Depressive Symptoms and Survival of Patients With Coronary Artery Disease

Behavioral Medicine Research Center, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 11/2000; 62(6):790-5. DOI: 10.1097/00006842-200011000-00008
Source: PubMed


Multiple studies have shown that high levels of depressive symptoms increase the mortality risk of patients with established coronary disease. This investigation divided depressive symptoms into groups to assess their relative effectiveness in predicting survival.
Questionnaires about the presence of depressive symptoms were administered to 1250 patients with significant coronary disease while they were hospitalized for diagnostic coronary angiography. Follow-up for mortality due to cardiac disease was conducted annually for up to 19.4 years. Factor analysis was used to divide items on the Zung Self-Rating Depression Scale into four groups: Well-Being, Negative Affect, Somatic, and Appetite. In addition, responses to a single item regarding feelings of hopelessness were available for 920 patients.
Well-Being and Somatic symptoms significantly predicted survival (p < or = .01). Negative Affect items were also related to survival (p = .0001) and interacted with age. A 2-SD difference in the Negative Affect term was associated with a relative risk of 1.29 for patients >50 years old and 1.70 for younger ones. Only Negative Affect remained significant in a model with the other symptom groups. Hopelessness also predicted survival with a relative risk of 1.5. Both the Hopelessness and Negative Affect items remained as independent predictors in the same model. All models controlled for severity of disease and treatment. With one exception (income and Hopelessness), results were essentially unchanged by additional controls for age, gender, and income.
Depressive symptoms differentially predicted survival, with depressive affect and hopelessness being particularly important. These effects were independent of disease severity and somatic symptoms and may be especially important in younger patients.

Download full-text


Available from: Michael J Helms,
  • Source
    • "Post-MI depression is associated with a 2-to 2.5-fold increased risk of impaired cardiovascular outcome (Tal & PourReza, 2008). Hopelessness has a negative relation with survival rate in cardiac patients (Barefoot et al., 2000). Feelings of hopelessness reduce patients' quality of life and health-related quality of life is associated with mortality in cardiac patients (Pedersen et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to explore the experience of spiritual care among a cardiac rehabilitation team. Spiritual care is an important dimension of providing comprehensive care, and understanding the views of health professionals is pivotal to making recommendations for caring. This study used an interpretive phenomenological approach. Semi-structured interviews were undertaken with 13 cardiac rehabilitation professionals. Seven persons participated in individual interviews and six in focus group discussions. Data were analyzed using Smith and Osborn's interpretative phenomenological analysis method. Study data were categorized into more than 150 initial themes, 12 clustered and four superordinate themes, included: 'Helping patients to obtain a meaningful sense of being', 'Providing religious/spiritual focused care', 'holistic approach to rehabilitation is needed' and 'spirituality as a neglected aspect of rehabilitation'. Participants described that they did not have sufficient training in providing spiritual care. Nurses' awareness of spiritual care meaning among a cardiac rehabilitation team is helping to respond to rehabilitation care in a holistic approach. Helping patients to get a meaningful sense of being is an important part of assisting in recovery and adjustment following an acute cardiac event. Providing clear guidelines and support for providing spiritual care in cardiac rehabilitation is required. © The Author(s) 2015.
    The journal of pastoral care & counseling: JPCC 06/2015; 69(2):68-76. DOI:10.1177/1542305015586347
  • Source
    • "A total of 14 studies met our inclusion criteria. However, as the authors of one study could not provide the confidence intervals (CIs) of the effect estimate, this study could not be included in the analyses (Barefoot et al. 2000). Hence a total of 13 studies were included in the meta-analysis, providing data on 11 128 patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Several prospective longitudinal studies have suggested that somatic/affective depressive symptoms, but not cognitive/affective depressive symptoms, are related to prognosis in patients with heart disease, but findings have been inconsistent. The aim of this study was to investigate the association of cognitive/affective and somatic/affective symptoms of depression with cardiovascular prognosis in patients with heart disease using a meta-analytic perspective. A systematic search was performed in PubMed, EMBASE and PsycInfo. Thirteen prospective studies on symptom dimensions of depression and cardiovascular prognosis fulfilled the inclusion criteria, providing data on a total of 11 128 subjects. The risk estimates for each dimension of depressive symptoms, demographic and methodological variables were extracted from the included articles. In least-adjusted analyses, both the somatic/affective [hazard ratio (HR) 1.30, 95% confidence interval (CI) 1.19-1.41, p < 0.001] and cognitive/affective (HR 1.07, 95% CI 1.00-1.15, p = 0.05) dimensions of depressive symptoms were associated with cardiovascular prognosis. In fully adjusted analyses, somatic/affective symptoms were significantly associated with adverse prognosis (HR 1.19, 95% CI 1.10-1.29, p < 0.001) but cognitive/affective symptoms were not (HR 1.04, 95% CI 0.97-1.12, p = 0.25). An increase of one standard deviation (±1 s.d.) in the scores of the somatic/affective dimension was associated with a 32% increased risk of adverse outcomes (HR 1.32, 95% CI 1.17-1.48, p < 0.001). Somatic/affective depressive symptoms were more strongly and consistently associated with mortality and cardiovascular events in patients with heart disease compared with cognitive/affective symptoms. Future research should focus on the mechanisms by which somatic/affective depressive symptoms may affect cardiovascular prognosis.
    Psychological Medicine 01/2014; 44(13):1-15. DOI:10.1017/S0033291714000063 · 5.94 Impact Factor
  • Source
    • "The Self-rating Depression Scale (SDS)18 has been confirmed to be a valid and reliable instrument in several studies,19,20 and in our research had shown good reliability, with a Cronbach’s alpha of 0.796. This assessment tool is a self-reported 20-item measurement of symptoms of depression. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to explore diabetes-related distress and depression and their influence on treatment adherence in Chinese patients with type 2 diabetes. We surveyed 200 type 2 diabetic patients from two public hospitals using the Diabetes Distress Scale (DDS), Zung Self-rating Depression Scale, and Revised Treatment Adherence in Diabetes Questionnaire (RADQ). A multiple regression model was used to explore the relationship between diabetes distress, depression, and treatment adherence. In the 200 eligible patients, the incidence of depression and diabetes distress was approximately 24% and 64%, respectively. The mean score on the RADQ was 23.0 ± 6.0. Multiple regression analysis showed that DDS scores (β = 5.34, P = 0.000), age (β = 0.15, P = 0.014), and family history (β = 3.2, P = 0.016) had a positive correlation with depression. DDS scores (β = -2.30, P = 0.000) and treatment methods (β = -0.93, P = 0.012) were risk factors for poor treatment adherence, whereas age (β = 0.089, P = 0.000) and cohabitation (β = 0.93, P = 0.012) increased treatment adherence. The independent-samples t- test showed that depression also affected treatment adherence (t = 2.53, P < 0.05). These findings suggest that the DDS is a predictor of depression and that diabetes distress plays a more important part than depression in treatment adherence. Screening for diabetes distress may be useful for primary prevention of psychologic problems; however, some form of specialized psychologic intervention should be incorporated to promote patient adherence with treatment.
    Neuropsychiatric Disease and Treatment 09/2013; 9:1289-94. DOI:10.2147/NDT.S49798 · 1.74 Impact Factor
Show more