Depression profile in patients with and without chronic heart failure

Holzapfel, Nicole; Müller-Tasch, Thomas; Wild, Beate; Jünger, Jana; Zugck, Christian; Remppis, Andrew; Herzog, Wolfgang; Löwe, Bernd

doi:10.1016/j.jad.2007.04.009

« Previous Next »Journal of Affective Disorders
Volume 105, Issue 1 , Pages 53-62, January 2008

Depression profile in patients with and without chronic heart failure

Nicole Holzapfel
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany
- Corresponding author. Department of Psychosomatic and General Internal Medicine, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Tel.: +49 6221 568654; fax: +49 6221 565749.
- Both authors contributed equally to this paper.
Thomas Müller-Tasch
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany
Beate Wild
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany
Jana Jünger
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany
Christian Zugck
- Department of Cardiology, Medical University Hospital Heidelberg, Germany
Andrew Remppis
- Department of Cardiology, Medical University Hospital Heidelberg, Germany
Wolfgang Herzog
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany
Bernd Löwe
- Department of Psychosomatic and General Internal Medicine, Medical University Hospital Heidelberg, Germany

Received 4 December 2006; received in revised form 10 April 2007; accepted 13 April 2007.

Abstract

Objective

Depression often goes undetected and untreated in patients with chronic heart failure (CHF). To investigate whether patients with CHF show a specific profile of depression symptoms, we compared depression symptoms in depressed patients with and without CHF.

Methods

Of a total of 921 patients from a CHF and a psychosomatic outpatient clinic, 137 met DSM-IV diagnostic criteria for major depressive disorder and 113 for other depressive disorders. Depressed patients with CHF (n=113) and without CHF (n=137) were compared with respect to severity of individual DSM-IV depressive symptoms, as measured with the PHQ-9. To stratify for depression severity, ANCOVAs with sociodemographic characteristics as covariates were performed separately for patients with major depressive disorder and other depressive disorders.

Results

Among the patients meeting the criteria for major depressive disorder, patients with CHF reported significantly lower levels of depressed mood (p=.006) and worthlessness/guilt (p=.019) than patients without CHF. In contrast, no significant group differences were found for any of the other depression symptoms. Group comparisons among the patients with other depressive disorders completely replicated these results (p≤.001, and p=.04, respectively).

Limitations

Our study population of CHF patients may not be representative for CHF patients recruited in the general population.

Conclusions

The diagnostic features discriminating between depressed patients with and without CHF are the cognitive–emotional symptoms of depression, not the somatic symptoms. This finding may partially explain the low recognition rate of depression in patients with CHF. The different profile of depression symptoms in patients with and without CHF should be considered in diagnosis, treatment and medical education.

Abbreviations: CHF, chronic heart failure, DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, PHQ-9, Depression module from the Patient Health Questionnaire (PHQ), LVEF, Left ventricular ejection fraction.

Keywords: Depression, DSM-IV, Chronic heart failure, Diagnosis, Classification, Comorbidity