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Chen Y, Fang X, Shuai X, Fritzsche K, Leonhart R, Hoschar S, Li L, Ladwig KH, Ma W, Wu H. Psychometric Evaluation of the Major Depression Inventory (MDI) as a Depression Severity Scale in Chinese Patients With Coronary Artery Disease. Findings From the MEDEA FAR-EAST Study. Front Psychiatry 2019; 10:493. [PMID: 31379618 PMCID: PMC6656859 DOI: 10.3389/fpsyt.2019.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background: It is highly recommended that all patients with coronary artery disease should be screened for depression. The Major Depression Inventory (MDI) is a widely used self-rating scale for the assessment of depression but is not valid in Chinese language. The present study was designed to assess the reliability and validity of a version of the MDI translated into Chinese among patients with acute myocardial infarction (AMI). Methods: Data were derived from the "Multicenter Delay in Patients Experiencing Acute Myocardial Infarction in Shanghai" (MEDEA FAR-EAST) study. Using a cross-sectional study design, the Chinese version of the MDI was administered to a total of 267 inpatients. The internal consistency reliability of the MDI scale was evaluated based on the Cronbach's coefficient and the binary coefficient for the whole scale. Exploratory factor analysis was performed to assess the internal consistency of the MDI. To examine discriminant validity, we analyzed the correlation of the MDI score with the General Anxiety Disorder-7 (GAD-7) and World Health Organization-5 Well-Being Index (WHO-5) scale scores. Results: The Chinese version of the MDI showed high reliability (Cronbach's alpha = 0.909, split-half reliability = 0.866). We identified one factor that explained 52% of the variance, which indicated that the MDI has satisfactory structural validity. The correlations of the MDI scores with the GAD-7 scores (r = 0.425) and the WHO-5 scores (r = -0.365) were moderate, suggesting that the MDI has acceptable discriminant validity. Conclusions: The MDI was proved to be a highly reliable and satisfactory valid diagnostic screening tool to assess depression in Chinese cardiac patients.
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Affiliation(s)
- Yixiao Chen
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Xueqian Shuai
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sophia Hoschar
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Li Li
- College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Wenlin Ma
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Kiropoulos LA, Meredith I, Tonkin A, Clarke D, Antonis P, Plunkett J. Psychometric properties of the cardiac depression scale in patients with coronary heart disease. BMC Psychiatry 2012; 12:216. [PMID: 23199307 PMCID: PMC3534230 DOI: 10.1186/1471-244x-12-216] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 11/27/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study examined the psychometric properties of the Cardiac Depression Scale (CDS) in a sample of coronary heart disease (CHD) patients. METHODS A total of 152 patients were diagnosed with coronary heart disease and were administered the CDS along with the Beck Depression Inventory- 2 (BDI-2) and the State Trait Anxiety Inventory (STAI) 3.5-months after cardiac hospitalization. RESULTS The CDS's factorial composition in the current sample was similar to that observed in the original scale. Varimax-rotated principal-components analyses extracted six factors, corresponding to mood, anhedonia, cognition, fear, sleep and suicide. Reliability analyses yielded internal consistency α - coefficients for the six subscales ranging from 0.62 to 0.82. The CDS showed strong concurrent validity with the BDI-II (r = 0.64). More patients were classified as severely depressed using the CDS. Both the CDS and the BDI-2 displayed significantly strong correlations with the STAI (r = 0.61 and r = 0.64), respectively. CONCLUSIONS These findings encourage the use of the CDS for measuring the range of depressive symptoms in those with CHD 3.5 months after cardiac hospitalization.
