Dangerous depression in cardiac patients: What can we do about it?

Abstract

A well-known clinical issueA few decades ago, the description of risk factors for coronary heart disease (CHD) focused mainly on smoking, lipids, and hypertension. These factors were said to account for about 50% of incidence of CHD. The remaining risk panorama was in those days said to be largely 'unknown'. The results of more recent research have filled most of that knowledge gap, and there has been an increasing emphasis on the importance of psychosocial factors, contributing to increased risk for both primary and recurrent events, as demonstrated in many studies and varying designs, and including many different populations. Depression, anxiety, stressful life events, lack of social support, financial and vocational stress, straining family situations, and low socioeconomic status (SES) have been shown to be independent risk factors for CHD. The INTERHEART case-control study assessed risk factors for myocardial infarction (MI) in populations across the world. 1 Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression. People with MI (cases) reported higher prevalence of all four stress factors. Depression in the past year was more frequent in cases than controls. The differences were consistent across regions, in different ethnic groups, and in men and women. 2 Psychosocial risk patternsPsychosocial risks can be classified into the following categories:Acute emotional states, such as anger and anxiety, which can act as triggers for acute cardiac events. Long-lasting but variable emotions and strain, such as depression, vocational stress, family stress, conflicts, financial stress, bereavement, and lack of social support. Chronic, stable, response tendencies, such as so-called type D personality, entailing a combination of irritability, excessive worrying, and lack of communicative skill in social situations.Classifying psychosocial risk factors is helpful in determining appropriate interventions. Depression in the context of CR interventionsRehabilitation and prevention usually have a focus on individual characteristics and behaviour, such as health behaviours/lifestyle, adherence to medication,