Download (.pdf) Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function.
Published in 'European Heart Journal' (Eur Heart J (2008) 29 (9): 1110-1117.)
Aims:
We investigated the relationship between autonomic nervous system balance, systemic immune activation,... more
Aims:
We investigated the relationship between autonomic nervous system balance, systemic immune activation, endothelial dysfunction, and depression in patients free of coronary heart disease (CHD) with increased CHD risk.
Methods and results:
Depression status (Beck Depression Inventory, BDI), selected CHD risk factors, inflammation markers, measures of heart rate variability (HRV), and indices of endothelial function (flow-mediated dilation, FMD) were evaluated in 415 subjects free of CHD, diabetes mellitus, and other life-threatening conditions, with at least two CHD risk factors among the following: older age, male gender, current smoking, hypertension, and dislipidaemia. Overall, 51.7% of the participants were males, aged 57.6 ± 8.8 years on average (minimum 30, maximum 70). Almost half were hypertensive, 43.9% were dyslipidemic, 30.4% current smokers, and 23.1% showed a depressive symptomatology (BDI ≥ 10). Logistic regression showed that, as compared with non-depressed individuals and after adjustment for age, gender, and hypertension, depressive subjects were significantly more likely to be smokers, to have higher total cholesterol, higher C-reactive protein, and Interleukin-6. In addition, depressed subjects were more likely to have altered HRV and their FMD was severely impaired (adjusted odds ratio of 1% increase = 0.72; 95% CI: 0.61–0.86).
Conclusion:
Our data indicate an independent association between depression and impaired HRV, systemic inflammatory, and endothelial function. These mechanisms play a role not only in the complication of advanced forms of disease, but also promote and/or accelerate the early disease and connect depression and CHD.
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Comparation of levels of anxiety and depression in patients with autoimmune and chronic-degenerative rheumatic: preliminary data].
Bagnato G, De Filippis LG, Caliri A, Bruno A, Gambardella N, Muscatello MR, Cambria R, Zoccali R.
Reumatismo. 2006 Jul-Sep;58(3):206-11.
Scientific research on rheumatic diseases was often focused on the link between psychological features and disease.... more
Scientific research on rheumatic diseases was often focused on the link between psychological features and disease. Depression and anxiety are frequently observed with an higher incidence among rheumatic patients in comparison to general population. In autoimmune diseases, such as rheumatoid arthritis, an important role for psychiatric symptoms could be played by the alteration of cytokines levels. In the chronic-degenerative diseases, psychological factors such as stress and depression, can be involved in perception of pain.
OBJECTIVE:
We aimed at evaluating in a sample of 50 patients (25 with rheumatoid arthritis and 25 with osteoarthritis) levels of pain, anxiety and depression.
METHODS:
We evaluated two group of patients with rheumatic disease, group A (25 with Rheumatoid Arthritis, mean age = 45.1; DS =15.24) and group B (25 with osteoarthritis, mean age = 54.3; DS =14.74) by clinic examination and with the following tests, SF-MPQ, HAQ, HAM-A, HAM-D.
RESULTS:
We found in group A higher levels of depression and anxiety but lower levels of pain, which was more expressed in group B.
CONCLUSION:
Depression and anxiety were observed with an higher prevalence in patients with autoimmune disease, whereas pain was stronger in patients with osteoarthritis, a degenerative disease. We could explain this phenomenon considering the aetiopathology of the two conditions. As regard to autoimmune disorders, these symptoms may reflect the direct effect of cytokines on the central nervous system. As far as it concerns chronic-degenerative diseases, anxiety and depression are usually considered "reactive" to pain, not "constitutive".
Depression, anxiety and anger in subtypes of irritable bowel syndrome patients.
Muscatello MR, Bruno A, Pandolfo G, Micò U, Stilo S, Scaffidi M, Consolo P, Tortora A, Pallio S, Giacobbe G, Familiari L, Zoccali R.
J Clin Psychol Med Settings. 2010 Mar;17(1):64-70.