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Affiliation(s)
- Litza A Kiropoulos
- Melbourne School of Psychological Sciences, The University of Melbourne, Victoria, 3010, Australia
- Psychology Department, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- School of Psychology and Psychiatry, Monash University, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Ian Meredith
- MonashHeart, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
- Department of Medicine, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - David Clarke
- School of Psychology and Psychiatry, Monash University, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Paul Antonis
- MonashHeart and Cardiovascular Research Centre, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Julie Plunkett
- MonashHeart and Cardiovascular Research Centre, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
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Di Benedetto M, Len Burns G, Lindner H, Kent S. A biopsychosocial model for depressive symptoms following acute coronary syndromes. Psychol Health 2010; 25:1061-75. [DOI: 10.1080/08870440903019535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cohen LM, Germain MJ. PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: The Psychiatric Landscape of Withdrawal. Semin Dial 2008; 18:147-53. [PMID: 15771660 DOI: 10.1111/j.1525-139x.2005.18201.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Withdrawal from dialysis is an appropriate decision for situations in which the burdens of treatment outweigh the benefits. Alternately, it can be viewed as a public health problem and suicide equivalent that contributes to the high mortality of end-stage renal disease (ESRD). More than one in five deaths of patients with ESRD are preceded by dialysis cessation, and approximately 15,000 Americans died last year following a determination to stop this life-support treatment. This article discusses what is known about the psychosocial aspects of the patients who terminate dialysis, the role of depression and other psychiatric disorders, the family perspective, and the relationship of these decisions to suicide.
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Affiliation(s)
- Lewis M Cohen
- Department Psychiatry, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
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5
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Depression predicts failure to complete phase-II cardiac rehabilitation. J Behav Med 2008; 31:421-31. [DOI: 10.1007/s10865-008-9168-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 08/04/2008] [Indexed: 01/20/2023]
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Kapfhammer HP. Depressive und Angststörungen bei somatischen Krankheiten. PSYCHIATRIE UND PSYCHOTHERAPIE 2008. [PMCID: PMC7122024 DOI: 10.1007/978-3-540-33129-2_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.
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Earle A, Ayanian JZ, Heymann J. Work Resumption after Newly Diagnosed Coronary Heart Disease: Findings on the Importance of Paid Leave. J Womens Health (Larchmt) 2006; 15:430-41. [PMID: 16724890 DOI: 10.1089/jwh.2006.15.430] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Studies have demonstrated the health benefits of work resumption for adults experiencing health problems, but there are important gaps in the research examining the factors that would help these individuals return to work. This study examines if working conditions predict whether women who experience angina or a myocardial infarction (MI) return to work. METHODS A sample of 289 employed women from the Nurses' Health Study was analyzed. Bivariate chi-square and logistic regression analyses were conducted to examine the relationship between working conditions and the likelihood of returning to work after experiencing an MI or angina. RESULTS Seventy-nine percent of women returned to work after experiencing an MI or angina. Women who had paid leave were substantially more likely to return to work after an MI or angina episode than women without this benefit (adjusted odds ratio [OR] 2.7, p = 0.04). CONCLUSIONS Public and corporate policies to promote paid leave for female workers who experience a serious health condition are likely to help these workers return to their jobs, thereby providing important health and economic benefits for both workers and society.
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Affiliation(s)
- Alison Earle
- Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Wise FM, Harris DW, Carter LM. Validation of the Cardiac Depression Scale in a cardiac rehabilitation population. J Psychosom Res 2006; 60:177-83. [PMID: 16439271 DOI: 10.1016/j.jpsychores.2005.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Accepted: 07/13/2005] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The current study was undertaken to provide further evidence supporting the reliability and validity of the Cardiac Depression Scale (CDS) in a population of cardiovascular patients. METHODS The CDS was administered to 627 consecutive ambulatory adult cardiac patients attending an outpatient Cardiac Rehabilitation program, and a subgroup also completed the Geriatric Depression Scale--Short Form (GDS-SF). RESULTS Factor analysis revealed six subscales accounting for 62% of scale variance. The CDS demonstrated high internal consistency (Cronbach's alpha=.92) and correlation coefficient with the GDS-SF of .77. Receiver operating characteristic curves suggested a CDS cutoff score of 100 to detect more severe depression, and 90 to detect mild to moderate depression. CONCLUSION These findings encourage the continued use and evaluation of the CDS for measuring symptoms of depressive affect in cardiac patients.
