Depression in Coronary Heart Disease Patients: Etiological and Screening Issues

Abstract

Coronary heart disease (CHD) is associated with significant psychiatric comorbidity, in particular, depression. Recent evidence suggests that depression following a coronary event or diagnosis is a significant risk factor for both mortality and morbidity. Further, there is compelling evidence that depression is a significant predictor in the development of CHD. Surprisingly, given the relationship of depression to patient outcome, screening for depressive disorder in this patient group is generally not routine and clinically significant psychiatric disorder often remains undetected. This mini review summarises the contemporary evidence of the mechanisms underpinning the CHD-depression relationship and explores the main issues that need to be considered by clinicians in providing effective screening for this clinical group. Examples of best screening practice will be highlighted and the efficacy of interventions targeting depression in this group discussed.

A psychometric evaluation of a Chinese version of the Cardiac Depression Scale

“…These findings are comparable with those reported by others [17] who, using the CDS, found that 17% of cardiac patients had mild to moderate depression and 22% had severe depression. The high proportions of Chinese cardiac patients with depression are consistent with studies conducted in China [4,22] and in the West [5,9,17,32], and this further supports the need for accurate assessment of emotional state in the clinical management of cardiac patients. The Cronbach α values for the total and all C-CDS subscales (except Inactivity) were highly acceptable, indicating satisfactory internal consistency of the instrument.…”

“…Thus, early recognition and treatment of depression might not only improve mood and quality of life but also possibly reduce morbidity and mortality in Chinese patients with cardiac disease. However, routine screening for the detection of depression and depressive symptoms is not common practice [9], particularly in China, even though some instruments, such as the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI), have been translated and validated for Chinese patients [10,11].…”

A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

“…2002). The HADS is quick and easy to administer and this led it being applied extensively in several clinical situations, including cardiac care (Martin & Thompson 2000, 2006, Martin et al. 2004).…”

“…Also, there are available extensive data pertaining to its use in international studies (Herrmann 1997, Bjelland et al. 2002, Martin & Thompson 2006).…”

Beyond the blues: the need for integrated care pathways

“…A fundamental barrier of screening for depression in patients with CHD is the lack of patient follow-up. 39 Where depression was diagnosed in hospitalised patients with MI, 60%-70% of patients were still depressed one to four months' later. 40 Clinical pathways for identifying and managing comorbid depression and cardiovascular disease clearly need to consider the link between hospital care and primary health care.…”