The present study aimed to elucidate the differences in depression, anxiety, anger, and quality of life in a sample of... more The present study aimed to elucidate the differences in depression, anxiety, anger, and quality of life in a sample of non-psychiatric IBS patients, starting from the hypothesis that IBS subtypes may have different symptomatic expressions of negative emotions with different outcomes on quality of life measures. Forty-two constipation-predominant IBS (C-IBS) subjects and 44 diarrhea-predominant IBS (D-IBS) subjects, after an examination by a gastroenterologist and a total colonoscopy, underwent a clinical interview and psychometric examination for the assessment of depression, anxiety, anger and quality of life. IBS subtypes showed different symptomatic profiles in depression, anxiety and anger, with C-IBS patients more psychologically distressed than D-IBS subjects. Affective and emotional symptoms should be considered as specific and integral to the syndrome, and recognizing the differences between IBS subtypes may have relevant implications for treatment options and clinical outcome.
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Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments.
Hardt J, Conrad S, Muche-Borowski C, Raspe H. Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments. European Psychiatry 2011;26(S1):2217-2218
Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort
by Sam Norton
Norton, S., Sacker. A., Young, A., & Done, J. (2011). Journal of Psychosomatic Research, 71(5):290-295.
Objective: As with other chronic physical illness, rates of depressive disorder are high in rheumatoid arthritis (RA).... more
Objective: As with other chronic physical illness, rates of depressive disorder are high in rheumatoid arthritis (RA). The aim of the current study was to identify distinct trajectories of psychological distress over 10-years in a cohort of RA patients recruited very early in the course of the disease.
Methods: Psychological distress as measured by the Hospital Anxiety and Depression Scale total score was assessed annually in a subgroup of 784 patients enrolled in a multi-centre RA inception cohort (Early RA Study). A latent growth mixture modelling (GMM) approach was used to identify distinct psychological distress patterns.
Results: Four distinct psychological distress trajectories were observed: low-stable (68%), high-stable (12%), high-decreasing (9%) and low-increasing (11%). Symptoms of pain, stiffness and functional impairment were significantly associated with levels of psychological distress at the time of diagnosis and after 3-years; serological markers of disease activity (ESR and CRP) were not.
Conclusions: Although the majority of individuals developing RA experience little or no impact of the effects of the disease on their psychological well-being, a significant proportion experience high levels of distress at some point which may be related to their subjective appraisal of RA. Assessment and treatment of psychological distress should occur synchronously with somatic symptoms.
Depressive vulnerabilities predict depression status and trajectories of depression over one year in persons with acute coronary syndrome
by Frank Doyle
Genera Hospital Psychiatry, in press
http://epubs.rcsi.ie/psycholart/25/
Objective
Depression is prevalent in patients hospitalised with acute coronary syndrome (ACS). We determined... more
Objective
Depression is prevalent in patients hospitalised with acute coronary syndrome (ACS). We determined whether theoretical vulnerabilities for depression (interpersonal life events, reinforcing events, cognitive distortions, Type D personality) predicted depression, or depression trajectories, post-hospitalisation.
Methods
We followed 375 ACS patients who completed depression scales during hospital admission and at least once during three follow-up intervals over one year (949 observations). Questionnaires assessing vulnerabilities were completed at baseline. Logistic regression for panel/longitudinal data predicted depression status during follow-up. Latent class analysis determined depression trajectories. Multinomial logistic regression modelled the relationship between vulnerabilities and trajectories.
Results
Vulnerabilities predicted depression status over time in univariate and multivariate analysis, even when controlling for baseline depression. Proportions in each depression trajectory category was as follows: persistent (15%); subthreshold (37%); never depressed (48%). Vulnerabilities independently predicted each of these trajectories, with effect sizes significantly highest for the persistent depression group.
Conclusions
Self-reported vulnerabilities – stressful life events, reduced reinforcing events, cognitive distortions, personality – measured during hospitalisation can identify those at risk for depression post-ACS, and especially those with persistent depressive episodes. Interventions should focus on these vulnerabilities.