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Ketterer MW, Wulsin L, Cao JJ, Schairer J, Hakim A, Hudson M, Keteyian SJ, Khanal S, Clark V, Weaver WD. “Major” Depressive Disorder, Coronary Heart Disease, and the DSM–IV Threshold Problem. PSYCHOSOMATICS 2006; 47:50-5. [PMID: 16384807 DOI: 10.1176/appi.psy.47.1.50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Seventy-seven patients with documented coronary heart disease (CHD) were evaluated for demographic/risk factor characteristics, Major Depressive Disorder (MDD) according to the Patient's Health Questionnaire (PHQ - Diagnostic and Statistical Manual IV criteria), and emotional distress by the Symptom Checklist 90-Revised (SCL-90-R). Early age at initial diagnosis for coronary heart disease (AAID) was used as a proxy for disease malignancy because early AAID is a known predictor of early mortality. MDD was unrelated to early AAID despite being strongly associated with all the scales of the SCL-90-R. Several of the SCL-90-R scales were significantly associated with early AAID in the sample as a whole (Depression, Interpersonal Sensitivity, Anxiety, Paranoia, and Psychoticism) and after removal of the patients meeting criteria for MDD (residual N = 54). Our results suggest a new criterion for determining whether depression, or any mental disorder, is "major": onset or aggravation of serious medical illness.
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Affiliation(s)
- Mark W Ketterer
- Heart and Vascular Institute, Henry Ford Hospital & Wayne State University, Detroit MI 48202, USA.
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Di Benedetto M, Lindner H, Hare DL, Kent S. Depression following acute coronary syndromes: a comparison between the Cardiac Depression Scale and the Beck Depression Inventory II. J Psychosom Res 2006; 60:13-20. [PMID: 16380305 DOI: 10.1016/j.jpsychores.2005.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study compared the Cardiac Depression Scale (CDS) and the Beck Depression Inventory II (BDI-II). METHOD Depression was assessed in 81 participants, 2 weeks post-ACS, using the BDI-II and the Composite International Diagnostic Interview. RESULTS The CDS had a strong concurrent validity with the BDI-II (r=.69). Cross-validation of the BDI-II and the CDS with the structured interview demonstrated the ability of both measures to detect severe symptoms. More patients were classified as depressed using the CDS. The CDS also had a significantly higher correlation with a trait anxiety measure than the BDI-II did. CONCLUSION The CDS is a more suitable scale for assessing the less severe depressive symptoms typically seen in a cardiac population.
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Di Benedetto M, Lindner H, Hare DL, Kent S. A Cardiac Depression Visual Analogue Scale for the brief and rapid assessment of depression following acute coronary syndromes. J Psychosom Res 2005; 59:223-9. [PMID: 16223625 DOI: 10.1016/j.jpsychores.2005.06.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A Cardiac Depression Visual Analogue Scale (CD-VAS) was developed as a rapid and easy method of assessing depressed mood in a cardiac population. The CD-VAS was contrasted against the Cardiac Depression Scale (CDS) and the Beck Depression Inventory-II (BDI-II). METHOD Depression was assessed in 58 participants, 2 weeks postacute coronary syndrome (ACS), using the BDI-II and the CDS. Participants then completed the six-item CD-VAS for 14 consecutive days. RESULTS Using mean weekly scores, the CD-VAS had strong internal reliability (.91) and strong test-retest reliability that ranged from .85 to .97. Principal components analyses found that the CD-VAS only measured one component. The CD-VAS had strong concurrent validity with the BDI-II (r=.81) and the CDS (r=.82) and was able to differentiate between depressed and nondepressed participants. CONCLUSION The CD-VAS is a valid and reliable measure for brief and rapid repeated assessments of depressive symptoms in a cardiac population.
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Sørensenf C, Friis-Hasché E, Haghfelt T, Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2005; 74:69-80. [PMID: 15741756 DOI: 10.1159/000083165] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this review was to survey the literature on depression in patients with myocardial infarction to assess the methodological quality and to test whether depression leads to an increased postmyocardial infarction mortality. Medline, Psycinfo, and www.UMI.com were searched, and researchers were contacted in the autumn of 2003. Thirty-one articles were reviewed. Only seven articles scored above a predefined level of 75% for acceptable quality. The articles lack description of non-responders, recall period for depressive symptoms, validation of applied instrument on target population, and sample size large enough to show differences between groups. The prevalence rates of depression ranged from 1.6 to 50%. In eight articles, a diagnostic test was applied, in the rest of the studies, questionnaires were used. The prevalence of depression was highest in those using patient-completed questionnaires. A significant positive association was shown between depression and postmyocardial infarction mortality in 15 studies, a non-significant association in 14, and in two articles, this was not reported. In articles with data collection starting after 1994, a non-significant relation tended to be reported. The studies were generally not of acceptable quality. They lacked sufficient power to show differences in stated end points between groups. Application of non-validated instruments caused large differences in prevalence rates of depression. Future studies should include a minimum of 1,000 patients, use a validated instrument, re-examine the patients, and describe participants and non-participants in detail.
