OBJECTIVE The aim of this study was to review qualitative findings about patient perspectives of contributing factors, associated symptoms, consequences, and self-care strategies used for depressive symptoms in HF. METHODS Qualitative studies were included if they were published between 2000 and 2012, if they were in English, and if they described emotional components about living with HF. Three electronic databases were searched using the key words heart failure, qualitative, and depression or psychosocial or stress or emotional. RESULTS Thirteen studies met the inclusion criteria. Patients with HF reported that financial stressors, overall poor health, past traumatic life experiences, and negative thinking contributed to depressive symptoms. The patients described cognitive-affective symptoms of depression and anxiety but not somatic symptoms of depression. Perceived consequences of depressive symptoms included hopelessness, despair, impaired social relationships, and a decreased ability to engage in HF self-care. Recommended management strategies consisted of enhanced social support and cognitive strategies. CONCLUSIONS Depressive symptoms in patients with HF were associated with a number of contributing factors, including those not specifically related to their disease, and serious consequences that reduced their self-care ability. Nonpharmacological management approaches to depressive symptoms that include improved social support or cognitive interventions may be effective and acceptable strategies.
Collapse
|
38
|
Gelbrich G, Störk S, Kreißl-Kemmer S, Faller H, Prettin C, Heuschmann PU, Ertl G, Angermann CE. Effects of structured heart failure disease management on mortality and morbidity depend on patients' mood: results from the Interdisciplinary Network for Heart Failure Study. Eur J Heart Fail 2014; 16:1133-41. [PMID: 25142121 DOI: 10.1002/ejhf.150] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/01/2014] [Accepted: 07/11/2014] [Indexed: 11/07/2022] Open
Abstract
AIMS Depression is common in heart failure (HF) and associated with adverse outcomes. Randomized comparisons of the effectiveness of HF care strategies by patients' mood are scarce. We therefore investigated in a randomized trial a structured collaborative disease management programme (HeartNetCare-HF™; HNC) recording mortality, morbidity, and symptoms in patients enrolled after hospitalization for decompensated systolic HF according to their responses to the 9-item Patient Health Questionnaire (PHQ-9) during an observation period of 180 days. METHODS AND RESULTS Subjects scoring <12/≥12 were categorized as non-depressed/depressed, and those ignoring the questionnaire as PHQ-deniers. Amongst 715 participants (69 ± 12 years, 29% female), 141 (20%) were depressed, 466 (65%) non-depressed, and 108 (15%) PHQ-deniers. The composite endpoint of mortality and re-hospitalization was neutral overall and in all subgroups. However, HNC reduced mortality risk in both depressed and non-depressed patients [adjusted hazard ratios (HRs) 0.12, 95% confidence interval (CI) 0.03-0.56, P = 0.006, and 0.49, 95% CI 0.25-0.93, P = 0.03, respectively], but not in PHQ-deniers (HR 1.74, 95% CI 0.77-3.96, P = 0.19; P = 0.006 for homogeneity of HRs). Average frequencies of patient contacts in the HNC arm were 12.8 ± 7.9 in non-depressed patients, 12.4 ± 7.1 in depressed patients, and 5.5 ± 7.2 in PHQ-deniers (P < 0.001). CONCLUSIONS Early after decompensation, HNC reduced mortality risk in non-depressed and even more in depressed subjects, but not in PHQ-deniers. This suggests that differential acceptability and chance of success of care strategies such as HNC might be predicted by appropriate assessment of patients' baseline characteristics including psychological disposition. These post-hoc results should be reassessed by prospective evaluation of HNC in larger HF populations.
Collapse
Affiliation(s)
- Götz Gelbrich
- University of Würzburg, Institute of Clinical Epidemiology and Biometry, Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
39
|
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
| |
Collapse
|
40
|
Potentially Modifiable Correlates of Functional Status in Patients with Chronic Heart Failure. Int J Behav Med 2014; 21:956-60. [DOI: 10.1007/s12529-014-9385-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
41
|
Tesio V, Molinaro S, Castelli L, Andriani M, Fanelli AL, Marra S, Torta R. Screening of depression in cardiac patients: is the HADS an effective tool? Int J Cardiol 2014; 172:e344-5. [PMID: 24461980 DOI: 10.1016/j.ijcard.2013.12.308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 12/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Valentina Tesio
- Clinical Psychology and Psycho-Oncology Unit, "Città della Salute e della Scienza" Hospital of Turin, Italy; Department of Neuroscience, University of Turin, Italy.