What predicts depression in cardiac patients: Sociodemographic factors, disease severity or theoretical vulnerabilities?
by Frank Doyle
Psychology & Health, in press (http://epubs.rcsi.ie/psycholart/21)
Depression is associated with increased cardiovascular risk in patients with acute coronary syndrome (ACS), but some... more Depression is associated with increased cardiovascular risk in patients with acute coronary syndrome (ACS), but some argue that elevated depression is actually a marker of cardiovascular disease severity. Therefore, disease indices should be better predictors of depression than established theoretical causes of depression (interpersonal life events, reinforcing events, cognitive distortions, type D personality). However, little theory-based research has been conducted in this area. In a cross-sectional design, hospitalised ACS patients (n=336) completed questionnaires assessing depressive symptoms and vulnerabilities. Nested logistic regression assessed the relative contribution of demographic or vulnerability factors, or disease indices or vulnerabilities to depression. In multivariate analysis, all vulnerabilities were independent significant predictors of depression. Demographic variables accounted for <1% of the variance of depression status, with vulnerabilities accounting for significantly more (pseudo R2=.16, χ2(change)=150.9, df=4, p<0.001). Disease indices accounted for 7% of the variance in depressive status (pseudo R2=.07, χ2=137.9, p<0.001). However, adding the vulnerabilities increased the overall variance explained to 22% (pseudo R2=.22, χ2=58.6, df=4, p<0.001). Theoretical vulnerabilities predicted depression status better than did either demographic or disease indices. The presence of these proximal causes of depression suggests that depression in ACS patients is not simply a result of cardiovascular disease severity.
Exhaustion, depression and hopelessness in cardiac patients: A unidimensional hierarchy of symptoms revealed by Mokken scaling
by Frank Doyle
Irish Journal of Psychological Medicine
http://epubs.rcsi.ie/psycholart/27
Objectives
Depression and vital exhaustion are associated with poor cardiovascular prognosis, but there is... more
Objectives
Depression and vital exhaustion are associated with poor cardiovascular prognosis, but there is substantial overlap between these constructs. Factor analytic studies have been inconclusive, and may not be the optimal analytic
strategy to assess dimensionality. We assessed whether exhaustion and depression formed a single, hierarchical dimension using a form of non-parametric item response theory.
Methods
Patients with acute coronary syndrome (n=430) completed questionnaires assessing depression and vital exhaustion. Mokken scaling was used to assess dimensionality.
Results
Mokken scaling formed a strong unidimensional scale, ordered in a hierarchy reflecting prevalence: fatigue (common), depression (less common) and hopelessness (rare).
Conclusions
Depressive symptoms form a clear hierarchy in cardiac patients, from fatigue to hopelessness. Vital exhaustion may be considered a less severe form of depression. Use of hierarchical scales may allow clinicians to better determine clinical significance and target interventions.
Depressive Symptoms In Persons With Acute Coronary Syndrome: Specific Symptom Scales and Prognosis
by Frank Doyle
J Psychosom Res. 2010 Feb;68(2):121-30. (http://epubs.rcsi.ie/psycholart/9)
OBJECTIVE: To determine which particular depressive symptom scales, derived from three scales, predicted poorer... more
OBJECTIVE: To determine which particular depressive symptom scales, derived from three scales, predicted poorer prognosis in persons with acute coronary syndrome (ACS).
METHODS: Hospitalized ACS patients (n=408) completed questionnaires (depression, vital exhaustion). Mokken scaling derived unidimensional scales. Major cardiac events (cardiac mortality, ACS, unplanned revascularization) were assessed at median 67 weeks post event.
RESULTS: Only depressive symptoms of fatigue-sadness predicted prognosis in univariate (hazard ratio [HR]=1.8, 95% CI 1.1-3.0, P=.025) and multivariate analysis (HR=1.8, 95% CI 1.1-2.9, P=.025). Symptoms of anhedonia (HR=1.6, 95% CI 0.9-2.8, P=.102) and depressive cognitions (HR=1.3, 95% CI 0.7-2.2, P=.402) did not.
CONCLUSION: Symptoms of fatigue-sadness, but not other symptoms, were associated with increased risk of major cardiac events. Depression should be considered as a multidimensional, rather than a unidimensional, entity when designing interventions.