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Todaro JF, Shen BJ, Niaura R, Tilkemeier PL. Prevalence of Depressive Disorders in Men and Women Enrolled in Cardiac Rehabilitation. ACTA ACUST UNITED AC 2005; 25:71-5; quiz 76-7. [PMID: 15818192 DOI: 10.1097/00008483-200503000-00003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Epidemiological studies have demonstrated that depression is an independent risk factor for the development and recurrence of coronary heart disease (CHD). The prevalence of depressive disorders, however, is not well documented in CHD patients enrolled in cardiac rehabilitation (CR). The purpose of this study was to estimate the prevalence of current and lifetime depressive disorders in the CR setting. METHODS One hundred ten men and women diagnosed with CHD and enrolled in a phase II CR program were screened via a psychiatric, structured interview to assess current and lifetime history of major depressive disorder, minor depression, and dysthymic disorder. RESULTS A total of 17 (15.5%) individuals screened positive for a current depressive disorder at entry into the CR program, with 10 (9.1%) individuals screening positive for major depressive disorder, 7 (6.4%) for minor depression, and 6 (5.5%) for dysthymic disorder. With respect to lifetime prevalence of mood disorders, 29 (26.4%) individuals met the diagnostic criteria for at least one depressive disorder during their lifetime. The lifetime prevalence of major depressive disorder, minor depression, and dysthymic disorder was 11.8%, 14.5%, and 10.9%, respectively. Female CR participants evidence significantly higher current and lifetime prevalence rates for depressive disorders compared to their male counterparts. CONCLUSIONS The results of this study suggest that a substantial number of CHD patients enrolled in CR report a clinically significant history of depression. Efforts to assess and treat depression are needed in the CR setting and may be associated with better adherence to lifestyle modification programs.
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Affiliation(s)
- John F Todaro
- Center for Behavioral Medicine, Brown Medical School, and The Miriam Hospital, Providence, RI 02903, USA.
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Barefoot JC, Burg MM, Carney RM, Cornell CE, Czajkowski SM, Freedland KE, Hosking JD, Khatri P, Pitula CR, Sheps D. Aspects of social support associated with depression at hospitalization and follow-up assessment among cardiac patients. ACTA ACUST UNITED AC 2004; 23:404-12. [PMID: 14646786 DOI: 10.1097/00008483-200311000-00002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE High levels of depressive symptoms have been shown to affect the morbidity, mortality, and functioning of patients with myocardial infarction (MI). Findings have shown that social support is associated with depression in both patient and community samples. This study examined various aspects of social support as they relate to depressive symptoms in patients with MI, both in the hospital and 2 weeks later. METHODS As part of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) pilot study, measures of perceived social support, social networks, social support received, and social conflict were administered to 196 patients with MI. These patients also were administered the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Depression was reassessed 2 weeks later. Relations between social support indicators and the depression measures were examined. RESULTS The prevalence of depression symptoms was high, especially among poorer and younger patients. There was modest improvement across time. Patients with high social support scores, particularly those reflecting perceived support, had lower scores on depression measures at baseline. High levels of perceived support and low social conflict at baseline were associated with less follow-up depression, as measured by the Beck cognitive scale, but not the Beck somatic scale nor the Hamilton scale. There were few associations with measures of social networks and received support. CONCLUSIONS Social support indicators were differentially related to depression among patients with MI while in the hospital and 2 weeks later. The pattern of associations also depended on the measure of depression. A broad assessment strategy of both social support and depression is needed for a full understanding of their interrelations.
