What is the definition of depression?
- Mood state: Transient feeling of sadness, a component of the normal personality domain of neuroticism (tendency to experience negative emotions)
- Clinical condition: Constellation of persistent symptoms
How many percent of cardiac populations have depression?
Up to 50% in the US!
Personal costs of depression
- Lowered quality of living
- Increased risk of addictions (e.g. Alcohol abuse), divorce, shame/stigma and unemployment.
Physical consequences of depression
Increased mortality rate in elderly and seriously ill individuals
Increased risk of:
- Heart disease
- Osteoporosis (hypersensitive HPA causes increased cortisol levels, which erodes bones)
- Diabetes
What is the DSM criteria for major depressive disorder?
(Must have 5+ symptoms for at least 2 weeks, must include two below)
Depressed mood
Decreased interest in nearly all activities for most of the day
(Must impair function, and cannot be attributed to bereavement)
To see if depression contributes to development and/or course of disease, where would you start? With a healthy population or a diseased population?
Diseased population and see whether depression worsens their prognosis –> smaller sample size (their health is already deteriorating, just have to see the progression of illness) and shorter duration (many would be dead in 6 months)
*Need to make a case with a smaller study in order to establish reason to do this with a bigger, healthy population (have to find a very large sample and need to follow over a long period of time)
In a study of “Depression in CAD Patients Undergoing Cardiac Catheterization”, what did researchers find about the distribution of care between Caucasian and African American patients? (Slide 12)
African American patients were receiving significantly less care (lower percentage were given anti-depressant meds - 11.7% vs 21%) than their Caucasian counterparts.
What did researchers find when they followed up with myocardial infarction patients 6 months later?
Those who were depressed were 5 times as likely to be dead!
What did researchers find when they investigated the link between depression and Long-Term Survival in CAD Patients?
Those who had high depressive symptoms at the time of their angiogram were TWICE AS LIKELY to be dead after 8-11 years than their low depressive counterparts.
What were the findings of the “Depression and Survival After CABG Surgery” study?
Method:
- Depression measured before surgery and 6 months post-surgery
- Followed up for up to 12.2 years to assess for all-cause mortality
Findings:
- Patients who were never depressed, or recovered from depression 6 months post-surgery: Similarly good prognosis!
- HOWEVER, if patients were depressed at time of surgery or developed depression 6 months post-surgery: Similarly bad prognosis (twice as likely to be dead when followed up)
What are the main takeaways from the studies done on depression and heart disease?
- The association between depression and CHD is consistent across different types of heart disease (e.g. Post myocardial infarction, angina)
- Mortality rate of depressed CHD patients is 2-4 times!
- Dose-related risk: The more depressed = the greater the mortality rate!
- Risk related to depression is independent of age and other cardiac risk factors!
What can be done to reduce the link between heart disease and depression?
(Advice from American Heart Association/AHA)
1. Screening for depression - An official depression scale should be administered for CHD patients, along with other standard health tests (e.g. Blood pressure)
- Coordination of care - Cardiologist and psychologist/psychiatrist should work as a team to deliver care to CHD patients with depressive symptoms.
What have studies on depression and CHD risk in HEALTHY people shown?
- Depression is consistently linked to higher rates of severe illnesses (e.g. Cancer and CHD) across different populations (US, Danish samples)
What did researchers find when they looked at the cost of care in depressed post-MI patients in Montreal?
- 260/848 post-MI patients were clinically depressed
- Clinically depressed group had 41% greater costs than non-clinically depressed group!