Challenges in reducing depression-related mortality in cardiac populations: cognition, emotion, fatigue or personality?
by Frank Doyle
Health Psychology Review 2007, 1(2), 137-172 (http://epubs.rcsi.ie/psycholart/13)
Depression is associated with increased morbidity and mortality in cardiac patients post-event; however treatment of... more Depression is associated with increased morbidity and mortality in cardiac patients post-event; however treatment of psychological symptoms has failed to reduce cardiovascular risk. We explore depression and related constructs in terms of construct overlap and intervention potential. Certain depressive symptoms may be more important than others for increasing risk. Depressive cognitions may have lesser importance than somatic symptoms, but there is potential for designing interventions based on distorted illness perceptions. Somatic depressive symptoms and vital exhaustion are associated with increased risk. However, these symptoms may be more indicative of cardiovascular disease severity. A global tendency towards negative affectivity could account for the associations seen with negative affect states, with those of Type D personality demonstrating especially high levels of risk for morbidity/mortality. Positive emotion is associated with better outcomes, and could provide clues of how to intervene with negative emotion. Construct overlap and a dearth of theoretically based studies remain significant challenges. Future research needs to encompass all relevant variables to identify the key symptoms or symptom constellations that increase cardiovascular risk. A more sophisticated understanding of these issues can lead to more precise pinpointing of the 'cardiotoxic' aspects of psychological status, and ultimately to more refined interventions.
The Hospital Anxiety and Depression Scale Depression Subscale, but Not the Beck Depression Inventory-Fast Scale, Identifies Patients With Acute Coronary Syndrome …
by Frank Doyle
J Psychosom Res. 2006 May;60(5):461-7 (http://epubs.rcsi.ie/psycholart/15)
OBJECTIVE: The objective of this study was to investigate the use of short-form depression scales in assessing 1-year... more
OBJECTIVE: The objective of this study was to investigate the use of short-form depression scales in assessing 1-year mortality risk in a national sample of patients with acute coronary syndrome (ACS).
METHODS: Patients with ACS (N=598) completed either the Hospital Anxiety and Depression Scale depression subscale (HADS-D) or the Beck Depression Inventory-Fast Scale (BDI-FS). Their mortality status was assessed at 1 year.
RESULTS: Cox proportional hazards modeling showed that patients depressed at baseline (combining HADS-D and BDI-FS depressed cases) were more likely to die within 1 year [hazard ratio (HR)=2.8, 95% CI=1.4-5.7, P=.005], even when controlling for major medical and demographic variables (HR=4.1, 95% CI=1.6-10.3, P=.003). Scoring above the threshold on the HADS-D predicted mortality (HR=4.2, 95% CI=1.8-10.0, P=.001), but scoring above the threshold on the BDI-FS did not (HR=1.8, 95% CI=0.6-5.6, P=.291).
CONCLUSION: The HADS-D predicted increased risk of 1-year mortality in patients with ACS.
Increase in observed mental health difficulties one year after acute coronary syndrome: general practitioner survey
by Frank Doyle
Ir J Med Sci. 2007 Sep;176(3):205-9 (http://epubs.rcsi.ie/psycholart/12)
Abstract
BACKGROUND: General practitioners (GPs) are often the first to assess mental health difficulties after... more
Abstract
BACKGROUND: General practitioners (GPs) are often the first to assess mental health difficulties after acute coronary syndrome (ACS).
AIMS: To determine whether GPs observed an increase in mental health difficulties one-year post-hospitalisation for ACS.
METHODS: Postal survey.
RESULTS: GPs rated patients (n = 442) as having probable (GP assessed 10%) or definite (formally assessed 7%) mental health difficulties pre-hospitalisation. Post-hospitalisation the prevalence of probable cases increased significantly to 19% (OR = 4.3, 95% CI 2.1-10.2, P < 0.001). In multivariate analysis, only smoking at index hospitalisation was associated with being assessed as a new case of probable/formal mental health difficulties (RR = 2.1, 95% CI 1.3-3.4, P = 0.003). Forty-seven percent of cases were prescribed some medication for this problem.
CONCLUSIONS: GPs recorded a significant increase in mental health difficulties in ACS patients 12 months after hospitalisation, with smoking used as an indicator of new cases.
PMID: 17701436 [PubMed - indexed for MEDLINE]