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Abstract
Heart disease and depression are among the most common diseases seen in developed countries. The relation-ship between heart disease and depression has been the subject of both popular interest and scientific research. Sadness is often portrayed as a feeling of heaviness in the chest or as a "broken heart." Interestingly as we learn more about the expression of emotions, it appears that these perceptions may simply be the language representation of somatic feelings. Large, prospective, longitudinal studies that have examined the relationship between depression and development of coronary artery disease (CAD) have shown that depression is a risk factor for the development of CAD. Depression also increases mortality in patients with stable CAD or myocardial infarction compared with patients without depression. The recent Sertraline AntiDepressant HeARt attack Trial (SADHART) has shown that selective serotonin reuptake inhibitors like sertraline can be safely used in patients with depression following myocardial infarction. There is also intriguing evidence that treating depression with antidepressants may improve outcomes, including mortality.
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Alvarez W, Pickworth KK. Safety of antidepressant drugs in the patient with cardiac disease: a review of the literature. Pharmacotherapy 2003; 23:754-71. [PMID: 12820818 DOI: 10.1592/phco.23.6.754.32185] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patients with cardiac disease, specifically ischemic heart disease and heart failure, have a higher frequency of major depressive disorder than patients without cardiac disease. The pathophysiologic reason for this is not completely understood. Previous depression, other debilitating illnesses, and type A personality are risk factors for the development of depression in cardiac patients. Depression has been shown to lower the threshold for ventricular arrhythmias. Therefore, treatment of depression potentially may prolong life in these patients. Antidepressant options that have been evaluated include several of the tricyclic antidepressants, trazodone, bupropion, and several of the selective serotonin reuptake inhibitors. Individual antidepressant drugs vary in their pharmacologic activity and side-effect profiles. Although clinical data are limited, it is important to individualize therapy in order to minimize cardiac adverse effects. Clinicians are encouraged to evaluate patients with cardiac disease for major depressive disorder and to consider antidepressant drug therapy for these patients when appropriate.
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Affiliation(s)
- William Alvarez
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland 21287-6180, USA
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Abstract
OBJECTIVE To estimate the prevalence of diagnosed depression in a large population of individuals with type 2 diabetes, compared to a matched control group, and to estimate the extent of depression that is independently associated with diabetes. RESEARCH DESIGN AND METHODS We compared the prevalence of diagnosed depression in all 16180 full-year health maintenance organization members in 1999 who had been diagnosed with type 2 diabetes and in 16180 comparison members without diabetes matched for age and sex. We ascertained diagnoses from the Kaiser Permanente Northwest Region's electronic medical record. Using multiple logistic regression, we adjusted the prevalence estimates for the presence of cardiovascular disease, age, sex, and body weight. RESULTS Depression was more common in individuals with type 2 diabetes than among matched control subjects (17.9 vs. 11.2%; P < 0.001). Women in both groups were nearly twice as likely to be depressed as men; however, the relative difference in depression prevalence between subjects with and without diabetes was greater in men. In the multivariate model for women, body weight was a much stronger predictor of depression than diabetes status. CONCLUSIONS This study further documents the association between depression and diabetes, providing unadjusted population-based estimates in a large sample. Depression remained associated with diabetes after adjustment for several other possible causes. The association among diabetes, cardiovascular disease, depression, and obesity are multifaceted and differ for men and women.
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Affiliation(s)
- Gregory A Nichols
- Kaiser Permanente Center for Health Research, Portland, Oregon 97227-1098, USA.