| | - Stefania Molinaro
- Clinical Psychology and Psycho-Oncology Unit, "Città della Salute e della Scienza" Hospital of Turin, Italy; Department of Neuroscience, University of Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
| | - Monica Andriani
- Cardiology Unit, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Anna Laura Fanelli
- Cardiology Unit, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Sebastiano Marra
- Cardiology Unit, Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Riccardo Torta
- Clinical Psychology and Psycho-Oncology Unit, "Città della Salute e della Scienza" Hospital of Turin, Italy; Department of Neuroscience, University of Turin, Italy
| |
Collapse
|
42
|
Risk factors for onset of depression after heart failure hospitalization. J Cardiol 2013; 64:37-42. [PMID: 24331765 DOI: 10.1016/j.jjcc.2013.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/16/2013] [Accepted: 11/01/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression is common in chronic heart failure (CHF) and associated with adverse outcomes. Knowing the risk factors for the development of depression at the early post-hospitalization phase may be a key factor of successful disease management programs. The aim of this study was therefore to identify the risk factors related to the onset of depression after heart failure hospitalization in patients with CHF. METHODS The study population included participants with an admission diagnosis of acute heart failure or exacerbation of CHF from a multicenter prospective cohort study. Patients completed clinical evaluation at discharge and functional and social status assessment at 1 month after discharge, and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and 1-year later. RESULTS Of the 131 patients without depression at discharge, 29 (22.1%) had developed significant depressive symptoms (HADS-D ≥ 8) at 1-year follow-up. Multiple logistic regression demonstrated that previous ischemic heart disease [odds ratio (OR) 3.09, 95% confidence interval (CI) 1.15-8.33], participation restrictions (OR 0.43, 95% CI 0.26-0.70), and lack of satisfaction with social support (OR 0.48, 95% CI 0.29-0.79) were independent predictors of developing depression. CONCLUSIONS The three clinically accessible variables and targets for interventions identified as predictors in this study may help to guide the optimal post-discharge disease management planning for these patients who are at high risk for depression.
Collapse
|
43
|
Affiliation(s)
- Ulrich Hofmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | | |
Collapse
|
44
|
Lossnitzer N, Herzog W, Gelbrich G, Störk S, Wild B, Ertl G, Angermann CE. Reply to: Risk assessment of depression by questionnaire for patients with heart failure. Int J Cardiol 2013; 168:3129. [DOI: 10.1016/j.ijcard.2013.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
|
45
|
Kawada T. Risk assessment of depression by questionnaire for patients with heart failure. Int J Cardiol 2013; 168:549. [DOI: 10.1016/j.ijcard.2013.01.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 01/13/2013] [Indexed: 12/01/2022]
|
46
|
|
47
|
Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol 2013; 2013:695925. [PMID: 23653854 PMCID: PMC3638710 DOI: 10.1155/2013/695925] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/18/2013] [Indexed: 12/13/2022] Open
Abstract
In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors—including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engagement in health-promoting activities—may link depression with adverse cardiac outcomes. Because of the potential impact of depression on quality of life and cardiac outcomes, the American Heart Association has recommended routine depression screening of all cardiac patients with the 2- and 9-item Patient Health Questionnaires. However, despite the availability of these easy-to-use screening tools and effective treatments, depression is underrecognized and undertreated in patients with CVD. In this paper, we review the literature on epidemiology, phenomenology, comorbid conditions, and risk factors for depression in cardiac disease. We outline the associations between depression and cardiac outcomes, as well as the mechanisms that may mediate these links. Finally, we discuss the evidence for and against routine depression screening in patients with CVD and make specific recommendations for when and how to assess for depression in this high-risk population.
Collapse
|
48
|
Tang HYJ, Sayers SL, Weissinger G, Riegel B. The role of depression in medication adherence among heart failure patients. Clin Nurs Res 2013; 23:231-44. [PMID: 23548500 DOI: 10.1177/1054773813481801] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of the study was to explore the association between depression and medication adherence in heart failure (HF) patients. Studies have shown that people with depression are likely to be nonadherent to their prescribed medication treatment. But other studies suggest that nonadherence may be overestimated by people with depression. A total of 244 adults with Stage C HF completed the study. Self-reported medication adherence was obtained using the Basel Assessment of Adherence Scale (BAAS); objective data on medication adherence were collected using the electronic Medication Event Monitoring System (MEMS). Depression was measured via self-report with the Patient Health Questionnaire (PHQ-9). There was a significant difference between depressed and nondepressed participants in self-reported medication nonadherence (p = .008), but not in objectively measured medication nonadherence (p = .72). The depressed sample was 2.3 times more likely to self-report poor medication adherence than those who were nondepressed (p = .006).
Collapse
|
49
|
O’Neil A, Berk M, Davis J, Stafford L. Cardiac-self efficacy predicts adverse outcomes in coronary artery disease (CAD) patients. Health (London) 2013. [DOI: 10.4236/health.2013.57a3002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|