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Sullivan MD, LaCroix AZ, Spertus JA, Hecht J, Russo J. Depression predicts revascularization procedures for 5 years after coronary angiography. Psychosom Med 2003; 65:229-36. [PMID: 12651990 DOI: 10.1097/01.psy.0000058370.50240.aa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression has been reported to increase cardiac event rates and functional impairment in patients with coronary disease. This article describes the impact of depression on subsequent healthcare utilization for such patients. METHODS One hundred ninety-eight health maintenance organization patients with stable coronary disease were interviewed after elective angiography using a structured psychiatric diagnostic scale. Cardiac events, hospitalizations, procedures, and costs were monitored for the next 5 years through automated data. Subjects were classified at the time of angiography by modified DSM-IV criteria into those with major, minor, and no depression. RESULTS In univariate analyses, the no depression group (N = 136) was most likely to receive coronary artery bypass grafting (CABG) (61% vs. 36% in the major depression group vs. 27% in the minor depression group, p =.001), and the major depression group (N = 25) was most likely to receive percutaneous transluminal coronary angioplasty (PTCA) (44% vs. 14% in the minor depression group vs. 24% in the no depression group). The minor depression group (N = 37) was least likely to be hospitalized for cardiac reasons during follow-up (54% vs. 80% in the major depression group vs. 80% in the no depression group, p =.005). Five-year rates of myocardial infarction and death did not differ significantly between groups. Proportional hazard models showed that those in the depression groups differed in time from catheterization to CABG (chi2(2) = 11.9, p =.003) and time to PCTA (chi2(2) = 7.74, p =.02) after controlling for relevant covariates. Median regression showed that patients with no depression had higher costs during the first year but tended to have lower costs in years 2 through 5 than patients with minor or major depression. CONCLUSIONS Depression status at angiography is associated with the need for revascularization and total healthcare costs for the following year.
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Affiliation(s)
- Mark D Sullivan
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98195, USA.
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Balog P, Janszky I, Leineweber C, Blom M, Wamala SP, Orth-Gomér K. Depressive symptoms in relation to marital and work stress in women with and without coronary heart disease. The Stockholm Female Coronary Risk Study. J Psychosom Res 2003; 54:113-9. [PMID: 12573732 DOI: 10.1016/s0022-3999(02)00485-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of marital and job stress on depressive symptoms in middle aged women with coronary heart disease (CHD) and healthy women who were cohabiting and currently working. METHOD Data were obtained from the Stockholm Female Coronary Risk (FemCorRisk) Study, a population-based case-control study, comprising all women aged 65 years or younger who were admitted for an acute event of CHD between 1991 and 1994. For each patient, an age-matched healthy control was recruited. Marital stress was assessed by a structured interview developed in our research laboratory and work stress by the Karasek demand-control questionnaire. Depressive symptoms were measured by a questionnaire derived from Pearlin et al. [J. Health Soc. Behav. 22 (1981) 337], which was validated by the Beck Depression Inventory. RESULTS Depressive symptoms were twice as common in women with as in women without coronary disease: Marital stress was statistically significantly associated with depressive symptoms, even after controlling for age, educational level, menopausal status, body mass index (BMI), sedentary lifestyle, cigarette smoking and severity of heart failure symptoms. In both groups, depressive symptoms increased with increasing exposure to marital stress in a graded fashion. Work stress was not associated with depressive symptoms after multivariate adjustment. CONCLUSIONS Marital stress but not work stress is independently related to depressive symptoms in women. Women with coronary disease react similarly to marital stress as healthy women, but depart from a higher level of depression, which may be explained by their poorer health status.
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Affiliation(s)
- Piroska Balog
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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Söderman E, Lisspers J, Sundin O. Depression as a predictor of return to work in patients with coronary artery disease. Soc Sci Med 2003; 56:193-202. [PMID: 12435561 DOI: 10.1016/s0277-9536(02)00024-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The importance of depression in coronary artery disease (CAD) outcomes is being increasingly recognized. The aim of this study was to investigate the power of depression as a predictor of return to work, both at full time and at reduced working hours, within 12 months of participation in a behaviorally oriented rehabilitation program in Sweden. The sample comprised 198 employed patients who had recently experienced an acute myocardial infarction (AMI, n=85), or had been treated with coronary by-pass surgery (CABG, n=73) or coronary angioplasty (PTCA, n=40). The results showed that clinical depression before intervention (>or=16 as measured by the Beck Depression Inventory) exerted a great influence on work resumption both at full-time (odds ratio 9.43, CI=3.15-28.21) and at reduced working-hours (odds ratio 5.44, CI=1.60-18.53), while mild depression (BDI 10-15) influenced only work resumption at full-time (odds ratio 2.89, CI=1.08-7.70). Education and, at full-time hours, age also predicted work resumption. This highlights the importance of depressive symptoms in relation to return to work after a CAD event. More research is needed in order to elaborate the degree to which treatment of depression enhances work resumption rates.
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Affiliation(s)
- Eva Söderman
- Research group for behavioral medicine and health psychology, Department of Social Sciences, MidSweden University at Ostersund, Ostersund, Sweden.
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Abstract
OBJECTIVE To review and quantify the impact of depression on the development of coronary heart disease (CHD) in initially healthy subjects. DATA SOURCES Cohort studies on depression and CHD were searched in MEDLINE (1966-2000) and PSYCHINFO (1887-2000), bibliographies, expert consultation, and personal reference files. DATA SELECTION Cohort studies with clinical depression or depressive mood as the exposure, and myocardial infarction or coronary death as the outcome. DATA EXTRACTION Information on study design, sample size and characteristics, assessment of depression, outcome, number of cases, crude and most-adjusted relative risks, and variables used in multivariate adjustments were abstracted. DATA SYNTHESIS Eleven studies met the inclusion criteria. The overall relative risk [RR] for the development of CHD in depressed subjects was 1.64 (95% confidence interval [CI]=1.29-2.08, p<0.001). A sensitivity analysis showed that clinical depression (RR=2.69, 95% CI=1.63-4.43, p<0.001) was a stronger predictor than depressive mood (RR=1.49, 95% CI=1.16-1.92, p=0.02). CONCLUSION It is concluded that depression predicts the development of CHD in initially healthy people. The stronger effect size for clinical depression compared to depressive mood points out that there might be a dose-response relationship between depression and CHD. Implications of the findings for a broader bio-psycho-social framework are discussed.
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Affiliation(s)
- Reiner Rugulies
- Division of Occupational and Environmental Medicine, University of California, San Francisco, USA.
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Creed F, Morgan R, Fiddler M, Marshall S, Guthrie E, House A. Depression and anxiety impair health-related quality of life and are associated with increased costs in general medical inpatients. PSYCHOSOMATICS 2002; 43:302-9. [PMID: 12189256 DOI: 10.1176/appi.psy.43.4.302] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Two hundred sixty-three consecutive medical inpatients were studied to assess whether depression and anxiety are associated with increased costs and reduced health-related quality of life. Seventy-three (27.8%) had depressive/anxiety disorders, 107 were "subthreshold" cases, and 83 were controls. After adjustment for severity of physical illness, using the Duke Severity of Illness Scale, cases and subthreshold cases incurred greater mean health care costs than controls over the follow-up period: $8,541 (SE = $605) versus $5,857 (SE = $859), P = 0.012. There was significant impairment of health-related quality of life (SF36 scores) in cases and, to a lesser extent, in subthreshold cases compared to controls. This impairment persisted at follow-up, as did anxiety and depression, indicating the need for future intervention studies.
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Affiliation(s)
- Francis Creed
- Psychological Medicine Research Group, University of Manchester, United Kingdom.
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Abstract
Over several decades, a large body of evidence has emerged to suggest that depressive disorder is a risk factor for heart diseases, both aetiologically and prognostically. Several large, prospective, longitudinal studies have examined the relationship between depression and the development of coronary artery disease (CAD); they reveal that the relationship is significant and independent of conventional risk factors. Prognostic studies have shown that depression is associated with two to three times higher mortality after myocardial infarction, unstable angina or coronary artery bypass grafting, and in patients with stable CAD compared with such patients without depression. Depression also has been found to increase mortality and morbidity in patients with heart failure, regardless of its aetiology. Such adverse associations persist after adjustment for conventional prognostic risk factors. Despite all of these findings, depressed patients with heart disease are less likely to be recognised clinically as being depressed than those patients who have depression but no heart disease. The very limited evidence available from pharmacological clinical trials raises concern about the safety of antidepressants in CAD and heart failure. In addition, no research has addressed whether the treatment of depression in patients with heart disease will improve their prognosis.
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Affiliation(s)
- Wei Jiang
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27707, USA
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Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24:1069-78. [PMID: 11375373 DOI: 10.2337/diacare.24.6.1069] [Citation(s) in RCA: 2471] [Impact Index Per Article: 107.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the odds and prevalence of clinically relevant depression in adults with type 1 or type 2 diabetes. Depression is associated with hyperglycemia and an increased risk for diabetic complications; relief of depression is associated with improved glycemic control. A more accurate estimate of depression prevalence than what is currently available is needed to gauge the potential impact of depression management in diabetes. RESEARCH DESIGN AND METHODS MEDLINE and PsycINFO databases and published references were used to identify studies that reported the prevalence of depression in diabetes. Prevalence was calculated as an aggregate mean weighted by the combined number of subjects in the included studies. We used chi(2) statistics and odds ratios (ORs) to assess the rate and likelihood of depression as a function of type of diabetes, sex, subject source, depression assessment method, and study design. RESULTS A total of 42 eligible studies were identified; 20 (48%) included a nondiabetic comparison group. In the controlled studies, the odds of depression in the diabetic group were twice that of the nondiabetic comparison group (OR = 2.0, 95% CI 1.8-2.2) and did not differ by sex, type of diabetes, subject source, or assessment method. The prevalence of comorbid depression was significantly higher in diabetic women (28%) than in diabetic men (18%), in uncontrolled (30%) than in controlled studies (21%), in clinical (32%) than in community (20%) samples, and when assessed by self-report questionnaires (31%) than by standardized diagnostic interviews (11%). CONCLUSIONS The presence of diabetes doubles the odds of comorbid depression. Prevalence estimates are affected by several clinical and methodological variables that do not affect the stability of the ORs.
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Affiliation(s)
- R J Anderson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
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Daniel M, Rowley KG, Herbert CP, O'Dea K, Green LW. Lipids and psychosocial status in aboriginal persons with and at risk for Type 2 diabetes: implications for tertiary prevention. PATIENT EDUCATION AND COUNSELING 2001; 43:85-95. [PMID: 11311842 DOI: 10.1016/s0738-3991(00)00153-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study assessed psychosocial correlates of dyslipidemia, towards enabling improved tertiary prevention of macrovascular complications of diabetes mellitus (DM). We tested the hypothesis that psychosocial measures are related to high-density lipoprotein cholesterol (HDL-C) and triglyceride concentrations in a rural aboriginal population in British Columbia, Canada. Persons sampled were on-reserve registered Indians (n=198) with and at risk for Type 2 DM. Relationships between HDL-C and psychosocial variables were associated with glycemic status. For persons with diabetes and impaired glucose tolerance (n=44), quality of life and mastery were positively related (P<0.001), and depression inversely related (P<0.001), to HDL-C. An apparent lack of effect of behavior suggests the influence of emotional pathways involving autonomic-neuroendocrine axes. We recommend assessing mental health, and promoting mastery and diabetes quality of life through empowerment oriented diabetes management strategies, in negotiating culturally acceptable treatment of diabetic dyslipidemia for aboriginal people.
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Affiliation(s)
- M Daniel
- Department of Health Behavior and Health Education, School of Public Health, The University of North Carolina, Chapel Hill, NC 27599-7400, USA.
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Detección de trastornos mentales por médicos no psiquiatras: utilidad del cuestionario PRIME-MD. Med Clin (Barc) 2001. [DOI: 10.1016/s0025-7753(01)71886-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Furlanetto LM, von Ammon Cavanaugh S, Bueno JR, Creech SD, Powell LH. Association between depressive symptoms and mortality in medical inpatients. PSYCHOSOMATICS 2000; 41:426-32. [PMID: 11015629 DOI: 10.1176/appi.psy.41.5.426] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The authors interviewed a consecutive series of medical inpatients (N = 241) using the Schedule for Affective Disorders and Schizophrenia to determine which depressive symptoms are associated with in-hospital mortality. Fifteen depressive symptoms, pain, and physical discomfort were assessed along with medical comorbidity. Twenty patients died in-hospital (8.3%). Logistic regression showed that anhedonia, hopelessness, worthlessness, indecisiveness, and insomnia predicted in-hospital death after adjusting for physical comorbidity and age. Clinicians should be aware that these depressive symptoms may predict mortality in medical inpatients. Future studies should address which treatment modalities lead to better outcomes.
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Affiliation(s)
- L M Furlanetto
- Department of Internal Medicine, Federal University of Santa Catarina, Brazil.
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